Healthcare organizations preparing for ICD-10
will need multiple strategies to cope with an anticipated drop in coder productivity. One strategy may be taking tough disciplinary action against physicians who fail to complete training in how to improve clinical documentation for the complex new coding system, industry experts told attendees at the American Health Information Management Association
convention in Atlanta.
Donielle Bailey, ICD-10 project coordinator for Rex/UNC Health Care, in Raleigh, N.C., said her organization's analysis found that their coder productivity standard of 2.5 charts per hour in ICD-9 fell below one chart per hour at the start of using ICD-10 and never made it back above two per hour.
The federally mandated deadline for nationwide adoption of the vastly more complex ICD-10 family of diagnostic and procedural codes is Oct. 1, 2014.
Bailey's numbers jibe with an Advisory Board Co. estimate presented by Thomas Ormondroyd, vice president and general manager of Precyse Solutions, a vendor of training programs. He said coder productivity will remain off by 20% even three to 12 months after the transition to ICD-10, with losses of 5% to 10% to be expected even longer term.
But the heart of the problem is not really with the coders, both speakers said. Rather, it's with poorly documented medical records. The incomplete records require coders to make time-wasting callbacks to physicians, and that causes much of the productivity loss, they said. A strategy to mitigate the productivity loss is to improve clinical documentation, and that requires training physicians on what coders need to complete their work in ICD-10, they said.
A key to effective physician training is having the total support of the organization's chief medical officer and chief medical information officer for clinical documentation improvement, Bailey said. With it, enforcement of training policies is possible.
“Last week, we suspended 245 physicians who had not completed their ICD-10 training,” Bailey said. “They cannot admit any new patients; they cannot schedule any new surgeries.” As a result, the physicians have been finishing their training so they can regain their hospital privileges. As of Friday, 92% of those physicians that have privileges have been trained, she said.
“If you do not have buy-in from your CMO or CMIO, it's going to be an uphill battle all the way,” Bailey said.
For those organizations just getting started, Ormondroyd advised attendees tasked with ICD-10 preparations to create a “tiger team” whose members take ICD-10 education before everyone else. The result will be a cadre of superusers that can sell ICD-10 readiness throughout the organization. A strong communications plan also helps in explaining the need for ICD-10 preparations, including e-mail blasts, in-house newsletters, mailbox stuffers, webinars and even ICD-10 messages on bathroom stalls.
For hospital organizations with large ambulatory-care practices, one strategy for coping with the productivity loss is to train all experienced outpatient coders in ICD-10 procedural coding systems. Organizations could replace the ambulatory coders with new health information management students, who historically have a tough time landing a first job because they lack experience, Ormondroyd said.
Danielle Reno, ICD-10 director at Sutter Health, Sacramento, Calif., warned of a 50% decrease in coder productivity that can go on for six to nine months, and said her organization has spent “many, many months” to get physician buy-in to ICD-10 preparedness. Sutter offered physicians 30-minute video programs tailored to 27 different medical specialties. Physician champions touted ICD-10 at mandatory monthly staff meetings, she said. Sutter also offered peer-to-peer training with physicians coaching other physicians.
Reno said Sutter will turn on its EHR's ICD-10 tools and functions—but not code in ICD-10—four months early, on May 31, 2014, so physicians can practice.Follow Joseph Conn on Twitter: @MHJConn