PAeHI On the Road. ICD-10 Workshop. Hahnemann University Hospital. October 17, Behrakis Grand Drexel University

Transcription

1 PAeHI On the Road ICD-10 Workshop Hahnemann University Hospital October 17, 2013 Behrakis Grand Drexel University 32 nd and Market Streets Philadelphia, PA 19104

2 Agenda Our Hospital ICD 10 Basics Our Approach A Pilot Study Many Thanks 2

3 Hahnemann University Hospital Tenet Healthcare (77 Acute Care Hospitals) Dallas, Texas Public Company Academic Teaching Hospital 540 Beds Urban Environment

4 Programs ALS Center Bariatric Program Cardiac Care Congestive Heart Failure Interventions (Cardiac, Carotid, PAD) Electrophysiology (complex lead removals) Center for Women s Health Stroke Center Transplant Center Liver, Kidney, Pancreas, Heart

5 The Value Equation Quality Value = provided at the correct time Cost Need to avoid duplicate studies (laboratory and radiology) when possible. How to manage risk. Regulators are looking for value. 5

6 The Value Equation (Outcomes + Experience) Value = Expenditures Expressed in Overall Measures and Illustrative Sub-Domain Measures. HIT Policy Accountable Care Clinical Quality Measures Subgroup - ( ). Presentation of CMS emeasure Development. Kate Goodrich. 6

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8 Presentation of Potential Framework by Janet Corrigan August 20, 2013 HIT Policy Committee: Accountable Care Clinical Quality Measures Subgroup 8

9 The Triple Aim Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. 9

10 International Classification of Diseases (ICD) International List of Causes of Death (ILCD) 1893 The World Health Organization (WHO) publisher, since 1948 (6 th edition, added morbidity). Global Health Information Standard for Mortality and Morbidity Statistics (>100 countries) ICD-9 published in 1977, adopted in the U.S in 1979 ICD-10 endorsed by the 43 rd World Health Assembly in May 1990 (International), adoption in 1994 Clinical Modification (CM) and Procedure Coding System (PCS) used in the United States (not in Europe nor in Canada)

11 Legal Basis Health Insurance Portability and Accountability Act of 1996 Administrative Simplification Required HHS to adopt transactions and national identifiers for providers, health plans and employers. Affordable Care Act of 2010 Operating rules for HIPAA covered transactions Unique, standard Health Plan Identifier (HPID) Standard and operating rules for electronic funds transfer (ETF) and electronic remittance advice (RA) and claims attachments

12 Some Facts Transaction Standards Version 5010 replaced version 4010/4010A Version 5010 is the updated version of the ASC X12 Standards for HIPAA electronic standards Compliance date was January 01, 2012 Enforcement discretion through June 30, 2012 Allows for improved standardization of administrative and clinical data Necessary for ICD-10 transactions (key!)

13 Version 5010 Transactions 837 Health Care Claim Transaction 835 Remittance Advice Transaction 834 Benefit Enrollment and Disenrollment 270/271 Eligibility/Benefit Inquiry/Response 276/277 Claim Status Inquiry/Response 278 Referral Certification and Authorization 820 Health Plan Premium Payments

14 Some Facts Everyone covered by HIPAA must use ICD- 10 by October 01, 2014 Healthcare providers (Hospitals, Offices) Payers Software vendors Clearinghouses Third-party billing services Does not affect HCPCS (Healthcare Common Procedure Coding System) Level I: CPT-4 codes (outpatient) Level II: procedure codes (outpatient)

15 Electronic Record: Workflow Usability CDS Natural Language Processing Structured Data Computer Assisted Coding (CAC) Business Intelligence Predictive Modeling Patient Safety Indicators Core Measures HAC POA Readmissions ICD-10* Clinical Documentation Billing Coding *Applies also to Case Mix Index (CMI) and to Medical Necessity 15

