ICD-10: Short-Term Challenges and Long-Term Gains

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  • 1. ICD-10: Short-Term Challengesand Long-Term Gains
  • 2. 2Perficient is a leading information technology consulting firm serving clientsthroughout North America.We help clients implement business-driven technology solutions that integratebusiness processes, improve worker productivity, increase customer loyalty and createa more agile enterprise to better respond to new business opportunities.About Perficient
  • 3. 3• Founded in 1997• Public, NASDAQ: PRFT• 2012 revenue of $327 million• Major market locations throughout North America• Atlanta, Austin, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus,Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Los Angeles,Minneapolis, New Orleans, New York, Philadelphia, San Francisco, SanJose, Southern California, St. Louis, Toronto, and Washington, D.C.• Global delivery centers in China, Europe and India• ~2,000 colleagues• Dedicated solution practices• ~85% repeat business rate• Alliance partnerships with major technology vendors• Multiple vendor/industry technology and growth awardsPerficient Profile
  • 4. 4Business Solutions• Business Intelligence• Business Process Management• Customer Experience and CRM• Enterprise Performance Management• Enterprise Resource Planning• Experience Design (XD)• Management ConsultingTechnology Solutions• Business Integration/SOA• Cloud Services• Commerce• Content Management• Custom Application Development• Education• Information Management• Mobile Platforms• Platform Integration• Portal & SocialOur Solutions Expertise
  • 5. John Bradshaw, Healthcare Industry Consultant at PerficientJohn is a consultant in Perficients national healthcare practicewho specializes in ICD-10 assessments. He has conductedextensive provider ICD-10 reviews and is well-versed in thechallenges faced by both the provider and payer communities.Our Speaker5
  • 6. 6• Requisite ICD-10 Background Slide!• Challenges• Myths• A Structured Approach• An Example of a Timeline• A Dance• Code Management and ICD-10• Closing• Q&AAgenda
  • 7. 7What?• Transition form ICD-9 to ICD-10• ICD-10 CM (diagnosis)– 3 to 7 digits instead of the 3 to 5 digits– 68,000 codes compared to 14,000 codesin ICD-9• ICD-10 PCS (inpatient procedure)− 7 digits instead of 3 to 4 digits− 84,000 codes compared to 4,000 codes inICD-9When?• October 1, 2014• NO DELAYS, NO GRACE PERIODSWho?• All HIPAA covered entities who transmitelectronic transactions− Providers, payers, billing services,clearinghouses, etc.BackgroundWhy?• ICD-9 is obsolete– It is 30 years old– It has outdated terms– Doesn’t reflect current medical knowledgeor advances in technology– Not descriptive enough– No room for expansion– Lack of flexibility• ICD-10 allows for:– Greater specificity• Will improve the ability to measurehealth care services and decrease theneed to include supporting informationwith claims– Includes updated medical terminology anddisease classification– Allows providers to better ID patients withspecific conditions• Will benefit from tailored disease mgmt.programs, e.g. diabetes, asthma
  • 8. 8• Areas of Primary Impact– Clinical Documentation– Coding & Billing– Education & Training– Reporting & Analytics• HCR initiatives already underway (MUI&II,EHR)• Anecdotal information– Early experience by some Health System and Payerorganizations testing the coding of bills as ICD-10utilizing existing patient records resulted in a low (< 50%)success rateChallenges
  • 9. 9• Upgrading the systems will make us compliant• Cross-walk will solve all your problems• Revenue neutrality• CMS will delay againMyths
  • 10. 10A Structured Approach• Create initial awareness, outline effort and establishgovernance• Organizational readiness and capacity for changeAssessment• Program management, drive communication activities,vendor engagement, Code Management, work streams toaddress impacts and operational preparednessRemediation• End-to-end integrated testing, include partners• Validation of Readiness activities• Training and Education beginsTesting• Implementation & distribution of Cross-Walk• Business operations transition plan execution• Data & Analytics preparationReadiness• Begin use of ICD-10 in daily operationsGo-Live• On-going monitoring of organizational activities impacted bythe ICD-10 change, identifying and making adjustments asnecessaryPost Implementation
  • 11. 11AssessmentProjectInitiationCharter Governance StakeholdersOrganizationalBackgroundCollection& ReviewOperationalBaselineInterviews Investigations DiscoveryImpact &GapAnalysisReview &Collection ofActivitiesMaster List ofFindingsDetermineImpacts &GapsRoadmap& NextStepsIdentifyProjects &InitiativesCompleteFindings &ObservationsRoadmap RecommendationPlan Project ReviewResources &DependenciesStaffingKickoff Communication PlanSteeringCommittee/SeniorManagementRoadshow
