Hospital officials that are well along in their planning for the ICD-10 switchover expect a loss of productivity when they move to the more complex diagnostic coding system, said panelists in a "town hall meeting" held at CHIME's Fall CIO Forum in San Antonio. But the speakers also said they hoped that computer-assisted coding (CAC) applications might be able to alleviate that productivity drop.
Canadian hospitals saw a 30 to 50 percent decline in productivity when they adopted ICD-10, noted Cassi Birnbaum, director of health information and privacy officer at Rady Children's Hospital in San Diego. "That's why we're interested in computer-assisted coding to mitigate the loss," she said.
Rady has issued an RFP to CAC vendors, Birnbaum noted. "Based on what we've seen, we'd like to make a decision by the end of the year."
Carole McEwan, ICD-10 project manager for St. Louis-based SSM Health Care, said her system probably will look at CAC applications next year, and choose one to implement in 2013. But SSM isn't relying on CAC to stem the ICD-10-related loss of productivity. The big healthcare system is already staffing up its coding department so that it will have time to train the new coders.
Another issue for Rady and SSM is whether their payers will be ready for accept ICD-10 claims by the deadline. If they aren't, the healthcare providers will have to code claims with ICD-9 and ICD-10 codes at the same time--an additional burden on their coders.
Both healthcare systems are ahead of the ICD-10 curve today, despite parallel electronic health record rollouts. Rady CIO Albert Oriol cited two major reasons for that: First, he said, his organization began preparing for ICD-10 more than two years ago, and second, the initiative received strong support from management, including the system's CFO and medical leadership.
In addition, Birnbaum pointed out, Rady decided to emphasize the need for clinical documentation improvement (CDI) to win over coders and physicians. "We combined our CDI effort with our ICD-10 effort," she said. "We saw CDI as the foundation for our initiative. If we don't document what we need, we can't code it."
SSM, which is about 25 percent through its ICD-10 project, has placed a strong emphasis on training, McEwan observed. It already has certified trainers, and will give training courses to the entire staff next year. Since SSM will have to provide more than 100,000 hours of ICD-10 training system-wide, she added, it decided to create its own training materials rather than buy them from an outside vendor
The panelists agreed that healthcare systems would be foolish to postpone their ICD-10 initiatives in the mistaken belief that the deadline will be postponed from Oct. 1, 2013. "It would have been easy to put off ICD10," Oriol said. "But the more we heard from the feds, the more sure we were it was going to happen on time. We made the bet that the deadline wouldn't be pushed back."