SAN ANTONIO—Representatives from two facilities discussed the magnitude of ICD-10 implementation during an Oct. 27 town meeting session at CHIME11, the Fall CIO Forum.
“We’ve got a good start but we’re not seeing the finish line,” said Albert Oriol, vice president of information management and CIO of Rady Children’s Hospital in San Diego. “This is bigger than a coding project.”
“The bottom line is documentation,” said Cassi Birnbaum, MS, director of health information and privacy officer at Rady. “We have a perfect storm of initiatives with meaningful use, documentation and other efforts.” She said that the health information management department began its ICD-10 initiative early, more than two years ago, with coder education and awareness training. She found that “we really need to shore up documentation and weave into it the more granular, discreet documentation that’s necessary with ICD-10.”
Conversion to the ICD-10 standards is “somewhat of a hot potato,” Oriol said. “It’s like a train moving at high speed. We must decide whether to play chicken or take the wheel and drive to avoid hitting the wall that is ICD-10. We’re lucky that it didn’t take a lot for our CFO and clinical leadership to hear the message.”
Come the Oct. 1, 2013 ICD-10 implementation date, “if you’re not ready then payors have an excuse not to pay you,” said Birnbaum. “That will have serious repercussions.” To prepare, she said her facility is adding to its ICD-10 trainers and looking at learning management software. Those who have started their preparations more recently may benefit from some lessons learned. For example, Birnbaum recommended to the audience that they “make sure your vendor has the capabilities you want and the ability to slice and dice the data the way you want.”
She also shared that one of her facility’s primary care groups is right on top of the issue, having already mapped a year’s worth of claims. The lesson is to take advantage of the people and skill sets you already have within your organization.
ICD-10 presents “an optimal role for the CIO as a key leader and enabler,” said Carole McEwan, MS, ICD-10 project manager at SSM Health Care, a St. Louis-based healthcare system covering four states. The effort also needs clinical and revenue cycle ownership. Her organization found that a big decision was whether to centralize or decentralize the effort. “We worked to use existing groups and most are centralized. Niche applications in some facilities are decentralized. We assigned these to one owner to make sure the application is upgraded.”
Another big decision was whether to build or buy education. “We estimated that we’ll need 110,000 hours of ICD-10 education. HHS will build its own and create six classes." She cautioned that there is a risk in implementing ICD-10 in too short of time. “It takes time to start rolling out the effort. If you wait too long, the ramp up time will be extremely difficult. You need to get lots of people on the same page and that doesn’t happen overnight. There are lots of tools available but they don’t make people move any faster.”
Birnbaum pointed out that there will be lots of competition for scarce resources—consultants, trainers and others that facilities may need for ICD-10 implementation.
When asked how to plan a ICD-10 budget, Oriol jokingly recommended that facilities pick a number and multiple it by 10. Training costs and the productivity impact on coding and billing are somewhat easy to estimate, he said, but beyond that, it’s difficult to plan.