  • 12. 12• Method– Understand Organization and Current State– Collect and inventory those activities and items that currentlyinvolve/utilize ICD-9– Develop a portfolio of projects to address the identified impacts andgaps– Assess the organization’s readiness for change• Artifacts– Assessment Document– Inventories Workbook– High-level Project Plan– Project Portfolio– Strategic RoadmapAssessment
  • 13. 13Inventory CategoriesSection DescriptionOrganization Structure List of departments, department managers and who they report toCustomers Organizations, individuals and other entities that are serviced by TCHPBusiness Process List of major, minor and other key business processes that support a service provided by TCHPto its customersBusiness RequirementsThose things that, when met or satisfied, enable the organization to meet its goals andobjectives.Business Partners Organizations, individuals and other entities contracted by TCHP to augment its services and/orprovide other services to TCHPs customersVendors Organizations, individuals and other entities contracted to provide products and support servicesto TCHP that enable it to meet its business requirementsApplicationsTechnology/systems that enable TCHP to execute certain tasks and activitiesInterfaces A service that enables an exchange of data to occur between an application, vendor, businesspartner or other entityReports Compilation of information specifically arranged as to communicate the results of activities orevents to the viewerDocumentsAny of a variety of business documents that describe the services to be delivered and themanner in which delivery is to be handled, such as fee schedule contracts, plan documents andstandard operating procedures
  • 14. 14RemediationProgramManagementGovernance Standards Roles &ResponsibilitiesPMOCommunicationCommunicationStrategyAwarenessCulture &ChangeManagementTeamBuildingEmployeeEducation &TrainingOperationalPlanningCodeManagementCross-walk Analytics Distribution TestingVendorManagementReadiness Upgrades DeploymentReporting &AnalyticsRiskManagementDataWarehousing& MartsClinical Operations FinancialClinicalDocumentationPolicies &ProceduresRecordsPatient CareTeamCodingProcesses &ApplicationsEHR RevenueAncillary &SupportInter-operabilityFoundational
  • 15. 15Typical TimelineMar-13Apr-13May-13Jun-13Jul-13Aug-13Sep-13Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Post ImplementationPhaseAssessmentRemediationTestingReadiness
  • 16. 16• What you need to do– Establish a governance structure and provide for oversight– Provide for/enable participation of SMEs and operational leadership duringAssessment– Assign responsibility/accountability for the completion of the many Remediationinitiatives to the appropriate business & technology leads– Manage the operational transition to support the 10/1/2014 implementation– Coordinate the Education and Training of impacted employees– Stakeholder Awareness• How you can leverage others– Program management, trusted advisor, able to look across the entire organizationand unencumbered by any organizational norms– Bring other key partners to the table to help– Point assistance with the remediation of transactional platforms, service solutions andanalytics– Visibility to how peer organizations are addressing various issues– Drive your Code Management effortChoreographed Dance
  • 17. 17• Code Management comprises:– Cross-walk development– Analytics– Distribution– Testing and validation• The experience and knowledge gained from developing theCross-walk and leveraging it to analyze the impact to theorganization, serves as an important input to the overallRemediation effortCode Management and ICD-10
  • 18. 18Code Management Benefits & ImpactCodeManagementPartnerManagementRiskManagementCorporateCommunicationProcesses &OperationsClinicalDocumentationProgramManagement
  • 19. 19• Business Intelligence (BI), Reporting & Analytics basedupon a mix of ICD-9 and ICD-10 originated encounters andbillings• Greater granularity will provide for a much richer set of datato drive analytics• Impact of more detailed patient records• Risk Stratification• Case Mix Index Analysis• IntrospectionLong-term Benefits of ICD-10
  • 20. 20• Organization-wide impact• While others can assist you, the breadth of the impactrequires long-term engagement in the effort by many fromacross the organization• The scope and effort demand structure, coordination andcollaboration to ensure the maintaining of on-going servicelevels and the managed introduction of change• Code Management drives prioritization of efforts, riskmitigation and focusClosing
  • 21. Questions?