Does ICD-10 have physicians running scared? How can the industry respond to their needs and concerns to ensure a successful switch?
- There are a lot of reasons for healthcare professionals to dislike the notion of ICD-10. More mandates, more money, more work, and more complications that do nothing but take highly-trained physicians away from the business of patient care have been repeatedly cited as reasons why the industry should just forget the new code set all together. But new research from the CAREinnoLab and the Department of Health Information Management in the School of Health and Rehabilitation Sciences at the University of Pittsburgh shows that frustration, empty pockets, and exhaustion may not be the only things slowing down the ICD-10 adoption process. Many physicians in a series of focus groups expressed straight-up fear about how the new codes will impact their practices – and even more worryingly, expected their EHR vendors and billing services to do most of the heavy lifting as October 1, 2015 draws near.
“ICD-10 is scary for most people,” one physician admitted during one of the interview sessions. The large-scale changes required to bring clinical documentation up to the appropriate level of detail and specificity are of great concern to many physicians, not only due to necessary changes in their workflow, but also because of the uncertain impact on their reimbursement.
Physicians may be jittery about the unknowns of the future, but they aren’t necessarily being proactive about addressing them. Blaming a lack of simple educational tools, comprehensive resources, and specialty-specific guides to clinical documentation improvement (CDI), physicians in the focus groups are generally taking a wait-and-see approach to problems that may arise from documentation issues. They will address issues as they occur and learn as they go after implementation. They expect their EHR and billing system vendors to provide them with templates and order sets that will make documentation easier, and tend to think the biggest problems will only hit providers who perform a wide variety of procedures or see very complex patients.
“I have not done anything except read an article or two about how codes are going to increase in ICD-10,” a participant said. “I am relying on my billing service to do that. With respect to the hospital, they have not really given us any formal training for ICD-10 at all.”
“Physicians…typically don’t want to spend very much time on training for things like this,” added another. “It’s hard to engage them, so finding a set of materials that they will respond to positively would be valuable.” Hiring an HIM or CDI professional to develop educational programs and train physicians on ICD-10 issues seemed an attractive path for some physicians, but others worried that hospitals with the resources to maintain an HIM department may only invest in significant training for inpatient coding, leaving the less lucrative outpatient coding aside.
“Hospital coding is totally depending on ICD-9 and as they convert to 10, they will do the training (for inpatient). But that is inpatient. What about outpatient? The hospital will train you as they have a vested interest. For outpatient, I don’t know,” remarked a participant.
“For surgeons, nothing came from formal groups; most of the information regarding ICD-10 preparation and training would come from the hospital side as they have the best interest in training the physicians mainly for hospital utilization and reimbursement purposes,” agreed another.
Will EHR vendors and billing partners pick up the slack? Physicians certainly hoped so, believing that vendors would provide training and assistance if their hospitals and specialty associations didn’t give them adequate education. The groups called ICD-10 a “new language” for them to learn, and put specialty educational materials at the top of their wish lists. One requested “ICD-10 for dummies dumbed down by specialty,” while others asked for easy-to-understand crosswalks and a top-ten list of the most frequent reasons claims are being rejected.
The problem, many of the responses seem to indicate, is that ICD-10 isn’t meeting physicians where they are. CDI itself is not the issue, nor is the extra burden of added time and education, even if the thought of spending a few lunch breaks or extra evenings in a specificity seminar isn’t enticing. ICD-10 has taken on a life of its own as the big bad wolf of the healthcare industry, its shadow of trepidation growing deeper each time the new code set is delayed. Many physicians want to view the changes as a positive development, but feel that available resources aren’t helping them do so. “Articles on ICD-10 are fear-based,” said a participant. “I try not to go there.”
So where will they go? To health information management professionals, hopefully, or to CDI experts offering outsourcing services or workshop materials that will preempt the watch-and-wait attitude that may result in significant reimbursement disruptions. It isn’t fear mongering to say that preparing in advance for ICD-10 is a wiser course of action than simply hoping that the storm will pass by without serious damage, or letting fear of the unknown preclude the search for resources that will meet a specialist’s particular needs. ICD-10 will require effort, but the industry has been preparing for the switch for a long time, and the right training is available to those who look for it.