Beacon Partners / BridgeFront ICD-10 Webinar: Building the Bridge as You Walk on It
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Date: 8/7/2013 Title: The Transition to ICD-10: Building the Bridge as You Walk on It Presented By: Christine Kalish, MBA, CMPE, National Practice Director, Strategic Advisory Group of Beacon Partners Description: With the transition to ICD-10 only 15 months away, organizations will have to find inventive ways to create their roadmap and execute on their plans. Rather than taking valuable time to complete a gap analysis and then create the plan, organizations should consider how to do these tasks concurrently.
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Beacon Partners / BridgeFront ICD-10 Webinar: Building the Bridge as You Walk on It
- 1. The Transition to ICD-10 Building the Bridge as You Walk on It Presented by: Christine Kalish, MBA, CMPE, National Practice Director August 5, 2013
- 2. Heading – Ariel 40 • Get up to date on ICD-10 • Define key strategies in the transition • Realistically identify work to be accomplished • Identify assumptions and constraints for the program and related projects • Create your organizational structure • Use resources and partners effectively • Questions 2 Agenda
- 3. 3 Current Status of ICD-10 Transition
- 4. Heading – Ariel 40 • Fifty percent of health plans will begin testing by the end of 2013 • Fifty percent of providers didn’t know when testing would occur • Two/fifths of providers had no idea when their impact assessment would be completed or their business changes made • Two/thirds of vendors will begin customer review and beta testing by the end of 2013 • At least forty percent of entities delayed their timeline by at least 6 months 4 Industry Readiness - Current Facts WEDI 2013 Survey Time frames have shifted
- 5. Heading – Ariel 40 • Denial rate increase from 10% to 25% • Backlogs – 64 days to 6 months • Billing delays • Payment declines > 2 years past the implementation • Thirty to fifty percent decrease in coder productivity • > 10% of charts lacking sufficient specificity in documentation • DRG shifts • Over-coding due to lack of experience – results in RAC audit 5 ICD-10 Revenue Cycle Impacts
- 7. Heading – Ariel 40 7 ICD-10: Competing Initiatives? ICD-10 Meaningful Use Organizational Monitoring and Performance ACOs and Medical Home HIEs Quality Reporting Initiatives Research Payment Reform Value-Based Purchasing
- 8. Heading – Ariel 40 • Practice and/or hospital acquisition • Achieve compliance by October 1, 2014 • Educate providers • Enhance quality through MU Stage2 • Stay solvent • Retain coder and CDS talent • Create alignment with community providers • Reduce negative impact to cash flow 8 Organizational Strategies and Goals
- 9. 9 Define the work to be accomplished
- 10. Heading – Ariel 40 10 Quick Look: ICD-10 Gap Analysis • ICD-10 – Not Just an IT Project ̵ Codes live everywhere in the organization ̵ The gap analysis is designed to understand where codes are currently utilized in the organization • Gap Analysis Designed to: ̵ Determine areas and roles where codes are utilized ̵ Determine processes where codes are utilized ̵ Complete software inventory, vendor query process, and impact analysis ̵ Complete outline of training and communications plan ̵ Understand financial impact of the transition • Challenges and Opportunities: ̵ Communication of practice-wide impact ̵ Role-based workforce education ̵ Updating processes and software ̵ Assuring revenue neutrality ̵ Determination of financial impact
- 11. Heading – Ariel 40 • Processes and departments ̵ Revenue Cycle ̵ Quality ̵ EHR tools ̵ Clinical Documentation/Chart audits ̵ Non-IT Project management ̵ IT • Entities that can be out of scope ̵ Retail pharmacy ̵ Wellness Centers 11 Define the Scope
- 12. Heading – Ariel 40 12 Technology Assessment and Reporting EXTERNAL REPORTING ICD-10 HIGH-LEVEL IMPACT DASHBOARD Department ICD-10 Impacted External Reports Yes Unknown Indirect None Cardiac / Stroke 1 2 0 3 Diabetes Education 0 0 0 1 Family Birthing Center 2 0 0 1 HIM 1 0 0 3 Home Health 1 0 0 0 IT 1 0 0 0 Joint Program 1 0 0 0 Oncology Program 1 0 0 0 Patient Financial Services 2 0 0 0 Quality 3 0 1 4 Radiology 1 0 0 0 Trauma 1 0 0 0 TOTAL 15 2 1 12
