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December 3, 2012

ICD-10: Give Them Something to Talk About
By Lisa A. Eramo
For The Record
Vol. 24 No. 22 P. 10

A sharply defined communication plan can efficiently spread the word about the steps necessary for a successful hospitalwide transition.

If your hospital isn’t buzzing with communication about ICD-10 by now, what are you waiting for? Everyone—yes, everyone—should be talking about this monumental change and how it may affect each individual personally within an organization. “The problem is that there are still many facilities where such a streamlined communication structure has not been defined,” says Deepak Sadagopan, general manager of clinical solutions and the provider sector at Edifecs.

In some hospitals, communication is so poor that chief financial officers (CFOs) didn’t even know about the proposed ICD-10 delay when it was first announced, says Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P, CDIP, an AHIMA-approved ICD-10-CMS trainer and senior manager at Blue & Company.

Grider says communication plans in general just aren’t up to par in many hospitals. “That’s very problematic because everyone is focused on information systems or education and training or documentation or processes, but they’re not focused on how they communicate with each other,” she says.

How can an organization ensure that the channels of communication are open and working as planned? Experts agree that communication takes a significant amount of planning and dedication. However, the good news is that the ICD-10 delay to 2014 gives organizations an extra year to develop a solid communication plan or refine an already existing one. Either way, the goal is to start talking—and to keep those conversations going.

Take Communication Subcommittees a Step Further
Experts say that every ICD-10 steering committee must include a communication subcommittee charged with keeping everyone informed and on the same page. This subcommittee should oversee a communication strategy that identifies who needs to know what specific information as well as how and when that information will be conveyed.

The subcommittee should include representation from senior management, HIM, the revenue cycle, and quality as well as physician and nursing liaisons, says Juliet Santos, MSN, CCRN, FNP-BC, senior director of business centered systems and ICD-10 lead at HIMSS. “One person in particular may not have the expertise to put communications out for everyone,” she says.

Involving senior management helps establish the importance of the initiative in general and can also help avoid any potential barriers with funding, Santos says. “I have hospitals telling me that they’re still preaching this to their CEOs and begging for money,” she says. “They shouldn’t have to sell it to upper management.”

It’s crucial to involve physician leaders in the communication subcommittee because they are the ones who ideally will in turn convey important details directly to other providers, says Heather Haugen, PhD, vice president of research at The Breakaway Group. Regular communication with physicians helps them understand that the organization has a plan for implementation and that the physicians play a role in that plan, she adds.

Without these communications, there tends to be a large gap in terms of physicians understanding their role in ICD-10, Haugen says. The Breakaway Group conducted focus groups during which physician leaders in large hospitals and academic medical centers reiterated that although physicians know that ICD-10 will affect them and their documentation, they don’t understand exactly what will be expected of them.

Some organizations also may want to involve marketing or public relations when creating the communication subcommittee. “They’re spokespeople for the organization,” says Grider, who serves as a consultant on various ICD-10 steering committees nationwide, adding that organizations struggle most with simply staying on track with their communication efforts. “Other competing issues come to the forefront,” she says.

The ICD-10 communication subcommittee should meet at least once every other month to track its progress and report back to the ICD-10 steering committee on a monthly basis, Grider says.

Who Needs to Be in the Know?
“Everyone needs to know about ICD-10. It affects just about every aspect of a facility,” says Jacqueline Thelian, CPC, CPC-I, president of Medco Consultants.

Key stakeholders (ie, the board of directors, medical director, CFO, and CEO) must be among the first individuals receiving any ICD-10–related communications, Grider says. They should also receive monthly updates outlining the overall ICD-10 budget, expenses incurred to date, and estimated future costs. “I don’t think we’re keeping them as informed as we should be,” Grider says.

It’s particularly important to communicate regularly with the CFO, she notes. “I think we have to communicate that the CFO holds the purse strings. He or she is going to have to approve all of the expenditures and changes, and they should be heavily involved,” she says.

Initially, everyone in an organization should get the same general message about ICD-10. Emphasize during an initial organizationwide training that a successful ICD-10 transition is crucial to the overall functioning of the organization, Grider says. “The communication piece of this is so important because [ICD-10] relates to the financial health of the organization. If we don’t do this right and if we can’t get paid appropriately, the organization can fail,” she says. Follow up quarterly with organizationwide meetings that discuss accomplishments to date, upcoming goals, and what employees can do to help, she adds.

Tailor the Message
In addition to providing more general organizationwide communications, the communication subcommittee should tailor messages to several important groups within the organization, primarily HIM, IT, quality, finance, the C-suite, and providers. The communication should reflect how ICD-10 will directly affect each group. This includes information about very specific changes in workflow and how those changes will be implemented or addressed, Santos says.

“It’s a big initiative and each person will only internalize the information that is most applicable to them and only when it’s most relevant,” Sadagopan adds. “When people understand how much their job will change, they will start to pay more attention.”

For example, when communicating with coders, organizations must clearly articulate their plans to improve documentation on which codes will be assigned, train coders in how to use ICD-10, and potentially maintain dual coding to accommodate the historical data at the early postimplementation phases. Communicating these details will go a long way in terms of alleviating anxiety and preventing turnover, Santos says.

Messaging to physicians also must be clear in terms of what’s in it for them individually, not for the industry as a whole, Haugen says. Provide specific examples of how ICD-10 coded data will ultimately help guide the clinical decisions they make, she adds.

Give clinicians exactly what they need to know for the type of services they perform, Sadagopan says. Shortlists, index cards, and other job aides that provide physicians a quick glimpse of key points to remember while documenting or responding will be helpful before, during, and after the transition, he notes.

“How we appeal to the intellect of the clinician is so important,” Haugen says. If possible, she suggests avoiding the term “ICD-10” entirely. Instead, focus physician-training efforts on clinical documentation improvement, a by-product of which will be ICD-10 preparation. When organizations begin to place the emphasis on clinical documentation, they make a stronger argument for improvements in patient care, data, and clinical decision support, she says. “Suddenly, [physicians] say, ‘Well, I care about that!’”

Stay Positive
The way in which an organization frames the ICD-10 transition is paramount. “I would encourage hospitals to frame it in the most positive way possible,” Santos says. Acknowledge the difficulty of the change but reiterate why the change is necessary. Remind people that by participating in the transition, they are part of a solution that will affect the greater good of healthcare and data reporting, she adds.

It may be helpful to align ICD-10 with EHR adoption, Haugen says. “There are some real synergies there,” she notes. For example, both EHRs and ICD-10 require a careful review of clinical note structure as well as rules for clinician decision support. With proper planning, some of these conversations can occur together while many of the key stakeholders are in the same room.

Time Your Message Carefully
Generalized, organizationwide communications should take place now, Thelian says. It’s also not too soon to begin communication with physicians either, as much of an organization’s success in transitioning to ICD-10 will depend directly on physician documentation, she adds.

In general, the earlier you can start communicating, the better, Grider says. Every organization should develop a communication schedule/calendar that clearly delineates when training events or other major communications will occur as well as the goals and objectives for those events or communications. Differentiate between organizationwide and department-specific information, she adds.

Communicating early on can help individual departments plan ahead, Grider says. For example, some software vendors may not be able to transition to ICD-10, and IT professionals need to be able to communicate this information—as well as potential solutions—to everyone who may be affected. “Every department that’s affected by this software program needs to know that you may potentially need to replace [the program],” Grider says.

Sadagopan says many of the organizations with which he has worked haven’t fully looped the IT department into communication strategies early in the process, and now they are scrambling because of that lack of foresight. “[They] don’t yet have a complete grasp on how this transition impacts areas such as reporting and clinical decision support,” he says. “A large number of reports have dependencies on ICD procedure and diagnosis codes, which means these reports have to be migrated. Organizations tend to underestimate the resource requirements and significance of these tasks.”

Communication in larger facilities is more complicated and therefore requires more planning time, Sadagopan says. Larger, multifacility institutions that have grown through acquisitions still retain largely autonomous facilities. “In these environments, setting up an effective centralized project manager who coordinates with a leader at each facility is critical to success,” he says.

