The recent American Health Information Management Association (AHIMA) ICD-10/CAC Summit provided an outstanding opportunity to share innovative approaches and best-practice strategies for meeting the greatest challenges associated with meeting the requirements of ICD-10 implementation.
On Tuesday, April 23, I provided the following 10-step, multi-faceted approach to address the critical success factors (CSFs) associated with the ICD-10 transition:
- Ensure the existence of a solid project governance structure.
- Translate the roadmap into manageable, measureable tasks with clear outcomes and accountabilities.
- Don’t let the technology drive you.
- Don’t underestimate workforce factors.
- Communicate, communicate, communicate.
- Education: Remember, one size does not fit all.
- Don’t create new problems.
- Plan for the previously unexpected contingency.
- Try the new workflows on for size (implement testing).
- Celebrate sweet success (on Oct. 1, 2014!)
I also emphasized the critical need for project governance and encouraged organizations to select and empower physician champions who can energize other physicians into action as they shore up their documentation gaps. One of the greatest challenges and sources of angst among my peers is the lack of a focused project manager. Many busy health information management (HIM) directors have been tasked with both leading and managing the ICD-10 transition, something that is not advisable under the best of circumstances. The magnitude of this effort requires a focused project manager who can, again, translate the road map into well-defined, measureable and concrete tasks with clear accountabilities. Maintaining involvement by the project director in meeting each critical milestone is a critical success factor (CSF).
The other major issue that resonated with those in attendance (and was also a topic of discussion at the conference) was the workforce challenges associated with the transition that cannot be mitigated by technology (computer-assisted coding, or CAC) alone. Several sessions involved talks about a research-based approach to dual coding and the additional time this process takes, with or without a CAC solution. Additionally, comparisons to the Canadian experience were shown not to be an “apples-to-apples” example that can be used for estimating productivity impacts, as the abstracting requirements and compliance requirements are non-existent in the U.S., and the associated work effort is less complex.
Our company has provided backfill for the dual-coding process after productivity was projected to decrease by 50-55 percent without a CAC solution when coding in ICD-10. The best of CAC solutions in ICD-9 still are producing a 70-percent accuracy rate, on average, making for a 30-35 percent projected productivity shortfall in a best-case scenario.
Organizations must come to grips with anticipated declines in productivity and address a multitude of strategies to reduce turnover and retain existing coding talent. I provided many examples in this area, from coder retention bonuses to ensuring that your salary base is competitive in the local and broader marketplace. If your coders do not have the opportunity to work remotely, this should be another step explored, as it represents an opportunity to address one key issue associated with the transition to the electronic record and to utilize a scanning solution to address the hybrid record challenges.
A model formula to incentivize coders to stay in their respective organizations also was showcased at the summit, highlighting a multi-pronged approach associated with mastering critical ICD-10 content and attaining necessary proficiency levels. Also, don’t forget to include your AHIMA-approved ICD-10 trainers in the mix. If you have invested in this training for those who will lead your training efforts, prepare a special contract requiring them to stay for a minimum of a full year following training – and, if that provision is violated, requiring them to repay the organization for either a full or a prorated salary amount associated with their departure date.
Organizations also should consider lining up additional resources through contract coding firms that have a trained ICD-10 talent pool. These organizations also can assist with dual coding and training needs and requirements associated with your transitional strategy. Many of these companies already are being inundated with requests for workforce commitments, so make sure to put this at the front end of your ICD-10 to-do list.
Another strategy our company has embraced involves partnering with CAHIIM-approved schools to deepen our talent pool through the development of a preceptorship program. Although this approach requires an investment of a dedicated coordinator and an internal training platform and trainer, organizations could partner with those companies that already have created this training environment to meet workforce needs and requirements.
At the very least, begin a small ICD-10 coding project in front of your formal dual-coding process to try on new workflows for size and to identify time-consuming issues that need to be addressed prior to launching your effort. This will enable you to test your new workflows and free up time for fine-tuning and refinement prior to transitioning to a production mode.
Hopefully, this 10-step approach (with some of the key points highlighted above) will enable you to sharpen your focus as you revisit your project plan and steer toward ICD-10 compliance during the final 15 months of your transitional journey. My next article will highlight some of the other main points associated with your technology and testing strategy.
About the Author
Cassi Birnbaum, MS, RHIA, FAHIMA, CPHQ, is vice president of health information management for Peak Health Solutions, specializing in providing remote coding, auditing, data collection and analysis, clinical documentation improvement, ICD-10 transition, and HIM resource planning services nationwide. For the last 15 years, Birnbaum was the director of health information and privacy officer at Rady Children’s Hospital in San Diego, Calif.
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