16 ICD-10 Codes (United States) ICD-10 CM 21 Chapters Diagnosis coding Classification/r eporting of morbidity data 10 th edition Clinical Modification 3 to 7 digits (instead of 3 to 5 digits in ICD-9) ICD-10- PCS Procedure Coding System 7 alpha numeric digits (instead of 3-4 numeric digits in ICD-9-CM Volume 3) 10 th edition Inpatient Procedure Coding

17 ICD-10 Codes (United States) ICD-9 CM 3-5 digits ICD-10-CM 7 digits Replaces ICD-9 Volume 1 & 2 14, 315 diagnosis codes Severity Parameters Limited Does not include laterality 69,099 diagnosis codes % increase in codes Extensive Severity Parameters Common definition of laterality

18 Codes Structure

19 ICD-10 Codes (United States) ICD-9 Procedures Volume 3 of ICD-9-CM 3 to 4 digits Not Structured 3,838 procedure codes Chapter 3 of ICD-9-CM Non-specific, common ICD-10-PCS National Center for Health Statistics (NCHS) 7 digits Structured 71,957 procedure codes 1,874.85% increase in codes Managed separately from ICD-10-CM Non-specific, uncommon

20 Codes Structure

21 General Equivalence Maps (GEMS) From ICD-9-CM to ICD-10-CM/PCS Submission of bill From ICD-10 CM to ICD-9 CM Adjudication of payments received One-to-One One-to-Many May require manual reworking May need to validate your work Temporary

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23 Clinical Documentation Quality You don t get reimbursed for what you do; you get paid for what you document Day Egusquiza. President, AR Systems. Need for Physician and Provider Education, to start in 2014 Risks of education too early (forget) Risks of education too late (too little time to assimilate) CDS (Clinical Documentation Specialist) on the floors in Expertise utilized before the patient is discharged and hope to have more accurate data. Accurate coding necessitates accurate and complete documentation by the provider

24 Quality Reporting Reports will be affected (ICD-10) By DRG By Diagnosis By Cost Center Nearly all Reports Need to be updated with ICD-10 Codes

25 Finance Must expect re-billing. Case Flow (DNFB Discharged Not Final Billed) Will the payers be able to accept the transactions? Has adequate testing be done (will all payers)? Revenue Projections? Adequate Cash Reserves. How will Profit and Loss (P/L) Statement be affected? Superbills for ambulatory practices

26 Training & Education Coding Professionals Monthly Sessions of Intense Training For the past year By October 01, 2014, nearly two years of education Pool of Coding Professionals Retention Retirement Format By Body System Anatomy and Physiology

27 Testing Coding Professionals Duplicate coding (in ICD-9 and in ICD-10) dual coding to start in 2013 for a selected week each month. Revenue analysis based on each coded chart. Transactions Conifer and IT to do test transactions with payers in 2014.

28 Technical Levers CAC (Computerized Assisted Coding) Increase efficiency and throughput of coding Timeline: : in place by June 2014 in all of Tenet Hospitals Dictation of History/Physical Examination and Consults must be in place for CAC. Currently, dictated document include Operative Reports Discharge Summaries

29 ICD-10 ICD-10-CM/PCS Impact Assessment Webinar May 05, 2009 AHIMA Caroline Piselli, RN, MBA, FACHE Allison Viola, MBA, RHIA

30 Technical Report: The Costs and Benefits of Moving to the ICD-10 Code Sets RAND Science and Technology Martin Libicki Irene Brahmakulam March 2004 TR-132-DHHS Prepared for the Department of Health and Human Services

31 Rand Technical Report Costs: $ 425 Million - $ 1.15 Billion $ 40 Million lost productivity $20 Million - $170 Million is codes are switched sequentially Benefits: $ 700 Million - $7.7 Billion Martin Libicki Irene Brahmakulam March 2004 TR-132-DHHS Prepared for the Department of Health and Human Services

32 Rand Technical Report (Summary) Overall, there are good grounds for believing that the benefits are likely to exceed the initial break-in costs within a few years of code adoption. ICD-10 permits a considerable expansion. in what we can know about the health of the population and the care it receives. The extent to which this information will be properly and intelligently exploited is hard to gauge at present. But the potential gain is large if the opportunities are taken.

