ICD-10 go-live delays will cost early adopters

Tuesday, 20 May 2014

The recent announcement by CMS that the date for ICD-10 implementation will be reconsidered will have a number of unintended (or more accurately, not thought out) consequences.

Many large providers, hybrids and academic medical centers are well on their way to meeting the current deadline and have significant investment made in both permanent and temporary staffing to support these projects. Also, many vendors are working hard to get their systems ready for ICD-10 and have established plans to complete prior to October 2014.

Unfortunately there is a great disconnect between the physician practices/AMA and the larger health systems and hospitals who have already invested considerable time and money working toward the October deadline. In a 2011 survey by HealthLeaders Media, respondents cited, "The No. 1 challenge providers named in preventing them from attaining ICD-10 readiness was physician cooperation" – who knew just how foreboding that statement would be!

Keep your foot on the pedal for MU Stage 2

Tuesday, 17 December 2013

Recently CMS announced their intention to propose a postponement to Stage 3 of Meaningful Use (MU) and the updated certification requirements for EHR software until 2017 for organizations that meet the basic criteria of having already attested to MU for two years previously. I belong to several organizations for medical informaticists and clinicians, and I continue to watch their back and forth with interest. Initially, there seemed to be some misunderstanding that the deadline for Stage 2 of Meaningful Use and 2014 EHR Certification was being postponed, but that is not the case. Only the end of Stage 2 and the beginning of Stage 3 and the associated EHR certification requirements are being pushed back. This clarification has caused something of a firestorm among these groups.

Benefits of the ICD-10 Transition

Thursday, 08 December 2011

The transition from ICD-9 codes to ICD-10 is long overdue. We have essentially run out of codes and unfortunately the timing could not be worse for physicians, hospitals and the healthcare industry overall. There is no good time to take this project on. It will be expensive, it will be tedious and it will not happen overnight.

In 1993 the World Health Organization (WHO) implemented the ICD-10 diagnostic code set to replace the ICD-9 code set, which was developed by WHO in the 1970s. ICD-10 is utilized in almost every country in the world except the United States. This code set is not simply an increased and renumbered ICD-9 code set, it comprises greater detail, changes in terminology, expanded concepts for injuries, and other related factors. The complexity of ICD-10 provides many benefits because of the increased level of detail conveyed in the codes.

When the dust settles, the benefits from implementing the ICD-10 code set will be noted. We can expect a decrease in claims returned for “insufficient documentation.” Historically, approximately 20% of all claims are returned to the provider due to lack of documentation to support the diagnosis or procedure code. The increase in granularity the ICD-10 codes provide should contribute to a decrease in administrative costs that are currently incurred using the ICD-9 code set. There should be an increase in auto-adjudication processes and a decrease in the need for the constant manual review, which currently delays reimbursement at a minimum of 60 days.

The new code set will clearly provide a better identification tool for patient population, demographics, and the tracking of disease in greater detail. Improved tracking of disease will improve case management and enhance the opportunity to involve patients in wellness programs. The global sharing of best practice information will also improve patient care and decrease morbidity and mortality rates in addition to contributing to more research globally. It will allow healthcare costs to be analyzed, outcomes to be measured in greater detail and finally processes and performance from the caregiver to be measured.

Bottom line - Meaningful Use, accountable care and the patient centered medical home processes are changing the industry from pay for performance to a payment for quality of care model. The detailed coding system the ICD-10 code set offers will support this move to improve our country’s quality of care. Without ICD-10 the multitude of changes impacting our healthcare industry will be ineffective.

What can a single practitioner do with all the data? Another benefit to having an EHR.

Sunday, 28 August 2011

There are multitudes of patient data that are generated from medical practices, hospitals, rehab centers, etc. This data encompasses demographics and the tracking and trending of care, treatments and diseases. This data is the primary source of data for Medicare, Medicaid and commercial insurance carriers via claims submissions from healthcare facilities. But what does the additional data that is captured through EHRs mean to a single practitioner?

Data is a valuable resource. It is generated from the practice management (PM) module and provides a multitude of reports, primarily accounts receivable. A physician can have an immediate snapshot of how long it is taking insurance carriers to process and pay claims and for a patient to pay their bill. Physicians know how much has been billed, what has been billed, and when to expect reimbursement. The PM module can provide patient demographics, median age of population, number of patients seen per day, week or month. It also knows what services have been billed and which code is used the most frequently - this information can be drilled down to specifically the amount of revenue each provider is producing. The PM system also tracks appointments scheduled, no shows and types of appointments that are being filled or left open.

With the introduction of an EHR into a practice, clinical data will now be more accessible and with it, improved quality of care. The very basic information that an EHR system should be able to track is: medication prescribed, dosages, outcomes and usage, patient vitals and weight fluctuations. Also, lab and X-Ray orders can be generated and monitored as to whether or not a patient is compliant. For example, with this preliminary information and a few simple keystrokes a physician can have the history of a cardiac patient’s blood work, what medications they have been prescribed, any drug interactions, and whether or not the medication is effective. Additionally, at the physician’s fingertips are social and family histories, diet and any pertinent history that can be analyzed.  This information can be reviewed in a matter of moments and as a result of this clinical documentation the physician can make solid treatment recommendations. The end result is improved quality of care.

The not so obvious benefits from having an EHR include:  tracking how long appointments take with certain diagnosis. Which provider spends more time with their patients, which employee is addressing patient messages in a timely manner, which patients are more involved in their own care.  The system can also tell the practice who is in need of a flu shot and who received sample medication that has now been recalled, for example.  

Additional benefits include:
Increased awareness and marketing opportunities, increased communication with patients, generate health maintenance alerts, appointment reminders along with,  improve practice productivity, reducing operational costs, improved documentation, solving the E/M compliance issues and on-line medical access.   

However, data gathering is not automatic and requires a conscientious staff to generate and produce quality information. Data integrity must be maintained through completeness, consistency, accuracy and timeliness and with the acknowledgement that without quality documentation the data can be skewed and inadequate.

The opportunities that sound data can generate are endless.
– Lisa Smaga, Director of Ambulatory Consulting