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.
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.