Month: December 2014
Applying Transparency to ICD-10
by Mark Spivey, ICD-10 Monitor
For full article, click here
“Transparency” is a term typically reserved to apply to government entities or picture windows – not ICD-10.
But Greg Adams, vice president of the consulting division of Panacea Healthcare Solutions, says it applies to that, too.
“You may have heard about price transparency since there has been a lot of publicity around this topic with a recent study by the Catalyst for Payment Reform showing that two-thirds of states received a failing grade for their healthcare price transparency laws – while another seven states squeezed out a D grade,” Adams noted, adding that only two states, Massachusetts and New Hampshire, managed an A grade.
“While the emphasis has been on price transparency,” he added, “I think of transparency in a broader perspective than just price.”
In its simplest terms, Adams explained, transparency in any market, the healthcare market included, is the ability to have sufficient information to compare the value of products.
“For healthcare this has recently been defined as quality over price,” he said. “Having this type of transparent information allows consumers to compare providers. In an economic sense, markets cannot function efficiently without transparency. If a buyer cannot distinguish the differences in price and quality between suppliers, then there cannot be an efficient market.”
As the U.S. healthcare industry amounts to something of an inefficient model, historically it has been “difficult, if not impossible” to compare hospital prices and quality, Adams added. But he also said the industry seems to be nearing a tipping points as patients become more responsible for a larger and larger portion of their healthcare bills.
“I believe transparency will happen, (and) it will happen fast. And it will be defined as price and quality – in other words, value,” Adams said. “We all agree that ICD-10 is connected to clinical documentation improvement, and clinical documentation improvement is connected to quality through the accurate coding of the medical record. And since quality is part of the value equation, remember that value equals quality/price.”
The bottom line?
“Coding in ICD-10 will result in a better reflection of the quality of care provided and improve transparency in healthcare,” Adams said.
NYP ICD-10 Project Update: December
As we roll into the holiday season, the ICD-10 Project Management Office would like to offer thanks to the more than 75 core project team members and hundreds of additional NYP staff, management, and leadership who tirelessly continue to contribute effort and expertise to the ICD-10 transition initiative. Effort and expertise that is readying NYP to code for those dangerous ‘holiday season’ conditions. Conditions such as being pecked by a turkey (W61.42XA). Or for those ambitious but unqualified Christmas light installers, T75.4XXA (Electrocution, initial encounter). And of course, no holiday season would be complete without the stresses of dealing with… THE IN-LAWS (z63.1).
The ICD-10 Project is a microcosm of the ongoing multidisciplinary collaboration that makes NYP the successful organization it is and is evidenced by the team’s most recent accomplishments across several of its stated milestones.
- Operationalize a dual coding production environment. NYP actually started coding using the ICD-10 code set more than one year prior to the October 1 implementation date. Through November, more than 5000 inpatient discharges and several hundred ambulatory surgery and emergency department visits have been coded in ICD-10. Though we can’t submit these codes to insurance companies, we are storing this information for external testing and analyzing it for potential reimbursement impacts and subsequent remediation activities.
- Complete end-to-end claims testing with payers. Our best evidence that the transition to ICD-10 will be smooth and seamless lies in our ability to submit test claims electronically to insurance companies and have those insurance companies acknowledge receipt and demonstrate an ability to process those claims in the form of accurate payment. To date, NYP has performed tests of varying levels of complexity and size with 7 of our largest contracted payers representing nearly 40% of the Hospital’s revenue.
- Support hospital operations with an ICD-10 ready technology and data infrastructure. All but one of the Hospital’s identified applications has been updated to be ICD-10 compliant. This means that the revised form and structure of ICD-10 codes can be accommodated for entry and storage and in many cases any functional processing for which the codes are used as criteria. In addition, to ensure those codes move seamlessly across different applications, approximately 10% of the affected interfaces have already been successfully tested.
- Manage the ICD-10 impact on quality and patient safety reporting. Through an innovative approach developed by the NYP team, 9 quality and patient safety metrics affecting value based purchasing incentives have been assessed. Two, accidental puncture and laceration and DVT/perioperative pulmonary embolism have been identified as being potentially impacted by the transition to ICD-10. The workgroup is evaluating potential mitigation strategies.
Many other activities are ongoing and progressing nicely. For a complete overview of the project status, click here to view the Project Scorecard.
Projects as complex as ICD-10 are not without their challenges and as we head into the final 300 days before October 1, 2015 efforts are underway to address these. They include:
- Maximizing the benefit of computer assisted coding technologies
- Further accelerating and expanding dual coding activities
- Accelerating claims testing activities with payers
- Continuing to identify mission critical reports for ICD-10 conversion activities.
Because ICD-10 is the dictionary that defines our daily operation, it has the potential to affect as many as 10,000 to 15,000 NYP employees in some way. We all can play a role in NYP’s readiness activities and prepare our respective departments for the transition. Some of those items include:
- Recognizing the transition is coming and the differences between ICD-9 and ICD-10 code structures;
- Identifying reports, documents, and forms that are using ICD-9 codes today so that they can be converted to ICD-10;
- Thinking about how the additional specificity included in ICD-10 can help create efficiencies and improved outcomes in your operation; and
- E-mailing questions about ICD-10 and how it may affect you and your department to ICD10Help@nyp.org.
Happy Holidays to all!
ICD-10 Readiness Spotlight: Report Conversion
At NewYork-Presbyterian Hospital, employees across the organization use reports for a wide variety of purposes. Whether we’re looking at operational metrics like length of stay and discharges, quality indicators like readmissions and infection rates, or financial measures related to billing and payment, it’s important that our reports be accurate and up to date so that we can make informed decisions. Because many of the reports we rely on to run our departments, practices, and units contain ICD-9 codes, the upcoming transition to ICD-10 means that we need to update our reports to reflect the new code set.
The ICD-10 IT workgroup, headed by Ken Thibault, has been leading the effort to ensure that all necessary reports are converted to ICD-10. The group has already created an inventory of about 150 reports that use ICD-9 codes, and has begun the process of determining which ones need to be updated, collecting the relevant ICD-9 codes, and converting those ICD-9 codes to ICD-10 codes. Once the ICD-9 codes are mapped to ICD-10 codes, the mapping is sent to the report’s business owner for approval, at which point IT will make the necessary updates so that the report will populate properly once we transition to ICD-10.
If you are a business owner of reports, you should be hearing from the ICD-10 team in the next month or two so that we can work with you on converting your reports. If there are reports that you use that you want to make sure are on the inventory, please reach out to the IT team that manages the system in questions. We look forward to partnering with you to ensure that your reporting needs continue to be met post October 1st, 2015.