Month: February 2015

ICD-10 and Quality Measures Reporting

Christine Valentin

In preparation for the expected transition from ICD-9 to ICD-10 on October 1, 2015, evaluation of the impact that this change will have on NYP’s quality measures data (e.g. – AHRQ Patient Safety Indicators, Value Based Purchasing) used for public reporting, is a critically important undertaking.

ICD-10 has greater specificity and detail for both diagnoses and procedures.   This enhancement provides better data for use in assessing patient severity, outcomes, and quality of care. Understanding the differences in the ICD-9 and ICD-10 definitions is important in assessing changes or shifts in volumes or outcomes observed. Increases or decreases in case volume and case compliance could impact publicly reported data, affect reimbursement, and change how NYP compares to and ranks among other peer organizations. Some measures, because of ICD-10’s impact on the qualifying patient populations could lead agencies to question the original intent of the measure, refinement of the measure, or even lead to some measures becoming obsolete.

Everyone is in a learning phase. NYP is in the process of thoroughly reviewing ICD-10 code set conversions and estimating changes in patient populations and the metric results for approximately 23 different safety and quality indicators. To date, four of those measures appear to be potentially affected by the transition. An example of one those measures, accidental puncture and laceration is included here.

To conceptualize the increase in number of codes, predominately due to specificity, that will occur in moving from ICD-9 to ICD-10 that are utilized in various inpatient quality measures reporting see TJC specification manual reference documents and website.

ICD-10 Project Update: February

Jason Gottlieb

At a shade under eight months (232 days to be exact) before the ICD-10 implementation date, we head into the most romantic of months fully investing in our relationships to drive ICD-10 over the finish line yet mindful of the continued challenges and complexities of those relationships. We can present bearing and receiving gifts coated in large amounts of chocolate and sugar only to suffer the consequences of R73.9 (Unspecified Hyperglycemia). And should those gifts come from a secret admirer – a veritable certainty to cause R00.2 (Palpitations). Don’t fall head over heels though for you may just be stood up resulting in a bout of R45.83 (Excessive Crying) leading to I51.81 (Takotsubo Syndrome)… Yes, a broken heart.

On a more practical note, investments in relationships at the industry and legislative levels are creating hope and high expectations that all the hard work and advocacy are beginning to pay dividends. The chairs of the House Energy and Commerce Committee have committed to meeting the October 1, 2015 date, the General Accounting Office (GAO) commended the Centers for Medicare and Medicaid Services (CMS) on its readiness and outreach activities, and here at NYP, the collaboration among the numerous departments contributing to the transition and across our healthcare system colleagues and our two school-based faculty practice partners continues. A special congressional hearing on ICD-10 implementation is scheduled for Wednesday, February 11 and is expected to be another successful milestone on the industry’s journey to realizing ICD-10.

A list of NYP’s most recent and cumulative accomplishments continues to demonstrate the multidisciplinary effort to lift NYP and NYPHS onto this new language called ICD-10.

  • Complete end-to-end claims testing with payers. We have completed end-to-end testing with Medicare in January and overall we have performed some level of testing with 8 of our largest payers accounting for 66% of our revenue base.
  • Support Hospital operations with ICD-10 ready data and technology. The number of system to system interfaces tested for ICD-10 readiness more than doubled in the last month and 31% of all interfaces have been successfully tested.
  • Enable provider support of ICD-10 documentation requirements. A new documentation selection tool that leverages physician friendly documentation concepts (and is mapped to ICD-10 codes) known as Intelligent Medical Object (IMO) has been deployed in pilot to select physicians for review and comment.
  • Assess impact on quality and patient safety metrics.52% of all metrics affecting value-based purchasing (and Hospital reimbursement) have been tested.
  • NYPHS readiness.Our most recent ICD-10 readiness survey results are available and provide NYP with a clear picture of how our healthcare system colleagues are progressing on their own readiness activities and where we can share and partner to gain efficiencies.

Other activities will continue to progress and expand under the assumption that no further delays shall occur. For a complete overview of the project status, click here to view the Project Scorecard.

Should you have questions about what you can be doing to get your department ready for ICD-10 or would like to request an in person presentation from the ICD-10 project team, please e-mail ICD10Help@nyp.org.

Happy Valentine’s Day!

GAO Gives CMS ICD-10 Readiness Thumbs Up

Jason Gottlieb

Efforts by the Centers for Medicare and Medicaid Services to prepare providers, clearinghouses, and health plans for the October 1 ICD-10 deadline are on track, and CMS is ready to process claims using the new codes.

That is the conclusion of a just-released Government Accountability Office report on the readiness of CMS for the ICD-10 switchover.

“The transition to ICD-10 codes requires both CMS and covered entities to develop, test, and implement information technology systems that can process the new codes,” states the GAO report. “In addition, these covered entities need to educate and train staff in using these new codes, and may need to modify internal business processes.”

