ICD-10 Compliance & Beyond

Transcription

1 ICD-10 Compliance & Beyond Medicaid Enterprise Systems Conference September 11, 2013 Cathy Munn, MPH RHIA CPHQ 1

2 Objectives At the end of the presentation the participant will: Demonstrate an understanding of the National Quality Strategy Demonstrate an understanding of the correlation between ICD-10 and health care quality as measured by public & governmental agencies 2

3 Healthcare Quality is Measured by.. 3

4 Agenda The National Quality Strategy Triple Aim Better Care Healthy People/Healthy Communities Affordable Care Six Priorities Quality Measurement Collaboration & ICD-10 National Committee for Quality Assurance - NCQA National Quality Forum - NQF Agency for Healthcare Research & Quality - AHRQ CMS Measure Harmonization & Alignment 4

5 The Intention of the National Quality Strategy To align the priorities & efforts of governmental & private sector stakeholders in improving the quality & reducing the cost of health care. To build a national consensus on how to measure quality so that stakeholders can align their efforts for maximum results 5

6 Triple Aim of National Quality Strategy Better Care Healthy People Improving quality of care by making care patient centered, reliable, accessible & safe Improve the health of the U.S. population by supporting proven interventions addressing behavioral, social & environmental determinants of health..delivering higher quality care Reduce the cost of quality health care for individuals, families, employers & government Affordable Care 6

7 National Quality Strategy Six Priorities of NQS: Making care safer by reducing harm caused in the delivery of care Ensuring that each person & family are engaged as partners in their care Promoting effective communication & coordination of care Promoting the most effective prevention & treatment practices for the leading causes of mortality; starting with cardiovascular disease Working with communities to promote wide use of best practices to enable healthy living Making quality care more affordable for individuals, families, employers & governments by developing & spreading new health care delivery models 7

8 Quality Measurement Collaboration NCQA NQF AHRQ National Quality Strategy 8

9 National Committee for Quality Assurance HEDIS 2013 contains 80 measures 45 HEDIS measures on initial conversion list 80 tables with diagnosis codes 34 tables with procedure codes 41K individual codes Include ICD-10 codes in HEDIS 2014 Convert 1/3 of measures each year Stakeholder review & comment period is open through December 15,

10 National Quality Forum 700 NQF Endorsed Measures Approximately 250 measures are impacted by the transition to ICD-10 All measures are on track to be updated by the compliance date of October 1, 2014 utilizing the Best Practice approach The NQF continues to evaluate questions related to ICD-10 measure submission and measure testing 10

11 Agency for Healthcare Research & Quality 2012 National Healthcare Quality Report Documented declines in measures associated with: Diabetes Foot exams Hemoglobin A1c Adverse Events Pressure ulcers Documented improvement in measures associated with: Cardiac interventions Congestive Heart Failure patients treated with ARB or ACE medications at discharge 11

12 CMS Alignment of Clinical Quality Measures Complete alignment of Hospital Value-Based Purchasing (HVBP) and Inpatient Quality Reporting (IQR) Program Clinical Quality Measures (CQM) reported on Hospital Compare. Implement the Medicare EHR Incentive Program Electronic Reporting Pilot for Eligible Hospitals and Critical Access Hospitals IQR will introduce EHR-based reporting. Additional details will be included in the Fiscal Year (FY) 2014 Inpatient Prospective Payment Schedule proposed rule that is targeted for publication in the spring of Beyond CQMs will be transitioned to EHR-based reporting in the EHR Incentive Program and then to IQR and other hospital reporting programs 12

13 National Efforts vs. Local Efforts What measures are you currently tracking & trending? Internally Collaboratively What measures are you currently reporting? State - Medicaid Federal Medicare Are you involved in a collaborative effort with area hospitals, health plans, ACOs? Do these measures have any ICD-9 dependencies? How are you translating measures that are based on ICD-9 codes? Is your ICD-10 Steering Committee looking at this aspect of reporting? 13

14 ICD-10 Compliance and Beyond September 11, :45 11:45 Ed Dolly, PMP, CISSP Deputy Commissioner, WV Bureau for Medical Services Bill Richardson, PMP Manager, BerryDunn

15 PROJECT CONTEXT The Bureau for Medical Services (BMS) is the single state Medicaid agency in West Virginia. BMS is part of the Department of Health and Human Resources in West Virginia. BMS has approximately 90 employees. BerryDunn is assisfng BMS with some project management acfvifes. 15

16 PROJECT CONTEXT 16

17 PROJECT CONTEXT 17

18 PROJECT CONTEXT West Virginia is mapping ICD- 9 codes to ICD- 10 with the help of the Edifecs tool. We are mapping in two waves: The first wave will include all ICD- 9 codes used in current MMIS system configurafon. The second wave will include all remaining ICD- 9 codes. These mappings will also be available to be leveraged by the DW/DSS. 18

19 ICD- 10 IN QUALITY INITIATIVES DW/DSS MMIS AQM Health Homes BeVer Health Outcomes Add Secret Sauce 19

20 ICD- 10 IN QUALITY INITIATIVES West Virginia is currently working on a Health Homes inifafve for people with bipolar disorder. Targets people at risk of having HepaFFs B or C. The pilot is focusing on a six- county area in West Virginia. ReporFng on outcomes will include ICD codes. 20

21 ICD- 10 IN QUALITY INITIATIVES West Virginia is parfcipafng in the Adult Quality Measures grant opportunity from CMS. West Virginia will be reporfng on 15 of the 26 measures. These 15 measures are defined by the NaFonal CommiVee for Quality Assurance (NCQA) and include ICD- 9 codes. As NCQA defines the quality measures using ICD- 10, we will compare our mappings and make adjustments. 21

22 OPPORTUNITIES PRESENTED Taking advantage of Federal funding to do this wisely and right at an Enterprise level West Virginia has been able to do this project in phases including: System compliance Coding updates Policy remediafon 22

23 OPPORTUNITIES PRESENTED Project concurrency allows a compliance focus for October 1, The ICD- 10 compliance focus allows us to fully map ICD- 9 to ICD- 10 with maps that can leveraged for quality reporfng. Project concurrency allows us to compare policy to system funcfonality and consider ICD- 10 impact on policy in one project. 23

24 CHALLENGES PRESENTED Concurrency also increases complexity in managing the project. MulFple projects with limited resources added to daily operafons work. Deadline driven implementafon date. 24

25 CHALLENGES PRESENTED ReporFng that includes both ICD- 9 and ICD- 10 codes will not be definifve. We will leverage code maps to lessen the challenge. For trending historical informafon, custom reports may be necessary and may need to be defined by the business owner. 25

26 LESSONS LEARNED ICD- 10 impact assessments is an addifonal place you can leverage your MITA SS- A. West Virginia looked at the MITA SS- A to idenffy business processes with potenfal ICD- 10 impacts. This minimized impact on operafons staff who were able to simply confirm the results of the SS- A review. 26

27 LESSONS LEARNED We did not have ICD- 10 experfse or experience with a code- mapping project. We started planning and engaging our partners and found that to be an informed parfcipant, we needed ICD- 10 experfse. We engaged SMEs with this experience and ICD- 10 experfse, which has had a posifve impact. 27

28 LESSONS LEARNED CMS and Nobilis have done a lot of planning work and made templates available. These are available through the ICD- 10 portal. Leveraging this informafon as well as the templates will help jump start many phases of your project. 28

29 QUESTIONS AND DISCUSSION Thank you! e Ed L. Dolly Ed.L.Dolly@wv.gov Bill Richardson BRichardson@BerryDunn.com