By Sarianne Gruber
Twitter: @subtleimpact
Just last week we were hearing rumblings from Congress that there could be a delay in the ICD-10 compliance date, similar to last year when in was moved to October 1, 2015. Bill and I had scheduled some time on Friday to catch up, and I was anxious to hear his perspective. My friend and colleague, William T. Oravecz is the Program Executive at Saint Francis Hospital and Medical Center, a 600-bed acute care hospital, the second largest in Hartford, Connecticut and largest Catholic Hospital in New England. As an one-man department, reporting to the CIO and CFO, Bill is responsible for facilitating the ICD-10 transition for the 900 providers from three hospital campuses, 12 satellite medical offices, and a variety of community clinics affiliated with Saint Francis Care. It’s great to get feedback from the frontline.
For the past two years at Saint Francis, Bill has been creating and implementing strategies to transition the staff and healthcare providers from ICD-9 to ICD-10. I asked Bill about some the basic requirements for starting the transition. He replied that project management is essential, beginning with the coders, who are being trained and tested on the new codes. There are agendas and project plans customized for all the various healthcare partnerships such as the Mount Sinai Rehabilitation Hospital, the Healthcare Partners ACO and twelve satellite medical groups. And having an analytics platform is critical for documenting, detailing coded variables and DRG revenue determination. Bill explained that often he requests departments to start with their top five or ten DRGs to focus on first whether they are highest volume or highest cost. The analytics platform provides insights on the 1st and 2nd service lines requiring documentation updates and which top payers would be potentially affected by DRG changes. Bill advocates implementing the technology and analytics, and worry about your service lines and top diagnoses, this way the strain of transition will be lessened
Physicians are concerned about the financial duress the transition will have on operating their practice. Bill foresees the ICD-10 conversion impacting the payer/provider billing and reimbursement process. I heard that realistically, physicians will need to have a year’s worth of operating costs in reserve for the transition process. In the beginning, he anticipates a high rejection of claim denials increasing between 100 and 200 percent due to lack of experience with acceptable codes and not knowing how payers are mapping claims. Also expect adjudications to increase 20 to 40 percent, waiting for claim status also slows down payments. It would make sense to be financially prepared. Though in the meantime, to improve overall operations coders need to be trained and medical staff receive clinical document education.
The number of codes will increase from 13,000 in the current ICD-9 to approximately 70,000 in the new ICD-10. And for Bill, the foundation of a successful transition is education and training. When working with a physician, he will ask him or her to provide one page of the most commonly used ICD-9 code, which when converted could become 50 pages. Why so many more codes? Bill explained that the ICD-9 codes were adopted in 1979, 36 years ago, and honestly, it is not practical to rely on what you had from that time in today’s medical practice. He recalled when he was a student at University of Chicago learning to us the CT scan and now the technology of choice is the MRI. Things change.
So why the push the push to delay the ICD-10 compliance date to 2017? Bill responded, “There is a lot of lobbying to stick to the October 2015 date”. Though he understands the AMA anti-ICD-10 sentiment by clarifying how the physicians are upset with the disruption. First, was the electronic health records implementation, then Meaningful Use compliance and now there is ICD-10 conversion, another unfunded mandate from government that is costly, reducing practice time and effecting their bottom line – getting paid. But the “what’s in it for me” credo will not halt the need to move forward in health care technology.
What will be the biggest success factors for healthcare to move forward? Bill said quite assured, “first when working with physicians, I stopped using the term ICD-10, I used a new phrase like ‘clinical document improvement’; second, the transition will have to be managed by the clinicians not through IT and that would make everyone darn happier, and third, I always use the tagline better data, better healthcare all the way around”. Thanks Bill!