33 Medical Office Practice Costs Small Practice (3) Medium Practice (10) Large Practice (100) Education $ 2,405 $ 4,745 $ 46,280 Process Analysis $ 6,900 $ 12,000 $ 48,000 New Superbills $ 2,985 $ 9,950 $ 99,500 IT Costs (PM, Scheduling, Billing, Charge Capture) Increase in Documentation Cash Flow Reduction $ 7,500 $ 15,000 $ 100,000 $ 44,000 $ 178,500 $ 1,785,000 $ 19,5000 $ 65,000 $ 650,000 Totals $ 83,290 $ 285,195 $ 2,728,780 Robert Barbour, JD, MHA Robert Tennant, MA HIMSS Virtual Conference, 2011

34 MGMA 2013 Annual Conference San Diego, October 2013 Holt Anderson, Executive Director North Carolina Healthcare Information & Communications Alliance (NCHICA) Established coding task force in 2010 ICD-10 End-to-End Testing Pilot Worker productivity decrease by 50% 20 Dual-codes and peer reviewed scenarios = 55% accurate (some were the best coders ) Taking twice as long to code: 2 medical records/hour (ICD-10) compared to 4 records/hour (ICD-9)

35 MGMA 2013 Annual Conference San Diego, October 2013 North Carolina Healthcare Information & Communications Alliance (NCHICA) Impressions: 4.8% of Practices report they have made significant progress Results: Just plain scary Can you lose that kind of productivity? Smaller healthcare practices do not have the resources Project major cash flow issue

36 MGMA 2013 Annual Conference Physician Concerns Lack of communication & Critical coordination between Physician Practices and their trading partners Claims clearing houses Electronic health record vendors Practice management system vendors Software updates, testing (which has not occurred)

37 MGMA President & CEO: Susan L. Turney, M.D. The transition to ICD-10, with its substantial impact on documentation of clinical care, physician productivity and practice reimbursement, is unprecedented. It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades At the same time: MU2, Insurance exchanges. Asks that vendors, clearing houses, and health plans to immediately release their implementati on and training schedules.

38 MGMA Research found: Lack of response from vendors. More than 52 percent of respondents indicated they had not heard from their practice management system vendor regarding when software changes would be available to the practice. Almost 50 percent had not heard from their EHR vendor. Lags in internal software testing. Only 5.9 percent of respondents reported that internal software testing has begun or is complete with their practice management software vendor and 4.7 percent with their EHR vendor. External testing delays. Just 11.9 percent of respondents reported that external testing with their clearinghouse has started or is complete. Almost 60 percent reported that they have not even heard from their clearinghouse regarding a testing date. Only 8.6 percent have started or have completed testing with their major health plans, with a concerning 70 percent stating that they have not heard from their major health plans. Low confidence for a successful transition. Nearly 60 percent of respondents stated they are slightly or not at all confident that their major health plans will be ready to meet the Oct.1, 2014, compliance date. Concern about changes to clinical documentation. Among a number of implementation concerns, 88 percent are concerned or very concerned about the expected changes to clinical documentation; 87.5 percent are concerned or very concerned about the loss of clinician productivity after implementation; and 81.1 percent of respondents indicated they are concerned or very concerned with the overall cost of switching to ICD-10. Absorbing costs for transition. Only 32.5 percent of respondents report that their cost to upgrade or replace their practice management system software will be covered by their vendor. Only 37 percent say their vendor will cover the cost to upgrade/replace their EHR. Cost of transition. For those organizations that must cover the costs themselves, the average cost for a 10- physician practice to upgrade or replace their practice management system and EHR software to accommodate ICD-10 is $201,690.

39 Thank you Mr. Martin Ciccocioppo Vice President, Research The Hospital & HealthSystem Association of Pennsylvania Mr. Robert Torres Chairman of the Board Pennsylvania ehealth Initiative Former, State HIT Coordinator Health Information Exchange Office

40 Legal EHR THANK YOU