- 13. Heading – Ariel 40 Insert Revenue Cycle Optimization graphic 13 Financial Planning - Revenue Cycle Optimization
- 14. Heading – Ariel 40 14 Key Financial Dashboard Metrics Metric Information Accounts Receivable A/R days by payer Aging of open A / R days in dollars First pass resolve Number / type of rejects / denials by payer Number of claims pending for additional information Liability insurance rejects Mismatch – hospital / physician data Case Mix Case mix index DRG shift DRG shift by service line Clinical Documentation Queries to physician Response to queries Query response time Query agree / disagree Query backlog Query versus chart review percent Coding and Billing Coder productivity rates Coding accuracy Discharged not final billed (DNFB)
- 15. Heading – Ariel 40 • ICD-10 affects every department • Develop communication plan • Staffing ̵ HIM/ Coding ̵ Patient Financial Services • Training Strategy ̵ Documentation for all audiences ̵ Types of training – online, lunch & learn, etc. • Train the policy and procedure changes 15 Training and Education
- 16. Heading – Ariel 40 16 Organizational Capability Current State Roadmap to ICD-10 Executive Sponsorship for the ICD- 10 Project is in place. ICD-10 requires high visibility and support to guarantee a successful transition. Continue to assure that Executive Sponsorship is strongly maintained. ICD-10 Steering Committee is not yet formalized. Formalize Committee membership and charter; establish regular meetings; increase visibility; drive project toward goals. Work groups have not been formed to accomplish ICD-10 related tasks. Formulate work groups under the Steering Committee Charter. Establish task lists and regular meetings to tackle tasks and implementation challenges. ICD-10 requires dedicated resources for project. Hire or retain an ICD-10 experienced project manager to drive progress toward a successful code set transition. Move to new hospital slated for May 2014. Review IT resources for both move and ICD-10 remediation of all systems. Supplement IT resources as needed. Lack of “physician champion” to assist in communicating the significance of the transition to ICD-10. Appoint one or more ICD-10 project “Physician Champions” to spearhead the provider education and training process to ensure momentum in this area and that provider needs are being met.
- 18. Heading – Ariel 40 • Define the areas of analysis and focus • Complete your analysis at a high level • Workflows – reference the EHR • Take descriptions of workflows at face value • Develop budget with assumptions from prior history • Systems and applications inventory – use information from the vendor 18 Project Assumptions and Constraints
- 19. Heading – Ariel 40 95, 78 % 27, 22 % Do you know what ICD-10 is? Yes No 19 What do your providers know? A total of 165 faculty members were surveyed regarding ICD-10. Thus far, 122 have responded, for a response rate of 74 percent. 86, 70% 36, 30% I know that I will have to code my billing encounters with ICD-10 codes by October 1, 2014 Yes No
- 20. 20 Creating your organizational work structure
- 21. Heading – Ariel 40 • Steering Committee and Workgroups ̵ Plan the strategy ̵ Create overall project plan ̵ ICD-10 Steering Committee • Multi-disciplinary • Able to make decisions • Fluid • Workgroups ̵ What areas are affected? ̵ Identify current teams and committees ̵ Do the affected areas have a plan and timeline? 21 Organizational Structure
- 22. Heading – Ariel 40 22 ICD-10 Workgroup Structure Across the Enterprise HIM Inpatient Departments Information Systems • Software • Interfaces/ Extracts Managed Care Ancillary Services Outpatient Clinics • Internal • External Training & Education Communication & Marketing Revenue Cycle Management SAH Physicians
- 23. Heading – Ariel 40 23 Project Management Structure
- 24. Heading – Ariel 40 24 Project Management Structure
