Note: Congress has passed legislation to delay ICD-10 implementation until October 1, 2015. Read the full story here.
The current healthcare system is broken. That’s clear—regardless of your political point of view. To be honest, I’ve been a bit of a naysayer in the past about the government’s capacity to be the driving force in healthcare reform—to improve standardization, which ultimately is the key to providing and scaling quality health services. However, after listening to and speaking with several leaders in government healthcare IT, I feel differently. In fact, I now know that they get it, that there are both good ideas and good intentions behind these changes because they all add to something greater. ICD-10 is one of these changes.
In mid-June, I attended the HIMSS ICD-10 Conference in Washington, D.C. The US is the last country in the world with modern healthcare to adopt ICD-10 diagnosis codes—for perspective, Canada, the second-to-last adopter, implemented them in each province between 2001 and 2005. So why transition to ICD-10? Well, besides catching up with the rest of the world, ICD-10 will allow providers to be even more specific and exact in describing patient diagnoses, thus improving interoperability, data sharing and outcomes, evidence-based practice, and ultimately public health.
With so much to absorb in just three days, you can imagine that I may have felt a little overwhelmed. Nevertheless, I took copious notes, and here are the most important things I learned from such interesting speakers as Farzad Mostashari, Denise Buenning, and Mark Lott:
1. ICD-10 is worth the time, effort, and resources the transition will require.
- We need standardization in the healthcare industry so we can better coordinate patient care.
- ICD-10 codes are now directly linked with Systematized Nomenclature Of Medicine (SNOMED) Clinical Terms, which rehab therapists will begin to hear a lot more about.
- Ultimately, the goal is to reduce the amount of data necessary to pay a claim. (Yes, please!)
2. There will be no extension this time.
- In case you missed it above, let me repeat: There will be no extension this time. Just because it happened in the past, does not mean that it will happen again. In fact, it won’t. According to everyone that spoke at the HIMSS conference—I heard this probably 20 times—there is no extension this year, and I believe they mean it.
- The transition deadline for ICD-10 is October 1, 2014, and you and your practice must be ready by then—well before then would actually be best. (Tweet this!)
- According to a recent Forbes article, less than 5% of physician offices are ready for ICD-10 today. (Tweet this!) That number is most likely even lower for rehab therapists, which is a bit unnerving considering the potential impact.
3. Prepare and plan.
- According to MGMA, physician offices should expect the transition to cost roughly $10,000 per full-time provider to upgrade or replace a practice management system so that it functions with ICD-10. Obviously these numbers will be different for rehab therapists; however, it’s important to note there is a financial obligation.
- Keys to successful implementation include awareness and assessment. Evaluate where your practice uses diagnosis codes (e.g., referrals, scheduling, documentation, and billing).
- Plan on training all of your employees, including clinical, billing, and clerical staff, as well as implementing testing with payers. Essentially, you should aim to over-communicate with your staff members and vendors
- Have a plan B, such as a line of credit or supplemental income to ensure your clinic's viability during the transition. Don’t wait until after October 1 because you’ll have to vie for financing and pay higher interest rates.
- Implement EMR—one that will be your ally in this transition. In addition to awareness and assessment, using the right EMR, like WebPT, is key to implementing smoothly.
4. Testing is happening right now.
- This testing phase—designed to identify all coding, operational, mapping, and reimbursement issues that still exist—is the most important one to ensure transition ease and minimize providers’ loss of income. However, details of the full testing period are not yet finalized.
- According to the MGMA, 80% of billing claims are currently being processed through a clearinghouse; 72% of claims are from a major health plan.
- Also according to MGMA, at this time, 60% of medical providers still have not received confirmation that their clearinghouse is prepared for the switch. Many are unsure if their plan carriers have an implementation plan.
- Interestingly, Palmetto GBA has stated that they will not conduct payment testing.
5. EMR/EHR is the key to success.
- Ten years ago, only 9% of hospitals had adopted electronic health records. Today, that stat has climbed to 70%. Additionally, about 50% of private physician practices—with the help of incentives—have jumped on board. Why? Because EMRs/EHRs are the best way we can ensure interoperability, accuracy, and complete patient records. They’re also the most effective method for exchanging data.
- Furthermore, EMR/EHR helps ensure population health management, patient engagement, and improved care coordination.
- Currently, only about 30% of physical therapy practices have adopted EMR/EHR. (Tweet this!)
- Note: EMR/EHRs will need to update their systems for ICD-10, so make sure yours is ready. (WebPT sure will be).
6. There are resources available to help.
- Regional extension centers (RECs)—62 across the country—are helping small practices transition to EMR/EHR.
- The APTA is releasing new ICD-10 information as it becomes available.
- CMS has many ICD-10 resources available, including general information, latest news, checklists, and an implementation timeline.
- Vendors, specifically EMR/EHR and billing, will provide resources—like the articles and information you’ll find on the WebPT blog—to make the transition easier.
Ultimately, ICD-10 is a good thing. We can’t keep doing the same thing and expect the same result—in other words, we can’t expect organization, communication, and data exchanges to improve if we continue using the same system. We must evolve—or even just catch up with the rest of the modern world. Of course, there will be big challenges. With anything new and with any transition this involved, there are bound to be a bumps in the road. And that’s okay. Just like functional limitation reporting and PQRS, we’ll tackle this too—head-on—by focusing on the positives. Here’s to standardization, transparency, quicker claim reimbursement, and overall a better healthcare system for our country.