YOUR HIM EDGE NAVIGATING THE ICD-10 CHANGEOVER: ADDRESSING CODER PRODUCTIVITY GAPS TO ENSURE LONG-TERM SUCCESS

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1 NAVIGATING THE ICD-10 CHANGEOVER: ADDRESSING CODER PRODUCTIVITY GAPS TO ENSURE LONG-TERM SUCCESS IOD Incorporated 1030 Ontario Road Green Bay, WI

2 Executive Summary Now only a year away, there s no doubt the impending ICD-10 transition will have a substantial impact on healthcare organizations. With the potential to produce administrative, financial and other woes, the question is: How much will the changeover impact your organization? A transition plan must be developed collaboratively between C-suite leaders - particularly CFOs - and health information management (HIM) directors to address the gamut of challenges that lies ahead. As part of any organization s transition plan, HIM directors and CFOs alike will need to engage strategies and programs to: Minimize the operational challenges of the changeover; Preserve coder productivity while training, as well as during the transition; and Protect the organization s bottom line. Ideally at this point, healthcare organizations should have vetted and engaged potential training vendors to help prepare for and navigate the changeover. At twelve months from the deadline, vendors bandwidths already are increasingly limited, which means one of two certainties for healthcare organizations that have yet to start the preparation process: Fees are going to dramatically increase due to sky-rocketing demand, or vendors are going to begin turning away clients. The sooner training resources can be vetted and engaged, the better. Organizations should also be laying the groundwork to ensure coders understand the theory behind ICD-10 and are primed for training. In addition to key practice time working with organization-relevant codes and charts, training programs should include a comprehensive educational component. Instruction should include reviewing anatomy and terminology with coders, as well as key information regarding the new guidelines. Sterile vignettes often found in offthe-shelf training programs fail to provide an accurate organizationspecific productivity assessment, making it difficult to forecast a productivity gap. CFOs in particular should be devising strategies to mitigate potential revenue loss during the transition. Industry experts recommend hospitals have six to eight months worth of cash-on-hand to address possible disruptions in revenue.1 However, most hospitals have financial reserves for only one month on average, and therefore must find alternative methods of alleviating cash flow concerns. 1 By engaging a comprehensive, platform-based training program, CFOs and HIM directors alike can effectively prepare their coders for the changeover, as well as: Track training progress in real-time and address issues as they arise; Accurately project short- and long-term gaps in productivity; Mitigate logistical and financial effects; and Ultimately, protect the bottom line. 2

3 Having a Timeline Isn t Enough At present, experts estimate roughly half of healthcare organizations have an established plan for training coders and implementing ICD-10 by Oct. 1, One year out, many of these organizations are beginning to roll out their plans. To be successful with the changeover, however, solely having a timeline for training and starting the work isn t enough. It is time for these HIM directors and CFOs to act. They must strategically commit to the transition and implement their plans to reduce risk and support an effective conversion. Designing a Strategic Blueprint Beyond developing a schedule for the rollout, HIM directors should design a strategic blueprint for the organization that digs deeper into preparation and training efforts. Some items to address in this comprehensive plan should include: Creating processes for accurately projecting both short and long-term productivity loss. Based on performance rates seen by the more than 20 countries that have made the switch to ICD-10, industry experts are forecasting initial coder productivity loss at about 40 percent, and long-term productivity loss at about 20 percent..2 Whether these estimates prove true for any one organization will depend on the organization s characteristics. Having an accurate method for predicting organization-specific short and long-term productivity gaps will help HIM directors assess what resources they will need to address any shortfall. Developing strategies for offsetting the productivity gap. Whether organizations are planning to hire additional staff to address the long-term productivity loss, engage temporary contractors to respond to the short-term coding spike or use a combination of the two strategies, HIM directors must have a strategic game plan to offset the productivity gap and know where to recruit reliable coders. Having a system in place for preparing new or temporary coders. Whether new, permanent or temporary, all coders are starting with the same amount of experience actually coding patient charts in ICD-10 - none. To make sure coding quality and accuracy are not compromised during or following the transition, HIM directors should develop a system for getting new or temporary coders up to speed as part of the organization s training program. On-boarding coders will take time, further underscoring the importance of securing additional coders as soon as possible and not waiting until the days leading up to the deadline to bring them aboard. Preparing providers for the transition. Though clinical documentation improvement (CDI) initiatives can be challenging - CDI is a sensitive and complex issue within the entire healthcare culture - coders have only the medical charts in front of them to capture and code patient encounters. Without complete information from providers, coders could end up either up-coding or down-coding, either of which creates a number of regulatory and reimbursement risks. To prevent this situation, coders may be forced to stop work mid-code and solicit clarification from providers, which could significantly impact their productivity. In order to meet the drilled-down layers required by the ICD-10 code set, HIM directors should work with clinical leaders to review documentation processes, emphasizing the importance of supplying accurate and detailed clinical documentation to ensure coders have everything they need in front of them to adequately code patient encounters using ICD-10. 3

