Think about where medical technology was in the 1970s, and all the advances that have occurred since then. There was no such thing as echocardiography at the time! The code sets utilized today are more than 40 years old and do not reflect current medical practices, while the new code sets slated to go into effect on Oct. 1, 2014 better reflect contemporary practice of medicine.
Today physicians also are paid based on procedures, not diagnoses. There currently is little out there to encourage physicians to engage in learning about the new documentation requirements of ICD-10. It is our job to establish a compelling case, or rather to outline “what’s in it for me” (WIIFM) for physicians.
Here are some reasons we believe it is in the best interest of physicians to learn the new documentation requirements. First of all, physician documentation tells a story for other clinicians. The more complete the documentation, the more accurately other clinicians can determine the status of a patient. Documentation also tells a story about quality, communicating vital information to payors and to litigators and defense attorneys. If you don’t want people reading too much into what you write, then accurate and complete documentation is your ally. Complete physician documentation accurately reflects severity of illness and can have a big impact on quality indicators, too.
Physicians will be overwhelmed with queries from clinical documentation specialists and coders starting on Oct. 1, 2014 if their inpatient documentation is insufficient. Physician practices will be inundated with phone calls if outpatient orders for tests do not contain an ICD-10 code or a complete description.
The question we ask at Catholic Health East (CHE) is this: How can we best provide the tools and education physicians need to learn the new documentation requirements presented by the ICD-10 codes well in advance of the implementation date?
Some of our ideas include the following:
- Begin early with a clinical documentation specialist to introduce to physicians some basic concepts, such as:
- Specificity (anatomical site, laterality, trimester, etc.)
- Underlying causes (infectious agents, drug-induced symptoms, etc.)
- Documentation of associated relationships (HTN related to heart disease, asthma exacerbated by bronchitis, etc.)
Also, consider taking the following steps:
- Provide monthly electronic vignettes about disease-specific documentation requirements.
- In late 2013, begin lunch-and-learns with physicians.
- In 2014 our Web-based physician training program will become available, featuring20-minute physician documentation educational modules grouped by specialty.
- Reach out to high-volume, non-directly affiliated referring physicians and offer specialty–specific training. Also provide other materials such as code mappers and companion guides to the e-learning videos.
- Develop disease- and specialty-specific documentation guidelines.
- Explore the creation podcasts and apps for physicians.
- For directly affiliated physicians, explore compliance with documentation requirements as part of their performance reviews and/or employment agreements.
- Provide tools/links easily accessible from the electronic medical record.
We don’t want physicians to have to memorize anything. We believe that repetition is the key to learning, so any and every avenue that supports physicians we can explore, we will try.
A nurse member of our System Office ICD-10 Core Team is meeting face-to-face with the chief medical officer at each of our hospitals individually to have a conversation about ICD-10 and gather their thoughts on the best ways to support and encourage medical staff to engage in learning the ICD-10 documentation requirements. We believe these meetings and other forms of relationship-building will work to our favor.
Complex processes (both clinical/quality and administrative/billing processes) begin with physician documentation. If not compliant with ICD-10 by Oct. 1, 2014, physicians and their practices will be inundated with questions about inpatient documentation and outpatient orders. So how can we start now to introduce a slow, steady and easy migration to complete and accurate physician documentation, and how can we continue it through 2014? What other tools are needed? What other types of training or communication can we provide?
We continually challenge ourselves and talk to our physician stakeholders, as they are the best gauge of what will be successful – and successful we will be.
About the Author
Cynthia D. Fry is Vice President of Revenue for Catholic Health East, a multi-institutional, Catholic health system located in 11 eastern states from Maine to Florida comprised of 35 acute care hospitals, four long-term acute care hospitals, 26 freestanding and hospital-based long-term care facilities, 12 assisted-living facilities, four continuing care retirement communities, eight behavioral health and rehabilitation facilities, 31 home health/hospice agencies, numerous ambulatory and physician practices . Cynthia leads the Revenue Management initiative which is designed to improve operational performance through synergistic efforts across CHE’s various entities and is also CHE’s executive sponsor for ICD-10.
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