According to GAO, CMS has developed various educational materials, conducted outreach, and monitored the readiness of covered entities and the vendors that support them for the ICD-10 transition. For example, the agency held in-person training for small physician practices in some states and monitored readiness through stakeholder collaboration meetings, focus group testing, and reviews of industry surveys, finds the report.

GAO also reported that CMS modified its Medicare systems and policies. For example, the agency completed all ICD-10-related changes to its Medicare fee-for-service (FFS) claims processing systems. Auditors also found that the agency provided technical assistance to Medicaid agencies and monitored their ICD-10 readiness. As a result, all Medicaid agencies reported that they would be able to perform all of the activities that CMS has identified as critical by the October 1 implementation deadline.

Nonetheless, while CMS’s Medicare FFS claims processing systems have been updated to reflect ICD-10 codes, GAO states that “it is not yet known whether any changes might be necessary based upon the agency’s ongoing external testing activities.” Auditors also conclude that although CMS has worked with states to help ensure that their Medicaid systems are ready for the ICD-10 transition, “in many states, work remains to complete testing by the transition deadline.”

At the same time, GAO reports that stakeholder organizations identified several areas of concern about the ICD-10 transition and made several recommendations, which CMS has taken steps to address. For example, stakeholders expressed concerns that CMS’s testing activities have not been comprehensive. To address this concern, CMS officials said that the agency has scheduled end-to-end testing with 2,550 covered entities during three weeks in 2015 (in January, April, and July).

In response to the GAO report, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) issued a statement saying they have “confidence” that CMS is “adequately preparing to implement” ICD-10 by the October 1 deadline. “As demonstrated by this report, the provider outreach and responsiveness to stakeholder concerns from CMS have kept the agency on track to upgrade to the next level of healthcare coding,” said Hatch. Wyden added that CMS has “taken unprecedented actions to help providers prepare for this change.”

Similarly, the Coalition for ICD-10 in a statement said that the GAO report “affirms widespread recognition across the healthcare industry that CMS is well-prepared to implement the U.S. transition to ICD-10 on October 1, 2015, and that the agency has undertaken extensive efforts to help the health care industry prepare,” adding that “the U.S. is ready to move forward with ICD-10

House Energy & Commerce subcommittee on healthcare to hold ICD-10 implementation hearing

Jason Gottlieb

Article by Mary Butler, associate editor at the Journal of AHIMA. “This article was originally published on the Journal of AHIMA website on February 4, 2015, and is republished here with permission.”

See full article here

A key Congressional committee will be holding a stakeholder hearing on ICD-10-CM/PCS implementation next week. The “Examining ICD-10 Implementation” hearing, set for 10:15 am ET on February 11, is being held by the influential House Energy and Commerce Committee’s subcommittee on healthcare, which is chaired by Rep. Joe Pitts (R-PA).

“This hearing is an important opportunity to hear about the state of preparedness of all those involved and ensure that we are continuing to move forward in health care technology,” Pitts said in a press release announcing the hearing .

Back in December, House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) issued a statement saying that they would hold hearings on ICD-10 and stay in communication with the Centers for Medicare and Medicaid Services (CMS) “to ensure that the [ICD-10-CM/PCS] deadline can successfully be met by stakeholders.”

463105901The Congressmen noted in the statement that “it is essential that we understand the state of preparedness at CMS. Following the most recent delay of ICD-10, we heard from a number of interested parties concerned about falling behind or halting progress.”

AHIMA staff will attend the February 11 hearing and closely monitor any developments that result from it. Panelists testifying at the hearing will include stakeholders who both oppose and support implementing ICD-10 on October 1, 2015.

The Majority Memorandum, a witness list, and witness testimony will be available online here as they are posted.

Historically, this subcommittee has played key roles in healthcare legislation and in the ongoing debate over the SGR patch—which last year included language delaying ICD-10. Another SGR patch may once again be voted on by Congress in the coming weeks if a permanent fix is not enacted. The House Energy and Commerce Committee also includes physician members of Congress who have a specific interest in the implementation of ICD-10.

AHIMA officials have said they are encouraged by the hearing announcement, and feel it is a chance for an open and frank discussion about ICD-10, the current industry readiness, the impact of any future implementation delays, and the best path to move forward with implementation. The initial statement announcing the hearings came during wide grassroots activism in support of no further ICD-10 delays on the part of AHIMA, the Coalition for ICD-10, and other supporters.

The House subcommittee hearing will be held the day after the Coalition for ICD-10’s Capitol Hill briefing on Feb. 10. The briefing will discuss rural provider and payer readiness for ICD-10, and include perspectives from hospital and physician groups who support the current October implementation deadline.

Click here for a list of the House Energy and Commerce Committee Subcommittee on Health’s members.

The hearing webcast will be available to watch live at http://energycommerce.house.gov/.