The migration from ICD-9 to ICD-10, achieving a revenue-neutral position, or better, is important for providers and other involved parties. Understanding that the transition in itself should not impact reimbursement significantly, what are the most effective messages administrators can use to engage and motivate physicians to take an interest in changing documentation behavior in support of the migration to the new code set? This is a question that was asked during a recent ICD-10 discussion.
Physician groups have expressed concern that the conversion to ICD-10 will create significant administrative burdens on practitioners. The American Medical Association (AMA) also has voiced concerns about the transition, citing high implementation costs and complexity due to related federal mandates. Even if positive reimbursement impacts are not anticipated during the short term, administrators can use the compliance deadline as a reason to educate physicians to embrace training for improvement and for potential future gains – and, in the process, prepare for the transition.
Navigating change is challenging, and getting physicians to embrace the new coding system is a big feat. Engaging physicians to accept training and introducing clarity regarding more detailed documentation requirements can bring rewards to how care is delivered. The end result is improved patient outcomes and enhanced quality scores, as well as potential future financial benefits for facilities, if they begin to document higher-reimbursing conditions that historically were missed.
Motivating and Engaging Physicians
There are several strategies administrators can use to engage physicians to adopt the documentation detail required in the switch to the new ICD-10 code sets:
Peer comparison: Just like consumers use rating systems when making purchases, ICD-10 data will be available for administrators and others interested in looking at physician performance and comparing it to their peer groups. All electronically processed healthcare transactions, including claims data, contain physicians’ National Provider Identifier (NPI) numbers to identify treating providers in patient records. This includes admission and discharge data as well as information affecting mortality and morbidity outcomes, all of which will be available for evaluation by consumers and peer groups.
How a physician documents quality, severity of illness, risk of mortality and conditions affecting care impacts how these criteria get scored and how providers get paid. The weighted value assigned to codes and data qualities captured from the record are important measurements for many reasons.
Assuming physicians document as they always have when migrating from ICD-9 to ICD-10, theoretically, reimbursement will not change much in the short term. As long as a physician is documenting to the greatest possible degree of specificity, there is no real need to change, but perform an ICD-10 documentation review to identify any long-term implications.
Physicians who document best, according to code rules, also can best illustrate the connection between a provider’s performance and the patient’s condition. So, while documenting to the specificity required for ICD-10 may not have a financial impact at the time of transition, it will have comparative value – and over time, it is expected to have financial consequences. Equitable peer comparison requires physicians to document in similar ways, using the available code set to ensure a standardized assessment ranking. Many physicians are embracing the documentation requirements of the new code set, so don’t be left behind.
Organizational efficiencies: Physicians who do not document to the greater degree of specificity required for ICD-10 will create inefficiencies within their own organizations. Yes, the AMA and some other organizations have been resistant to the new code set, but fighting implementation of new codes is a losing battle – the deadline may be delayed, but change is still coming.
The whole industry is moving, and whether that movement includes a slower transition from ICD-9 to ICD-10 or a longer delay before we are able to embrace ICD-11, change is imminent, because the current coding system cannot take healthcare into the future. And as we progress along the continuum of code sets, they become more focused on disease management. Combined with other changes in the healthcare industry, we all likewise must become more focused on disease management so together we can provide better and more efficient and affordable care.
Providers who fail to document the specificity required for using complete, accurate and up-to-date diagnostic and procedure codes will create inefficiencies in their own organizations as other coders, practitioners and administrators learn and embrace ICD-10. For example, without documenting to the specificity required by ICD-10, queries will increase, requiring physicians to supply additional documentation or for coders to review charts to determine the most appropriate procedure and diagnostic codes. This will result in increasing complexity, billing delays and potentially an increasing number of payer audits.
Physicians who document using expanded detail can produce more meaningful data and alleviate delays, preventing inefficiencies and the need for additional queries. Physicians who document with greater detail also will be poised to take advantage of opportunities for using better data and improving quality of care. And providers not documenting in ICD-10 may be missing opportunities for care improvement, even if only comparatively.
Ability to mine data for future improvements: While the Centers for Medicare & Medicaid Services (CMS) does not anticipate an immediate revenue impact from ICD-10, eventually rates will be modified to reflect documentation and reporting changes in ICD-10 data. It is widely known and reported – including in the Journal of the American Health Information Management Association (AHIMA) – that complete, accurate and up-to-date procedure codes will improve data on the outcomes, efficacy and costs of new medical technology, ensuring fair reimbursement policies for the use of this technology.1 AHIMA also notes that expanded detail will help payers and providers more easily identify patients in need of disease management and more effectively tailor disease management programs.
Engaging physicians in documentation improvement plans is critical, because how care is documented can affect how care is delivered. As healthcare transparency initiatives grow, a doctor who can document to the specificity required for ICD-10 can better demonstrate proficiency of care and show patterns of care – including how patients are healing, with or without complications. This will be beneficial to the physician because quality scores will speak to his or her capabilities. If someone is mining data and wants to know who the better practitioners are, they will have data to prove it. The financial health of the provider may be improved with documentation improvement if the documentation accurately and truthfully justifies a higher level of reimbursement.
Easing the transition
As an administrator, getting physicians to embrace ICD-10 requires making the transition easy and straightforward to understand. Take the time to conduct an audit, understand changes by specialty and be able to communicate clearly and succinctly to providers based on their particular area of practice or need. Perform a chart audit to understand where deficiencies exist and where there is opportunity for documentation improvement. Then emphasize these points in training.
When designing training, focus on education by specialty while also considering physicians’ adaptability to change, preferred learning style and appropriateness of training levels. Also use real-life examples to help deliver the message. Organizations that customize training based on how individual physicians learn and practice will benefit from training programs that resonate.
Administrators and physicians shouldn’t be battling over ICD-10, but rather working together to improve the full spectrum of care, from documentation to enhanced patient outcomes. What physician has not had a discussion with a coder or coding representative about improving documentation?
Clinicians and coders use different language tools that are not perfectly matched. The clinician uses a language for providing care, and a coder uses a language for documenting quality and reimbursement outcomes. A request to document differently is not a request for a provider to change something that is wrong – it is simply a request for improving a process for all involved: the provider (with peer comparisons), the coder (to eliminate guesswork and queries), the reimbursing entity (eliminating questions of accuracy) and the patient (best outcomes).
All participants in this process should think about the opportunities that could be missed by not documenting to the greater specificity required. Any hedge on proceeding will prevent practitioners from knowing how much better they can do and how much better patient outcomes can be.
Engaging physicians is needed for an effective transition. Whether you do it now or later, it has to be done – so get ahead of the curve and help physicians not only document better, but understand the value it has for their practice.
About the Author
Veronica Hoy, MBA, is vice president of SOURCECORP HealthSERVE Consulting, Inc. Veronica has been an operating executive for 10 years, focusing on providing strategic leadership and direction to healthcare professionals and organizations. She has more than 20 years of healthcare experience in business process outsourcing, accounts receivable management, coding, billing, release of information, consulting and systems implementation.
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1 Bowman, Sue. “Why ICD-10 Is Worth the Trouble.” Journal of AHIMA 79, No.3 (March 2008): 24-29.