CDI: One tactic to solve two problems-ICD-10 and VBP

Thanks to value-based purchasing and the ICD-10 transition, clinical documentation is on the mind of most every healthcare leader. How accurately a patient's hospital visit is documented will ultimately affect VBP incentive payments and whether reimbursements dip, grow, or stay the same during the ICD-10 transition. Millions of dollars are hinging on your clinicians and coders, so here are two tactics to help you tackle these transitions.

 

1. Ease in ICD-10 codes now. Clinicians have been documenting patient records under ICD-9 for years. Although there were far fewer codes, documentation still often came up short. So it's not surprising that physicians, nurses, and coders find it a bit daunting to think about the number of new codes required by this 2013 transition—from 17,000 to approximately 141,000 ICD-10 codes.

 

The leaders at Mayo Clinic in Rochester, MN, are applying this technique. With 212 IT systems spanning a network of physician practices and hospitals across Arizona, Florida, Minnesota, Wisconsin, and Iowa, the Mayo Clinic faces a major task in the coding transition, just from the sheer magnitude of the organization. Mayo's goal, not unlike many healthcare systems nationwide, is for the ICD-10 transition to be revenue-neutral.

 

To meet that end, managers started working with their clinical staff early on, and determined that a slow introduction to ICD-10 would be better received than a full-scale launch on Oct. 1, 2013.

 

"Instead of one choice for a headache now, there may be five to 10 choices [for codes] and that takes a little getting used to, but to have it happen all at once is very hard on the physicians," says Jeff Thompson, MD, physician lead across the Mayo enterprise.

 

Mayo Clinic eased the transition by initiating training and technology changes little by little. The first step was to add a few of the expanded ICD-10 codes into their existing coding system, working in more new codes over time. The second step is to show how the current documentation under ICD-9 differs from what will be required under ICD-10.

 

"As part of our ongoing training, we encourage physicians to get used to mentioning all the complicating factors that will be needed under ICD-10," explains Thompson.

"We target this documentation to help the physicians realize that this [older method] may work now, but under ICD-10 you need more specifics on what the procedure was and what complications occurred with the disease process. We provide the physician with feedback so he or she can understand what they need to start adding now for ICD-10 before it starts affecting revenue," Thompson says.

 

Thompson stresses that getting physicians engaged now is essential to a smooth roll-out.

 

"Getting them involved early on and helping them understand the magnitude of this and the effect it will have on them personally on the front lines makes a difference. It gives them a chance to help guide the training and strategies that will help them in their everyday work," he says.

 

2. Beef up your clinical documentation integrity program. Under the second year of VBP, risk-adjusted measures such as mortality kick in. This ups the requirement for documentation.

"How do we know physicians are providing specific enough information to give [an organization] credit for the severity of the patient's [diagnosis]?" asks Susan Wallace, MEd, RHIA, CCS, CCDS, director of compliance for inpatient reviews and an AHIMA-certified ICD-10-CM/PCS trainer for the Shawnee, OK–based Administrative Consultant Service, LLC.

 

"[CMS] will look at those mortality measures over three years, which means hospitals need to work on [documentation] now or it could potentially hurt [the organization]," she says.

 

Wallace says organizations need to be sure their clinical documentation improvement programs are up to snuff in order to accurately gauge where clinicians may need to improve to meet the ICD-10 requirements.

 

"Once you have the data, it gives you a sense of the shape your [organization] is in.… You can set up specific initiatives to get the information you need to get your scores up," she adds.

 

A CDI program can be created using an expert coder trained in documentation, though the individual would need to analyze numerous files—a lengthy process. Alternately, organizations can apply technology to help with the review process.

 

Jennie Stuart Medical Center, a private, not-for-profit organization that comprises a 200-bed acute-care hospital, medical imaging, outpatient surgery, laboratory and rehabilitation services, and an integrated physician network, took the technology route to address the upcoming transitions.

 

Starla Stavely, HIM director at the Hopkinsville, KY–based facility, joined the organization in 2010 and quickly added ChartWise CDI software to fix what she says was a glaring problem with clinical documentation.

 

Stavely says the organization found that the diagnoses and procedures being documented weren't accurately showing the severity of illness or the length of stay of the patients, so the case mix index was below expectation.

 

"Ailments were being treated but when it came time to code, none of that information was in the charts. It was in the physician notes but no one was getting credit for doing the work. Patients could be very sick, but when it came time to code it didn't look like they were very sick, and we weren't getting paid," she says. "The lower the case mix, the less per case on average you're getting paid [by Medicare]. You could pick up almost any [patient] chart and see obvious [revenue] opportunities."

 

One month after Jennie Stuart started using the program, the facility calculated a $100,000 profit by coding the correct case mix. The improved clinical documentation is also helping them prepare for the ICD-10 transition by allowing them to gauge the impact the changeover may have on their organization.

Don't wait for 2013 to plan for VBP and ICD-10. By addressing clinical documentation holes now, you can improve your organization's odds of landing on the right side of both of these regulations.

 

Editor's Note: This article was written by Karen Minich-Pourshadi for HealthLeaders Media.