When it comes to ICD-10, physicians, as a group, are much farther behind the curve than their hospital counterparts. The claims clearinghouse Navicure recently polled 350 physician practice administrators, office staffers, and coders about readiness for ICD-10. While the survey found that 82 percent of respondents are optimistic about being ready by Oct. 1, 2015, only 21 percent reported that they believe their practice is actually on track to meet the implementation deadline. One reason is that almost two-thirds of the respondents indicated that they put a hold on their conversion efforts after last year’s congressional extension of the compliance deadline to this year.
The larger concern should be the many physician practices that have not started to prepare for ICD-10. Fifteen percent of the survey respondents reported that their practice has done nothing to prepare for ICD-10, and another 18 percent reported that their progress has not developed beyond the planning and responsibility assignment stages. Reasons given for this include:
- Time or resource constraints (29 percent)
- Waiting on software updates (25 percent)
- Belief that implementation won’t take long (15 percent)
- Belief that the deadline will change again (15 percent)
- They don’t know where to start (13 percent)
- Belief that ICD-10 won’t have a big impact (2 percent)
Hospitals should be especially concerned about this lack of physician responsiveness to the ICD-10 mandate, as most are highly dependent on community physicians. Those of us who work with ICD-10 on a daily basis have long realized that ICD-10 readiness and organization size are closely correlated. The larger organizations are more likely to have made significant progress, and the smallest hospitals and physician groups are more likely to be behind the curve. Regardless, in the end, organizations large and small that have business relationships will have to continue being able to operate using ICD-10 coding. The unavoidable truth is that hospitals need their community’s physician practices to get on board with ICD-10, as they will be financially and operationally vulnerable if they don’t.
Hospitals should consider how to make ICD-10 assistance part of their larger physician engagement strategy. The fact that hospitals must work to bring their own internal physician staffs into the ICD-10 fold means that there are various options for supporting external physician practices at little additional expense:
- Hospitals can broaden the reach of their internal ICD-10 educational resources to support ICD-10 learning within associated physician practices. Because hospitals are already making significant commitments to education for ICD-10, extending those training resources to cover community physicians and their key office staffs is a relatively small investment. This will help to yield a more stable physician practice community and further physician engagement with the hospital, both overall and with the hospital’s own ICD-10 efforts.
One hospital we’ve worked with has chosen to give practice staff members access to formal online training and hospital coders who can help answer ICD-10 questions. Their charter for this process anticipates at least two benefits: the hospital will be demonstrating the overall importance of the physicians to the hospital, while at the same time, the hospital will increase the odds that incoming documentation (like lab orders and prescriptions) will be ICD-10-compliant.
Another hospital, which has created a formal ICD-10 help desk to provide certified coding assistance to their internal coding teams, has also decided to give access to the physician offices in their own community.
Another organization is creating versions of both of the above training programs, and adding a twist. This organization is planning to bring in a physician–turned– ICD-10 consultant to provide in-person, on-site education that will support the broader training programs. While such a measure may not be practical for many hospitals, the concept of offering an ICD-10 “superuser” to offer direct educational support is one to consider.
- Hospitals can provide IT or billing services to the community practices. As many IT and billing shops already provide services to groups of hospital-employed physicians, expanding those services as a commercial endeavor to physician practices is not a complicated operation. Doing so will allow practices access to services and expertise for ICD-10, as well as everyday operations that they could not afford on their own. A shared electronic health record platform would have particular additional benefits, as it would expand data sharing in the community to advance population health.
- Hospitals can name an ICD-10 project manager to coordinate implementation work for community physician practices. While much of ICD-10 involves knowledge and capabilities that every practice will need to become familiar with, there are many transition activities that are one-time events. Providing a coordinator to help guide the transition and share best practices with other physician groups in the community is an efficient way to help advance readiness in the physician practice community.
- Another area where hospitals can provide a common resource to support physician practices’ transitions to ICD-10 is in data analysis after the actual conversion. It will be critical for every provider to have the capability to analyze revenue effects and denial patterns for unexpected ICD-10 impacts. A shared community resource could not only provide this assistance to the practices, but also offer information on critical issues affecting other practice groups, to ensure that they are not having the same issue.
- Finally, hospitals might consider the combination of ICD-10 and meaningful use initiatives as an opportunity to move toward purchasing physician practices, and then quickly converting them to a compliant billing and electronic health records system. This is consistent with the trend in the physician practice world in which few physicians are remaining in solo practice because the business office overhead for a single provider is unaffordable.
It is evident that many larger hospitals are following similar thinking with regard to smaller hospitals. A recent analysis of HIMSS analytics data shows that EPIC holds the No. 2 slot in number of installs (almost 16 percent) in electronic health records (EHRs) in hospitals under 100 beds, even though EPIC doesn’t focus selling efforts on that market. These small hospitals are obtaining access to EPIC through direct ownership by a larger health system or some other formal affiliation.
By utilizing one or more of the above strategies to enhance physician engagement in ICD-10, hospitals can achieve several long-term benefits:
- Stronger ties with community physician practices, which can lead to increased referrals and referral revenue.
- Better relationships with the physicians themselves. There is ample evidence that hospitals with positive physician relationships have a much easier time of implementing major initiatives such as ICD-10 or meaningful use.
- A more stable physician community that will find itself in a better position to remain in business and meet the larger community’s healthcare needs.
- Direct revenue enhancement through the purchase of physician practices or selling of IT and billing services to affiliated practices.
Finally, and to the original point of this article, hospitals that have spent millions to convert to ICD-10 risk an unsuccessful transition if they haven’t also supported the physician practices in their communities. Hospitals will need these practices to send properly coded diagnoses and orders, at the very least to save time and effort on getting them corrected. Most importantly, without making sure their associated physician practices can transition, on time, into the ICD-10 world, hospitals risk disruption and errors in patient care – and non-payment of their claims.
About the Authors
As a co-founder of Phoenix Health Systems, D’Arcy Gue has had leadership roles in the growth of the company. Currently, she leads overall corporate administration, marketing and industry relations, services development, human resources, and knowledge management. She has led various strategic initiatives, including the development of ICD-10 services, HIPAA-based security and privacy compliance tools, and online education programs.
Thomas Grove has more than 16 years of experience in healthcare IT. As a principal at Phoenix Health Systems, he provides IT project leadership and consulting services with a focus on ICD-10, meaningful use, and privacy and security.
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