However, smaller hospitals certainly aren’t immune to challenges. “There are fewer people to communicate with, and there’s a little better alignment among the stakeholders,” Haugen says. “However, where we found they were constrained was around resources.” She says these facilities may be more likely to hire outside help simply because they don’t have the internal expertise.

Don’t Forget External Communication
In the scramble to develop an internal communication plan, organizations can’t forget that there are a whole slew of external parties with whom communications must occur. These include vendors, third-party billers, clearinghouses, and outside billers/coders.

“Who is keeping on top of [communications] with these people? You shouldn’t just assume that they’re going to be ready. You’ve got to make them part of your communication plan,” Thelian says.

Software vendors often are left out of the communication loop. Ask vendors specifically what they’re doing to prepare for the October 1, 2014, go-live date, Grider says.

Some hospitals also forget that their communication plan must take into consideration how ICD-10 will affect patients, Grider says. “Our patients are our customers. Once we go live with ICD-10, communicating with patients is going to be critical because they don’t know that we’re moving to a new coding system,” she says. “They don’t know that there’s a potential for denials, delays, and suspended claims.”

Also don’t forget to include physician practices that your hospital owns and operates, Thelian says. Some of these practices will be transitioning to ICD-10 as well as moving to the same EHR as the hospital, which makes an effective and inclusive communication plan even more crucial, she adds.

Evaluate the Plan’s Effectiveness
Once a communication plan is in place, how do you know whether it’s actually working?

One way to take a pulse on whether people are talking and thinking about ICD-10 is to simply walk through the departments and inquire about it. “Whoever oversees the communication committee has to be out there within the departments talking to the directors and staff finding out what they think about ICD-10—whether it’s good, bad, or indifferent,” Grider says. “If they don’t know anything about it, then you know there’s a lack of communication in that department.”

Listen to the types of questions that staff members ask during educational sessions, as this information may be indicative of any misconceptions they have about ICD-10 as well as whether your message is getting through, Santos says.

Attendance at meetings may be another barometer of whether your strategy is working. Lack of attendance may be one sign that the message isn’t getting through, according to Grider. Consider rescheduling meetings at which attendance is poor and make them mandatory to attend, she adds.

When clinicians in particular aren’t engaged and don’t attend meetings, that’s a sign the communication strategy may need some tweaking. Engaging physician leaders can help, Haugen says.

Progress also can be measured during steering committee and subcommittee meetings when people are asked to report on their progress (or lack thereof), Thelian says.

Oversimplification of the ICD-10 transition also may be a bad sign, Haugen says. “When people start thinking of it as a simple project, I think it’s a sign that it’s not going to achieve the goals you need. People are going to find that it takes a ton of their time for very little benefit,” she says.

Organizations may want to avoid the word “project” entirely, as this term generally implies a smaller-scale undertaking with a clear beginning and end, Haugen says. Hospitals need to make it clear that ICD-10 is a long-term process with no end date. “[ICD-10] doesn’t end in October [2014]. It actually begins then,” she says. “It shouldn’t be something that we have to do to comply with a mandate. Complying with a mandate and improving clinical documentation for improvements in clinical care are very different.”

Monitoring a communication plan’s effectiveness also may include tracking actual communications to determine whether people are reading them, according to Thelian. “If you’re sending out an e-mail to 150 people, how many people responded back? Who didn’t get the message? It could be that the 10 people who didn’t get the message were key people who needed to get the message,” she says. “Things start to fall through the cracks.”

Ensure there’s a tracking system so that each employee who receives that communication can sign off to indicate they read the material, attended the event, etc, Santos says. Most hospitals can use human resources tracking systems that are already in place for this purpose, she says.

Directors and supervisors can help, Grider says. “I think we need to put some of the burden on the directors and supervisors in each department to make sure that their staff members are kept up to date,” she says. Making organizationwide training mandatory may be one solution. Participants can sign in and out to verify attendance and perhaps even take a test to ensure they understood the message, Grider says.

— Lisa A. Eramo is a freelance writer and editor in Cranston, Rhode Island, who specializes in healthcare regulatory, HIM, and medical coding topics.