ICD-10 Implementation Case Study: Baptist Health System rethinks budget, staffing

“When we were getting ready for ICD-10, we did a very robust analysis,” says Chloe Phillips, MHA, RHIA, corporate director for HIM and clinical revenue at Baptist Health System. 

 

Baptist Health System began hiring new college graduates in 2014 to fill open coding positions. While organizations often look for experienced coders, Baptist Health System invested resources in training new coders for its “post-graduate program,” Phillips says.

 

Originally, they  planned to bring in two coders but later added a total of seven staff members and may bring additional coders on board as the new implementation date draws near, Phillips says. However, once ICD-10 was delayed, the health system—like many others—was forced to take a look at whether certain ICD-10 efforts should be scaled back, including the post-graduate program.

 

“We had some really tough conversations about our post-grad program, but it is a program that’s close to my heart,” Phillips says. “I think it’s something that we need in our industry, not just because of ICD-10. We’ve needed it for a long time.”

 

Baptist Health System reviewed its budget to determine what should stay and what could be delayed. The health system pushed retention bonuses from its budget for 2014 out to 2015.

 

In addition to placing a temporary freeze on hiring, many organizations opted to revise their training timeline for workforce members to meet the new implementation date, says Kayce Dover, MSHI, RHIA, president of HIM Connections, LLC, in Birmingham, Alabama.

 

Baptist removed most of the contract and consulting fees from its 2014 budget. It also opted to forgo ICD-10 on-site training in favor of online training for the remainder of 2014, Phillips says. “Those items will be back in my budget for fiscal year 2015,” she says.

 

The health system continued budgeting for ICD-10 education for physicians, nursing, clinical documentation improvement, coding, and other departments, but extended the timeline for completing the education for these workforce members by several months. In 2015, the organization will focus on documentation improvement opportunities.

 

“We were not one of those organizations that was really thrilled about the delay because we feel like we’re ready for ICD-10,” Phillips says.

 

 

Outpatient surgical coding. Prior to implementation of ICD-10, determine how your organization will tackle outpatient surgical coding, Phillips says. Will your organization use ICD-10-PCS for inpatient and outpatient procedural coding or will it rely on CPT^® coding for outpatient cases? The answer to this question will affect coder training for ICD-10. Outpatient coders will need additional training if they will use both ICD-10-CM and ICD-10-PCS. Baptist decided to use ICD-10-PCS in addition to CPT to code outpatient surgical cases after implementing the new code set.

 

“One reason we are moving forward with this is because decision support uses those codes for so many things in the organization,” Phillips says.

 

Code and revenue analytics. Analyzing your coding revenue prior to ICD-10 will help you better understand the effect of the transition after the new code set is implemented, Dover says. Take a look at current coder productivity so you can analyze it before, during, and after the ICD-10 transition. Once you have a plan in place for monitoring these areas, share the feedback with coders. This will be important for ongoing education, establishing new productivity goals, and helping your team understand the overall impact of ICD-10, she says.

 

Productivity monitoring and measurement. Be proactive in measuring key performance indicators (KPI) associated with ICD-10. Baptist developed a KPI dashboard to help track some of the data tied to the transition, Phillips says. “We can look at different KPIs prior to ICD-10 and be able to watch it as ICD-10 goes live, so that we can quickly identify some gaps or variances in those indicators so we can jump on it and solve the problem,” she says.

 

Baptist monitored its coders to identify strengths and weaknesses within the department and for each individual. This helped the health system develop a plan for ensuring each coder possesses the necessary skills for transitioning to ICD-10, Phillips says.

One of the most important resources necessary for successfully tackling ICD-10 is your workforce. Focus on the following to ensure your organization is well staffed for ICD-10:

 

Strengthen retention. Healthcare organizations with retention plans in place for HIM workforce members were once uncommon, but they are becoming the norm as organizations invest time and money in training and educating coders and other staff members to prepare for ICD-10. Find out what other hospitals and health systems in your area offer in terms of retention plans and bonuses, Dover says. Sharing this information with human resources may help your organization remain competitive and will likely increase the chance that your organization retains its staff well after ICD-10 implementation.

 

In addition to retention bonuses and competitive salaries, organizations should not forget to evaluate their overall compensation package. Consider offering softer benefits as well, including tuition reimbursement or flexible schedules, Dover says.

 

“Making sure you’re on the same page as your internal recruiters and/or the recruiting firm you’re working with is also important,” she says. “Candidates are often considering multiple offers, so presenting a full compensation package is very important.”

 

Manage burnout. Learn a new code sets while maintaining current workflow, can cause staff stress.

 

“Hospitals have to monitor and manage burnout appropriately or it will increase the risk of losing good team members, no matter what the retention plan looks like,” Dover says.

 

Open communication can often help curb burnout, Phillips says. Make sure any staff members who work from home, remain informed about what is happening within the organization and involve them in decision-making.

 

Ramp up hiring. After news of the delay, many organizations postponed hiring new staff. Now is the time to work this back into your budget and make the necessary decisions regarding hiring and training processes, Dover says.

 

“Giving yourself adequate time to onboard new [staff] is extremely important, especially as the transition date gets closer,” she says.

 

Focus on recruitment. Enhance your recruitment process so you are ready when the time comes. Work closely with human resources to establish a timeline for new hires and review the job requirements so your recruiters have a full understanding of the position and the changing needs of your department, Dover says.

 

Creative staffing solutions. Thinking outside the box when it comes to filling positions can often benefit an organization. Baptist’s post-graduate program allows the health system to tap into a pool of coders when a new position opens. This is beneficial because the coders in this program not only have industry experience but are familiar with operations at Baptist, Dover says.

 

In addition to the effect ICD-10 will have on productivity and budgets, there will undoubtedly be other challenges associated with the transition. However, planning ahead can often help alleviate some concerns.

 

“We don’t truly know what the impact of ICD-10 ultimately is going to be,” Dover says. “You have to plan for the worst and hope for the best.”

 

Editor's note: This article was originally published in the February issue of Medical Records Briefing. Email your questions to editor Steven Andrews at sandrews@hcpro.com.