Becker's Hospital Review

Executive Briefing: ICD-10 53 Sponsored by: The Financial Risks of Transitioning to ICD-10: Key Considerations for Hospitals and Health Systems By Helen Adamopoulos C oncerning ICD-10 preparation, the time has come for hospital finance executives to put pen to paper, says Kerry Martin, CEO and founder of healthcare intelligence provider VitalWare. Waiting too long could result in getting caught in "rush hour" as providers leave crucial tasks until the last-minute scramble to catch up before the deadline next year. "Being an early adopter in the ICD-10 world is the smartest thing they can do," Mr. Martin says of hospitals and health systems. A key part of preparing for the transition is assessing the potential financial impact and taking steps to prevent a decline in physician and coder productivity, which could lead to revenue loss. The fiscal risk depends on various factors, including physician documentation, coder education and DRG Grouper version updates, which will change in the months before ICD-10 goes live Oct. 1, according to Mr. Martin. The process is definitely "more like a marathon than a sprint," he says. He shared some advice to help healthcare providers make it across the finish line by the implementation deadline. Look beyond predictive analysis and top DRGs Many companies in the healthcare marketplace promote predictive analysis, which involves "cross-walking" ICD-9 claims to ICD10, using general equivalence mappings or some other translation tool, to determine whether a diagnosis-related group shift will occur or not. But Mr. Martin says this technique isn't the best way to comprehensively determine financial risk. "To me, the only way they can assess their risk is by pulling charts, coding those charts and grouping those charts natively," he says. "Until a coder looks at a chart and codes it [in ICD-10], they have no idea what their financial risk is. It's not fun and it's not easy, but it's the only way for them to get their arms around that." VitalWare has natively ten-coded 7,500 inpatient charts from hospitals around the country and can run a hospital's claims against this data to get a good understanding of what lies ahead for the provider's finances, he says. Based on those coded cases, they've discovered the real risk lies outside of the top 20 or 100 high-volume DRGs, according to Mr. Martin. Therefore, it's crucial for hospitals and health systems to look beyond those DRGs when preparing for the transition to ICD-10. "That's exactly where CMS has said they're going to be financially neutral," he says of the top DRGs. "They've made sure the grouper is solid in those top DRGs." Focus on physicians: The risk is in the charts Lost coder productivity has emerged as a point of concern for providers as the ICD-10 changeover date looms closer. Based on other countries that have already switched to their own uses of the coding system, some health information management leaders have projected a 20 to 40 percent decrease in coder productivity, which could lead to delayed cash flow and lost revenue. Mr. Martin says providers must address the coder's productivity in unison with physician productivity. Why should healthcare executives look to physicians to prevent a drop in productivity? Because, he says, "it all starts with documentation." That's what coders code from and, if the right details are not in the chart, then the physician will need to be "queried" for additional information. "The best thing we can do is educate the physician," he says. "If we focus on physician productivity, the coder productivity loss will be nominal." It's only when coders are searching charts for information that doesn't exist that their productivity really suffers, he says. For hospitals and health systems looking to keep physicians productive, it all comes down to training them to document the right things so coders don't have to use not-otherwise-specified codes or query back to the physician for clarification, he says. "If [the physician is] interrupted the next day for more information from the previous day that he didn't document, the physician's productivity is going to go down," he says. "We should be focused on how we can keep the physician's productivity such as it is today and not decreased due to additional queries and interruptions by clinical documentation specialists." He advises providers to pull charts, look at what's in their current documentation and note any deficits. For instance, physicians might not include documentation that may lead to major complications or comorbidity designation in the DRG groupers, resulting in the patient looking less sick on paper and the hospital getting reimbursed less than it should.

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