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ICD-10 education, CDI training must be flexible for physicians

By Jennifer Bresnick

- In the few months left before ICD-10 collides with the healthcare industry, providers have a last chance to close the gap by providing training and education to their physicians and coders.  Documentation must be improved, coding skills must be practiced, and technology must be implemented in order to turn underprepared providers into ICD-10 champions.

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Obviously, this is easier said than done.  ICD-10 codes are many times more complex than the current set, and require a great deal more investment from clinicians who produce documentation and the coders who parse through it to come up with a claim.  Over the past few years since ICD-10 implementation has been on the radar, different staff members have acquired different degrees of familiarity and comfort with the concepts behind the new codes, adding another layer of difficulty for leaders who want to make sure that everyone is up to snuff.

This will require providers to be flexible when designing, purchasing, and teaching ICD-10 curriculum, says Michelle Leavitt, Director of Courseware and Product Strategy at HealthcareSource.  “The recommendations that we’ve seen from AHIMA, the AAPC, and other thought leaders out there, is to think about providing only a level of education to docs and clinicians that they need,” she told EHRintelligence.  “It’s not the same kind of education that a coder needs, obviously.  Physicians are not going to be coding.  So you really have to tailor that approach so that the content you’re delivering to doctors hits only what they need to know.”

Clinical documentation improvement is the primary area of concern for physicians, but ensuring that they include the right level of detail and specificity in every single patient’s notes can be a challenge.  Just the act of getting busy and overwhelmed clinicians to pay attention to education materials can be problematic, Leavitt adds.  “Having content that’s available on mobile devices, or in very short five-minute segments is important,” she says.  “That’s the type of information that doctors will consume.  You’re never going to get all your doctors together in a room for even two hours of education, so you can forget that right from the start.”

“Organizations are actually starting to realize now that ICD-10 implementation is going to require a change in the way that clinicians document care, which necessitates buy-in and awareness from physicians to nurses or clinical staff,” Leavitt added.  “The educational materials need to be written by a physician or created by a physician or delivered by a physician so that the doctors have that immediate rapport with the educator and feel that the person providing the education gets where they’re coming from and what they really need.”

Despite the recommendation to let physicians learn from their peers, neither clinicians nor coders can work in isolation from each other during the process of ICD-10 education.  Ensuring that claims get coded and paid appropriately is a team effort that is at the heart of any healthcare business, even if coders and physicians occasionally butt heads when clarification or additional detail is needed.

Having a CDI specialist to coordinate the learning process and act as a neutral party when disputes or questions arise will be crucial for a harmonious learning process, Leavitt says.  “I think that it would be a really good way for CDI specialists to demonstrate their purpose in the workflow, so that both the doctors and the coders are seeing the CDI specialist as the person who’s connecting the dots for them as to how this new process will work.  I do think that it is helpful for both coders and physicians to have a bridge between them.”

With only three quarters of the year left to take advantage of expert advice, providers need to get their education programs in gear if they want to see success in October.  “There’s no more room for waiting.  There’s no more room for talking.  It’s time to start doing,” Leavitt urges.  “On October 2, 2014, organizations will actually realize that their claims processing times are going to be extended, the time to reimbursement is going be much longer, and that those things are going to have a direct effect on their operating margins.  They are going to be faced with the question of what to do.”

“Do they reduce their patient census and reduce services offered, or do they spend even more money to hire lots of contract staff to manage that influx while they do what they should have done over the last two years?  I think we would all encourage those organizations not to put themselves in that position, because neither of those options are good options.”



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