4 Strategies for HIM Directors to Navigate the ICD-10 Changeover and Address Productivity Gaps 4 As part of an organization s strategic ICD-10 blueprint, HIM directors should establish a method for measuring and monitoring training progress. They should always know where the organization falls in relation to its rollout plans and have the ability to track progress during training, as well as during implementation efforts. A key element HIM directors should include in the organization s rollout plan is a comprehensive education program for coders. Beginning with a 30,000-foot view, coders need to grasp the new code set at a high level and be familiar with anatomy and relevant terminology before drilling down into specific practice scenarios. Because many coders have ICD-9 codes committed to memory, they need to understand the differences - as well as the similarities - between the ICD-9 and ICD-10 codes and guidelines to fully maximize their knowledge. Once a high-level knowledge is achieved, coders then must be able to command the very codes that accurately capture the care the organization provides on a daily basis. To do so, coders should be trained using their organizations most relevant and commonly seen DRGs, performed procedures and diagnoses - both principal and secondary. Unfortunately, most off-the-shelf training programs do not provide the type of organization-tailored experience required to effectively prepare coders. Regardless of how detailed an organization s rollout plan is, there is no guarantee things will go accordingly. In the words of a famous boxing axiom, Everyone has a plan until they get punched in the face. To mitigate against potential roadblocks associated with a rollout, organizations should include a method for tracking and assessing their productivity and accuracy by coder and service line as the plan unfolds. Waiting until go-live to determine whether training has been effective could be catastrophic. By developing or leveraging commercially available technology and training solutions that provide immediate coder feedback and management reporting, such as available through IOD Incorporated s ICD-10 Gym, HIM directors can address smaller brushfire issues before they become larger forest fires. For instance, HIM directors can begin engaging vendors and additional coders for support during the training window - rather than waiting until the ICD-10 implementation date - to prevent potential coding backlogs. Likewise, they can steer training efforts to address specific, identified problem areas, rather than continuing to train at such a high level that coding quality could possibly be compromised. Furthermore, HIM directors must be able to project ICD-10 s impact on productivity come Oct. 1, 2014, so that the organization can be adequately prepared for the shortfall. To accurately forecast productivity, coders will need to practice ICD-10 coding in an environment that closely resembles the one in which they ll be working following the changeover. Creating such an environment requires organizations to train coders using comprehensive, real-life charts that include everyday nuances found within their patient population, rather than general coding examples. Sterile vignettes often found in off-the-shelf training programs fail to provide an accurate organization-specific productivity assessment, making it difficult to forecast a productivity gap. However, if practice scenarios reflect the organization s patient population and real-life records, it makes assessing productivity more precise.

5 IOD Incorporated has developed the ICD-10 Gym, a comprehensive technology platform that allows coders to practice on either the organization s own charts, using the organization s most frequently seen DRGs, or universal charts from IOD s vast library, using the most frequent DRGs and procedures experienced in healthcare today. Using ICD-10 Gym, organizations also have productivity and quality tracking as well as real-time assessment capabilities built directly into the program, so they know exactly how their coders are performing at any given point and can address shortcomings as they arise. Strategies for CFOs to Minimize Financial Ramifications and Preserve the Bottom Line By taking a proactive approach and working collaboratively with HIM directors, CFOs will be able to develop a tactical plan to prepare for ICD-10, forecasting the impact and mitigating potential instances of revenue loss. CFOs should be involved from the start of ICD-10 training, and coder productivity should be monitored to determine how it is trending over time. Using data and statistics provided by HIM directors, CFOs can then gauge how productivity loss will impact the organization s bottom line and work closely with HIM directors to identify ways to offset the gap. Once the organization has a plan for narrowing the productivity gap, CFOs should continue working with HIM directors to identify, vet and secure resources as soon as possible, since coders and training vendors already are becoming scarce. CFOs also must be aware of associated costs for engaging these resources and allocate funds accordingly. By preparing for and enlisting these resources early, CFOs can be confident that they have ample funds appropriated to execute the changeover as well as reliable resources in place for when implementation time comes. In simple terms: Waiting until implementation to assess the conversion s impact and allocate or secure necessary resources will be too late. These resources will be gone or engaged by other organizations, and a productivity backlog will quickly amass. CONCLUSION With an organization s bottom line and more at risk, CFOs and HIM directors cannot afford to wander blindly into the ICD-10 transition. A complete transition plan goes beyond just a timeline to include a strategic blueprint for properly preparing coders and other staff. In addition, this blueprint must include effective methods for gauging the success of the ICD-10 education program and assessing the changeover s potential impact on the organization. By engaging a comprehensive, technology-based training program like ICD-10 Gym, an organization will be amply poised to effectively train its coders, accurately forecast its productivity gap, develop plans to offset productivity loss - and thereby ultimately protect its bottom line. 5

6 Citations 1. Countdown to ICD-10: Prepared for Success? Or, Prepared to Fail? ZirMed. White paper, Mar 25, Johnson K. Implementation of ICD-10: Experiences and lessons learned from a Canadian hospital. AHIMA, Retrieved from hcsp?ddocname=bok3_ CONTACT US: For more information about ICD-10 Education and Training, as well as Coding Services, contact the company at: or visit us online: