Electronic Health Records

What’s so important about thinking beyond ICD-10 compliance?

In the context of ICD-10 compliance, getting to Oct. 1, 2014 will represent a key milestone for each health system, hospital, and physician practice that puts in the time and resources. However, it doesn’t mean that the work is done and it’s time to rest. It’s simply the beginning of staying competitive in a new healthcare environment.

“October 2 is going to be an interesting day. We’re all showing up for work that day. That’s when the fun will start,” JaeLynn Williams, Senior VP of Client Operations at 3M, told EHRIntelligence.com during a sitdown interview at AHIMA 2013.

“They haven’t had the time to sit back and let the dust settle and consider how this is actually changing operations in their facilities,” she continues. “What can I do today that I couldn’t do before? They have to ask that question now.”

Until the morning after October 1, the healthcare industry will have its head down, focused on taking care of the different activities that will enable them to achieve compliance. But once this is achieved a new need will take its place. “The world now looks different and they’re going to want analytics that help them understand the ICD-10 data. There’s a big opportunity there because there’s also more data there,” Williams argues.

Healthcare organizations of all shapes and sizes will want to understand the data that they have. According to Williams, being able to analyze this information will subsequently become the top priority for these organizations:

They’ll have a pause here as they do all of their testing with their payers, and in early 2015 the leading systems will do this while the smaller systems won’t be there quite yet. It’s going to become a competitive advantage for those who jump in, plan their strategy, understand their sources of data, and map out their gaps.

In particular, Williams believes that three areas will be of immediate importance. The first deals with documentation.

“Even those who have had longstanding documentation improvement programs, as we start to run those through our ICD-10 autosuggestion engine it cannot suggest a code because there’s a key piece right up front that’s not there,” she explains. “That gives us any early view at real customer records from large systems that we’ve started to run through — that their data isn’t as good. On October 2, they are going to be saying that they need to understand those gaps.”

The second area has to do with all that ICD-9 data. Although it belongs to an outmoded coding system, this information is still needed by physicians and clinicians. In order to maintain a longitudinal view of a patient’s health, providers must be able to map information between data elements coded for ICD-9 to those coded for ICD-10.

“On October 2, they still care about what happened in September, August, and July,” notes Williams. “They won’t have their ICD-9-trended information, so they’re going to want to know how they can get a view of that information.”

The third area concerns interactions with payers. According to Williams, this area will raise many questions for healthcare organizations as they seek to keep payments flowing predictably:

What is all this data and how is it going to be used to make a tougher negotiation? How will that detriment my payment because now they have this data? The larger systems will start to take some proactive steps to understand and prep for what potentially could be a financial hit.

In many cases, their ability to understand the data they have will be the only line of defense for these organizations as they work with their payers. “You’re not going to be able to argue your point or defend it,” adds Williams.

Until now, talk of ICD-10 compliance has focused on the minimum things health systems, hospitals, and physician practices must do. Going forward, doing just enough to maintain compliance with ICD-10 won’t ensure a healthcare organization’s odds of staying competitive with its peers.

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