ICD-10: Opportunities for success still exist

It’s been just over a year since the long-awaited implementation of the ICD-10 coding change, and we’ve seen a lot of success stories. The hospitals that fared the best were those that had a robust clinical documentation improvement (CDI) program in place. But other organizations were not as well prepared and experienced productivity or Case Mix declines. But it’s not too late for everyone to be successful. Taking the right steps now—from improved training to better awareness of documentation gaps—will help hospitals more accurately and completely document the care delivered, resulting in widespread benefits.
The impact of ICD-10 on physicians has been great. Training and ongoing opportunities with CDI help demonstrate improvements in quality and value

October marked the one-year anniversary of ICD-10 and the end of the grace period, so we’re taking this opportunity to reflect on the many hospitals that transitioned to the new system and what’s in store next. A good number of the nation’s hospitals fared well because they already had a comprehensive clinical documentation improvement (CDI) program in place. Some were not so fortunate or prepared, reporting a loss in productivity or a drop in Case Mix. Regardless of past performance, hospitals need to pay close attention to ICD-10 performance to ensure documentation gaps do not occur as they do not just impact the codes themselves, they impact patients and the organization as a whole.

Since we last reported in June, Nuance clients have sustained their positive results throughout the ICD-10 transition, maintaining their case-mix levels and major complications and comorbidity capture rates. Their productivity has also continued or improved. Their preparation and accuracy of documentation made the overall transition to ICD-10 much more benign than anyone in the industry had anticipated.


Key Steps to Improvement

For hospitals and health systems that were not as well prepared for the ICD-10 transition, there is still an opportunity. If their case mix dropped, they can still conduct an analysis to determine what the cause was and which areas to focus on for improvement. Often times, the problems are related to CDI and coding, so they can take the following steps:

Strengthen staff education – These health systems need to make sure their physicians and clinical documentation specialists are well trained and educated by providing them with the information and programs they need to succeed. Our clients were successful with ICD-10 because they were provided with a lot of training and practice work. Good preparation leads to successful outcomes.

Collaborate with HIM coders – Health systems need to focus on the front end of ICD-10 success by looking at where there are gaps in documentation to make sure that coders can code to the highest specificity. This also helps for a smoother final reconciliation at the time of discharge.


Overcoming Challenges

We now anticipate that many health systems and providers will be faced with challenges related to increased denials due to more intense ICD-10 coding specificity as well as changes in valid, reimbursable surgical procedures, to name a few. But this is manageable with good awareness and preparation.

Looking ahead, there is one question we should be asking the industry: now that we have all of this information and specificity, how is it going to be used for good? With all that we have learned from ICD-10 thus far, we need to start thinking about if there is anything measurable that we can use to improve patient care and population health as a whole.

For example, if there is more information available about diabetic complications, a diabetic educator could be hired to examine the data to fill in gaps and identify risk factors. This could ultimately help patients with diabetes, leading to fewer amputations or heart attacks which could be prevented with this more in-depth information.

The next step for the industry around ICD-10 before we move to ICD-11 in 2022 should be focusing on how to use what we have now to benefit patient outcomes and the quality of care. There is a natural progression happening as a result of having much more data available thanks to EHRs. Once we get this data accurate, we can then leverage this heavily beyond billing codes to support predictive analytics and population health management. That will make all this hard work worth it.

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Mel Tully

About Mel Tully

Melinda (Mel) Tully is the vice president of clinical services and education for Nuance Healthcare, overseeing the development and expansion of clinical documentation programs and clinical education best practices. Mel joined Nuance in 1998 and has more than 25 years of experience in multiple healthcare arenas as a provider, clinical manager in a large academic facility, and as an expert in clinical documentation improvement (CDI). Mel attended Emory University, where she earned her Master’s degree in Nursing. She has been certified through the Association of Clinical Documentation Specialists (ACDIS) as a clinical documentation specialist, as well as by the American Health Information and Management Association (AHIMA) as a documentation improvement practitioner.