- 25. Heading – Ariel 40 • Focus on patient care, documentation, and coding • Promote and expand your clinical documentation initiatives ̵ Use training, software, and Clinical Documentation Specialists ̵ Automate prompts and templates • Educate your providers • Lay your metrics as a base, and then monitor for: ̵ Improved patient assessment ̵ Improved clinical documentation ̵ Improved coding ̵ Improved information ̵ Improved outcomes and improved business 25 Strategies for Physician Work Structure ICD-10-CM: The Case for Moving Forward, Joe Nichols, MD
- 26. Heading – Ariel 40 • Incorporate work into already existing teams • Use on-line survey tools • Leverage existing inventories and work partners • Correspondence – use RFIs for vendors – applications, managed care contract partners, patient financial services and business office 26 Leverage Existing Infrastructure
- 27. 27 Effective Use of Your Partners
- 28. Heading – Ariel 40 • Safety net hospital with 151 beds • Appointed strong internal PM • Clear direction from Executive Leadership • Conservative approach – limited dollars • Utilize strong partnerships ̵ Revenue cycle management ̵ Clinical documentation ̵ IT – system specific • Identifying each focus area and assessing 28 Case Study
- 29. Heading – Ariel 40 • Identify your physician champions now • There are no shortcuts, just opportunities • Continue to expect the unexpected • Identify areas for standardization, centralization and increased efficiency • Communicate, communicate, communicate ̵ Keep senior management informed to remove roadblocks ̵ Work for senior management support and buy-in • Leverage everything you can – people, processes, and technology • Think outside of the box 29 Take-Aways
- 31. 31 Questions?
- 32. Thank You For more information please contact: name@beaconpartners.com 1.800.4BEACON │ BeaconPartners.com BOSTON · CLEVELAND · SAN FRANCISCO · TORONTO 32 For more information please contact: Christine Kalish ckalish@beaconpartners.com
- 33. Heading – Ariel 40 ICD-10 • Developed and manage the ICD-10 service line, which includes assessment processes and toolkit development, knowledge transfer and training. • Completed a modified gap analysis for a hospital system in Texas, providing guidance and oversight for planning and implementation efforts, which include project plan and dashboard development. Served as team leader for a revenue cycle project that mapped the revenue cycle for a $50 million clinical enterprise. • The team developed KPIs, identified training opportunities, and additional opportunities for performance improvement. • The team provided workflows for all processes and utilized fish bone analysis to identify work process improvement and develop training. Mapped the revenue cycle process flow for a $2.6B health system, identifying documentation requirements for the IS operations. • Developed the documentation process, forming a working committee to identify all supporting documents and process to support the change management, design and implementation process as systems are upgraded, replaced and made compliant for Meaningful Use, 5010 and ICD-10 and as other facilities are added. 33 Christine Kalish, MBA, CMPE Christine Kalish National Practice Director, Strategic Advisory Services M. Christine (Chris) Kalish is an accomplished healthcare executive with 25 years’ experience in ambulatory care and academic medicine. She has served in senior leadership positions in large academic medical centers in the southwest. She leads strategic planning efforts, process improvement projects and business assessments in all areas of the clinical practice, as well as developing business opportunities within the community. She has exemplary skills in researching and resolving operational, financial, productivity and staffing issues. Ms. Kalish understands the unique opportunities and challenges in an academic practice and the majority of her experience over the last ten years relates to academic medical centers and relationships with county / safety net hospitals. She is a systems and strategic thinker with strong problem-solving and organizational skills. She is accustomed to building relationships with all levels of leadership and staff..
