ICD-10 The Case for Action and Collaboration. Dr. Daniel Nigrin, CIO Boston Children s Hospital Bill Fandrich, CIO BCBSMA

Transcription

1 ICD-10 The Case for Action and Collaboration Dr. Daniel Nigrin, CIO Boston Children s Hospital Bill Fandrich, CIO BCBSMA

2 Discussion Overview Risks Associated with ICD-10 Implementation Making Strategic Collaboration a Reality Areas for Strategic Collaboration 2

3 Potential areas of risk for the Healthcare Industry in MA Will reimbursement rates for treatment and procedures be impacted? For example, in ICD9, an inpatient facility fee schedule for a laparoscopic and open procedure are included together in a single code, whereas in ICD10 they are in different codes. Will payer maps adjudicate this as they did in ICD9 for the purpose of revenue neutrality? Will this impact the determination of member benefits / eligibility and patient liability? Have we thought out the impact to processes? How will patient liability be determined? We don t want this to impact our patients 3

4 Potential areas of risk for the Healthcare Industry in MA Will there be enough resources to train? Should we each provide our clinicians with training to develop accurate documentation or should we collaborate on resources based on discipline (Cardiology, Pediatrics, etc) and venue (LMA, South Coast, Berkshires, etc)? Will there be enough subject-matter-experts available to train on ICD10? With the absence of test data, and the recommendations to have coders coding in both ICD9 and ICD10 for training, can we capture and share this data? Studies have shown a reduction in coder productivity can be mitigated with an increase in ICD10 practice time. 4

5 Potential areas of risk for the Healthcare Industry in MA What is the best method of handling interim billing for both payers and providers? How will the interim bills be handled for payment of services provided to the stay of a long-term inpatient that spans compliance? Will providers need to recode for services rendered before the compliance date? How can we leverage other resources in the state (MHA, MMA, MHIMA) to help us with this migration? How will reporting requirements with the state be handled? How do we include small physician practices in this discussion? 5

6 The Call for Collaboration Across the Industry To truly mitigate ICD-10 risks within the industry, we must agree to work together in ways we never have before Organizations must commit, at every level of their organization, to collaboration efforts in Massachusetts CIOs that meet through the Mass Health Data Consortium agree that MHDC can and should be a coordination / leadership axis for ICD- 10 collaboration 6

7 Areas for Strategic Collaboration Maps & Mapping Vendor Readiness Collaboratively provide leverage to getting vendors to disclose readiness Common outreach, tracking, readiness verification Work Force Education, Communication, and Training Alignment of Government/Regulatory Requirements Provider-Payer Interoperability Testing Financial Impacts Member / Patient Impacts Operational / Business Process Impacts 7

8 Testing Collaboration will be KEY! Utilizing the lessons from 5010 mandates to determine the best approach for industry-wide testing and implementation? Creation of a detailed test timeline ensures that each institution has a concrete date. Vendors have been both slow to provide solution and queues for installation are long. If you know where you are in the queue for testing, it can provide leverage in your discussion with vendors. Example BCBSMA tests w/children s, BIDMC Tufts tests w/mgh, St. Elizabeth's HPHC tests w/lahey, Winchester BCBSMA tests w/beverly, Mt. Auburn Tufts tests w/mclean, BWH HPHC tests w/joslin, MGH Feb 2014 Mar 2014 Apr 2014 May 2014 BCBSMA tests w/mgh, Cape Cod Tufts tests w/children s, BIDMC HPHC tests w/berkshire Health, BWH BCBSMA tests w/st. Luke's, Emerson Tufts tests w/franciscan, NWH HPHC tests w/st. Elizabeth's, Children's 8

9 Example: Provider-Payer Interoperability Testing Utilizing the existing MHDC ICD10 Forum, jointly agree on a testing approach to: Determine testing strategy and timelines for testing Define scenarios for generating, transmitting, receiving, processing & reporting codes Use these to determine underlying risk in various approaches Jointly define & create test data sets Test data sets of relevance to provider-payer relationship (e.g. cardiology, obstetrics, pediatrics, etc.) Utilizing industry resources (i.e. HIMSS) to help with this effort Define business-oriented & clinically-oriented measurement criteria Examples include: Reimbursement / Financial measures Measures for pends/denials/rejections Measures of authorizations Validation of benefit determination (including member liability) Risk scores (AQC & Medicare) 9

10 How do we make Strategic Collaboration work? MHDC is currently creating an overall scope and approach for leading ICD-10 collaboration efforts Gain commitment within organizations, at every level Create a communication vehicle to disseminate decisions. Create an MHDC ICD-10 Executive Steering Committee to define policies and oversee collaborative activities. Composition will be Executive leadership from: Academic Medical Centers Community Hospitals Physician practices Specialty Facilities State representation Provide the resources to support MHDC ICD-10 efforts 10

11 OPEN FOR COMMENTS AND DISCUSSION

12 Contacts Janet O Malley ICD-10 Program Director Boston Children s Hospital 1295 Boylston Street Boston, MA janet.omalley@childrens.harvard.edu Ted Marsh Vice President, Information Technology & Operations edward.marsh@bcbsma.com Gerry Johnston Director, Government Mandates gerry.johnston@bcbsma.com Blue Cross Blue Shield of Massachusetts 401 Park Drive Boston MA