Until a few months ago, AMA was requesting that ICD-10 not be implemented at all, therefore, it isn’t surprising that most physicians have had little or no enthusiasm for ICD-10, and many have waited to see if the October 2013 deadline was extended. The trouble is, they are now lagging behind regarding their office preparation for ICD-10.
According to a recent ICD-10 physician study, less than 5 percent of practices reported that they have made significant progress in overall readiness for ICD-10 implementation. Likewise, several industry surveys reveal the same thing: many of the nation’s 4,000-plus hospitals have only just begun implementation efforts.
It’s easy to hate something you don’t understand. Misinformation related to ICD-10 and the AMA’s resistance to it, has helped physicians dig their heels in the sand. What they need to hear is that ICD-10 will improve care because of increased specifity. If you label everyone as sick, there is less to work with as a physician, but if clinical documentation provides more detail related to the nature of illness and the decision making of the caregiver, a physician can better manage the illness.
As with all documentation-related initiatives, medical staff enthusiasm can only be built on medical staff participation. Don’t try to impose ICD-10 solutions on physicians; partner with them. We have learned from years of experience that Clinical Documentation Improvement (CDI) programs championed by medical leadership and focused on quality have much higher success with physicians and collaborative response rates than programs imposed on medical staff.
I have had the opportunity to work with several hospitals where the medical staffs are actively engaged in preparing for the ICD-10 transition. Certain characteristics inevitably emerge at these facilities. First, physicians involved in clinical research tend to be early adopters of ICD-10, recognizing how antiquated and insufficient ICD-9 data is for epidemiology or clinical research. So at academic centers in particular, leadership can gain traction by educating departmental leadership on the benefits of ICD-10 implementation.
I also have seen community hospitals gain physician endorsement of ICD- 10 by beginning education of their medical staff about the benefits of ICD-10 as early as 2011 or 2012. This helped align the hospital and physicians for a very collaborative process. We have worked with those hospitals to develop specialty-specific education, eliminating many of the myths of ICD-10 and rendering the transition much less daunting to any given subspecialty.
Plan and Execute Customized Physician Education
Physicians did not go to medical school to learn how to “optimize coding” and were in fact taught to do what is best for the patient “at all costs,” so approaching physicians from a revenue cycle or HIM angle will fail. A successful ICD-10 physician readiness program will require some core elements:
- Answer “What’s in it for me?” – Explain how more detailed clinical documentation (for I-10) helps physicians better manage patients, perform better on physician profiles and receive appropriate payment for the care they provide, and you will have their attention.
- Provide customized training – Provide details and examples that apply to each physician’s medical specialty. They don’t need or want to learn the entire ICD-10 codebook.
- Make education convenient and relevant– it should not disrupt clinical practice.
- Offer peer-to-peer training – Education by physicians to physicians.
- Leverage technology to be supportive in the transition.
What’s next? Once the planning, education and collaboration have taken place and physicians and coders are prepared for the transition, the next step is testing. Several months before the trigger date of 10/01/14, we suggest you have coders initiate a dual coding process for the most common diagnoses and procedures at your facility. Educational content should be delivered to physicians at or near the time that coders begin the dual coding process. Otherwise, retention of information by physicians will be limited. This approach will allow a phased rollout of ICD-10 engaging your physicians with your CDI and coding team.
The ICD-10 implementation can be daunting. Your hospital or office practice should be actively working with your physicians to assure collaborative engagement with a planned transition period to effectively implement ICD-10.