Last month, SEI’s Matt Walton, PhD and John Halamka, MD, CIO of Beth Israel Deaconess Medical Center (BIDMC), co-presented a technical and operations overview of BIDMC’s ICD-10 program at Massachusetts Health Data Consortium’s (MHDC) ICD-10 conference held on March 10, 2014.

Technical View

Matt & Dr H_2450Speaking at the conference, Dr. Halamka said that the technology itself, moving from ICD-9 codes to ICD-10 codes is mechanical and he is not worried about that. What he is concerned about, is getting meaningful data into that new ICD-10 code and actually being audit-proof. He added, “this will be a bounty hunter’s delight as they find a disconnect between what was actually documented and what was coded. That’s the real technology dilemma.”

BIDMC implemented a code freeze on their financial system, and Dr. Halamka said that he and his staff were very unpopular over the winter because they were not taking any user requests for system enhancements during the freeze. BIDMC is just about ready to release systems to the users after all the clinical and financial remediation. Dr. Halamka stated, “We can mechanically pass a code from a clinical system to a financial system through a healthcare information exchange to the payer but whether that code is accurate, relevant or auditable, that’s a totally different problem.”

Operations View

Matt& Sean_2445To prepare for their ICD-10 transition, BIDMC has partnered with SEI. Dr. Walton presented the approach and ongoing results of the ICD-10 project at BIDMC, focusing on Operations. Dr. Walton said that ICD-10 “is far from just being an IT project as maybe people thought when we started out.” SEI’s team of consultants is managing workstreams at BIDMC that are addressing five major focus areas: Workflow, Technology, Finance, Education and Testing. Dr. Walton said, “When you are talking about workflow, in context of an outpatient clinic, it’s not just talking to the admins, it’s also the medical staff, IT, Finance, and Compliance. They all have got a different perspective. We all have been coming together as a single group to make sure we can address each one of these clinics and workflows.” However, he stated that “this has been no small feat. We actually started talking with the individual departments back in 2012, and since then, it has very much been an iterative process, trying to dig down, understand where the major pain points were, where the commonalities are across all of the systems and where there are specific differences.”

BIDMC uses paper fee tickets in some scenarios of outpatient clinics. Dr. Walton said, “It’s been well-documented that certain clinical areas are going to be up a creek without a paddle because of the code explosion.” Because of this, BIDMC has taken the approach of building an electronic system. They went through the exercise of analyzing all of their claims for the past year to get a sense of where the ICD-9 codes were coming from. Dr. Walton said, “if you look at the different range of ICD-9 codes selected, sometimes there is a very long tail of codes that are being selected which simply aren’t on the superbill in the first place. Inherently, you have a limitation with those paper bills even in an ICD-9 world. So moving to an electronic system is just a good thing in and of itself.” He added that ICD-10 has been a convenient driver to move to an electronic system which is a good thing because it allows for greater flexibility, more search functionality and greater options for physicians in how they select the codes that they need.

ICD-10 Delay

Since the conference, there was a legislation passed by the Congress delaying ICD-10 until at least October 1, 2015. This delay is a mixed blessing. Many healthcare organizations have already spent millions of dollars and enormous resources to meet the original timeline for ICD-10 implementation. Although, there is more time to prepare now, it is important to maintain momentum and continue moving forward with some elements of the ICD-10 program work.

DiagramThe big question, of course, is which elements should be continued and which should be delayed? It makes logical sense to complete the software remediation and continue the End to End testing for the ICD-10 remediated systems. The MHDC Collaborative Testing Program (CTP) is helping drive some of the testing in the state of Massachusetts. In fact, all the payers and providers participating in MHDC’s CTP have voted to continue with the CTP program. In addition to testing, it is important to maintain momentum on Clinical Documentation Improvement (CDI) which is not just essential for ICD-10 coding but also addresses existing issues with ICD-9 coding. The delay also provides an opportunity to pursue Computer Assisted Coding (CAC). On the other hand, it makes sense to delay physician and clinical staff training until we know more about the final ICD-10 implementation date.

So in conclusion, stay the course and take full advantage of the ICD-10 delay!

Jitesh Gandhi

About Jitesh Gandhi