An Opportunity to Lead: HIM’s Role in Leveraging ICD-10 for Strategic Advantage
By Ann Chenoweth, MBA, RHIA
While healthcare reform and meaningful use consume the majority of a hospital C-suite’s time, energy, and budget, the U.S. healthcare industry is facing a new challenge: ICD-10. The transition to ICD-10 is a major undertaking, and most analysts agree that implementation will be both time and resource intensive. Yet many hospital executives continue to underestimate the impact ICD-10 will have on operational systems and strategic plans.
As a result, many organizations are funneling ICD-10 resources into other initiatives with more urgent deadlines. Some may decide to invest only in core Centers for Medicare & Medicaid Services mandates such as claims adjudication, referral processing and related payer transactions, and basic coding and core revenue cycle processing. Those organizations will likely experience a negative return on their investment and gain very little strategic value.
While it may be tempting to see investment in ICD-10 from a solely tactical vantage point, it is, in reality, an investment in strategic innovation and future advantage—a future in which proactive organizations will become industry leaders. The massive amount of data ICD-10 will provide is the key, and HIM is the gatekeeper.
The following is a brief description of six areas HIM professionals should focus on over the coming months to help their organizations position themselves for success:
1. Clinical Documentation Improvement
ICD-10’s greater clinical specificity drives the imperative for complete and accurate documentation. Processes and tools such as dictation, structured EHR templates, pick lists, and other mechanisms for capturing clinical information should be assessed and redesigned as needed to support ICD-10.
This is an ideal opportunity for HIM, in tandem with clinicians, to review current documentation standards and practices to ensure that they meet and support the following:
• clinical best practices according to professional and regulatory standards;
• the ability to measure quality, performance, and safety data;
• more precise grouping and reimbursement methodologies;
• value-based purchasing initiatives; and
• disease management goals and standardization of disease monitoring and reporting worldwide.
2. Contractual Relationships
ICD-10 will alter contracting norms with payers, physicians, and vendors. Now is the time to examine relationships that award payment or measure performance based on codes; examples of code-based contract users include hospital case rates, payer contracts, vendor financial and performance criteria, and special physician rates for particular conditions and procedures.
HIM professionals have the skills to analyze the impact that ICD-10 will have on these contractual relationships and can collaborate with other stakeholders to evaluate how ICD-10’s more granular data can be leveraged for deeper and richer analysis.
3. Budget Neutrality
HIM professionals are their organizations’ ICD-10 experts. By utilizing industry metrics and conversion tools, they can help maintain budget neutrality by projecting financial performance under ICD-10. This kind of analysis can uncover any internal obstacles and identify where improvement efforts should be concentrated.
Even if systems, staffing, and processes are in place to support ICD-10, there is no guarantee of correct reimbursement. Mapping errors and misjudgments about the “most appropriate” code to map will undoubtedly occur. HIM can help executive teams evaluate processes and implement corrective action to ensure appropriate compensation for the care provided.
4. Quality and Patient Safety
ICD-10 has the potential to reveal much about quality of care, enabling clinicians to better understand complications, design more clinically robust algorithms, and better track outcomes. It paves the way for improved service delivery, care systems, and patient safety. HIM departments can play a key role in evaluating how their organizations collect, maintain, and utilize clinical and quality data and work with key stakeholders on how the granularity of ICD-10 can enhance quality and patient safety initiatives across the care continuum.
5. Competitive Advantage
Early adopters of ICD-10 will be in a position to secure new business partnerships and greater market share as a result of improved data capture, cleansing, and analytics. HIM departments can assist their organizations in developing advanced analytical capabilities such as physician scorecards, targeted research, and disease and medical management support programs to create a competitive advantage.
6. Postimplementation Optimization and Auditing
Transitioning to ICD-10 does not stop on October 1, 2013. After this milestone has been reached, HIM can take the lead in performing postimplementation audits to identify areas for optimization. Ongoing audits will help ensure the quality and integrity of the coded clinical data for accurate reimbursement, quality reviews, research, contracting, and other purposes.
Leveraging ICD-10 for strategic advantage requires a thoughtful review of your organization’s strategy and corporate goals and how ICD-10 can best support those goals. Those who invest in such a process will be the real beneficiaries in this conversion. With foresight and planning, HIM professionals can position themselves as the “thought leaders” who can help transform the ICD-10 transition into a competitive advantage for their organizations.
— Ann Chenoweth, MBA, RHIA, is director of industry relations for 3M Health Information Systems.