Notes de l'éditeur
- In 2012 all health plans expected to begin testingSimilar to the last survey
- No ShortcutBig investments on toolsCAC and CDITranslation toolsTrainingBarriers/ challengesDecreased cash flowLess efficienciesIncreased workload along the revenue cycleBig bang implementationLong learning curveProcessing and service issuesRemediate all applications, reports and interfacesRely on providers for cash flowPayers use sophisticated analytics – laying groundwork for future reimbursement rules and rates adjustmentsSignificant areas of riskClinical documentationPhysician preparednessCompeting prioritiesResourceDenials managementDept workflow changesVendor application readiness
- Stay focused
- EHR implementationsMergers and acquisitionsMeaningful Use AttestationICD-10
- Enhancing clinical documentation programs and toolsMove to ACO structurePatient Centered medical homeMove to bi-modal billing
- Define project resource requirementsProvide instrumental project leadership, including the development of work plans, timelines, and keeping projects on taskReport and communicate project status to ICD-10 steering committeeIdentify and remediate project risks as they emergeMaintain client relationships throughout the project by apprising clients of project progress on a regular basis, initiating and maintaining contact with other key project individuals for clarification, coordination and negotiation of critical issuesCommunicate project status on a regular basis to management and maintain a repository of project documentation
- Develop inventory of systems, applications and provide risk analysisEstablish vendor and agreementsIdentify system upgrades and replacement requirementsDevelop testing plansExtensive testing is needed with interfaces, claims files and GEM crosswalksTesting Needs AssessmentSystems Risk Analysis Assess readiness and “red flag” potential issuesFunctional features impactsData and process interactionsDetermine the testing scopeTest planning and strategyEnterprise Testing PlansBy vendor/application and roleOperational risksStakeholder involvement – roles and responsibilitiesTimelines and milestonesResources and expertiseApproach- dependent on the riskRemediation or replacementNeutralizeHybridPrepare the environmentImplementation MethodologiesCreate comprehensive test casesPositive, negative, boundaries, real worldDeveloped with IT, payers, end users, business unitsProvide a mixed strategyTranslate historical claims- review historical billing patternsBuild a set of test claims coded nativelyRegression, integration, end to endExternal interfacesVendorTest ExecutionVertical or horizontal testingFind ways to automate creation of test data and decrease manual interventionRemediationExisting custom and external reportsPopulation, quality and analytics dataClinical data (encounter forms, EHR pick lists, etc.)Analytics to Validate ResultsTranslation and business processesWill provide information on Operations readinessClaims transparencyFinancial neutrality
- Fiscal ImpactsWhat is the financial impact if revenue drops by 40%?What is the financial impact if AR days increase by 10%?Complete appropriate testing with clearing houses to insure that denials for coding are accurately reportedStaff and train billers for the extra workloadContract re-negotiationDevelop budgetReporting ChangesReports will need to be reviewed and remediatedUpdate all affected policies and proceduresImplementation Strategy
- Define areas of analysis current use of ICD-9 systems workflows Managed care contracts training needs find the gapsLimit to scope and available hours
- Oversee the implementation of a comprehensive training and education planMonitor and meet project objectives within approved budget planDevelop ad hoc cross-functional teams where neededReview and modify organizational structures and processes as needed to assure a smooth conversion to ICD-10Review recommendations related to software, tools, training, processes and productivity impacts to assist with a smooth implementation of ICD-10Identify and develop strategic projects related to ICD-10
- Other teams;ICD-10 systems complianceRevenue cycle redesignClinical documentation and content enhancementPhysician Education and alignmentCoder retention strategyICD-10 data strategy Do you have the right people and the right tools?Vendor management
- Documentation ReviewWhat areas are affected?Do the affected areas have a plan and timeline?Concurrent use of codesFor a time period ICD-9 & ICD-10 will be usedProvide documentation for the top 30 diseasesTraining StrategyDocumentation for all audiencesTypes of training – online, lunch & learn, etc.Policies & ProceduresReview and updateAble to make decisionsEngaging physicians:Connect ICD-10 information with EMR enhancementUse less training sessionsReduce the barrier between hospitals and practice chartsFind physician championsEMR enhancementCDI design and re-designEducation events
- Program / Project management Revenue cycle gap analysisAssist workgroup with process mapping and metricsCoding assessmentsSearch and selection processComputer assisted codingTranslator SystemsBusiness intelligence and program metricsCDI program review and developmentPost implementation support
- Eliminate redundant processesGet the right message to the right people at the right timeStrong executive/physician-level support focused on the ICD-10 transitionProject stance: ICD-10 impacts entire organization – not just an IT projectProject management processes and principals appliedDedicated business resources will be available and assigned to this projectAvailability of workgroup leads and subject matter experts (SME), including technology and training experts