ICD-10 Implementation & Budget An Alternate Perspective

1. ICD-10 Implementation & Budget An Alternate Perspective Nicole D. Harper, PhD, RHIA, CCS-P St.Vincent Health - Indiana

2. Session Objectives Review Implementation Timeline Outcomes of Implementation Phases Discuss Budget Development & Maintenance Provide tips on emerging best practices and ICD-10 future success AGENDA Approach Impacts Phases of Implementation Organizational Costs Budget Plan of Action 2

3. 689 DAYS… and counting!!!! 3

4. "If you don't have time to do it right, when will you have time to do it over?" - J. Wooden

5. It’s Not Just About Coding ICD-10 is more than a compliance activity 5

6. Impacts More than Just a Larger Coding Inventory of Systems According to the Healthcare Information Management Systems Society (HIMSS) Registration Registration and scheduling systems Advance Beneficiary software Performance management systems Medical necessity edits HIM DRG grouper Encoding software Abstract systems Compliance software Medical record abstracting Support Systems Case Mix systems Utilization management Quality management Case Management Reporting Provider profiling Quality measurement Utilization management Disease management registries Other registries State reporting systems Fraud management Aggregate data reporting Clinical systems Patient assessment data sets (e.g. MDS, RAI, OASIS) Clinical Systems Clinical systems Clinical protocols Test ordering systems Clinical reminder systems Medical necessity software Disease management systems Decision support systems Pharmacy systems Billing/Financial DRG grouper Conversion of other payment methodologies National and local coverage determinations System logic and edits Billing systems Financial systems Claim submission systems Compliance checking systems 6

7. ICD-10 Project Approach 7

8. 3M Health Information Systems: 2012 Countdown to ICD-10 Calendar 8

9. Phases of ICD-10 Implementation • Planning • Make sure you have the right “people on the bus” • Engage your Project Management Office • Use standard Project Management methodologies • Solid decision-making and escalation process • Don’t reinvent ICD-10 planning activities (many industry resources available) • Conduct a Stakeholder Analysis • Use existing modes of communication • Have an action plan before people start working • Start outlining your ICD-10 Training Plan 9 http://www.jimcollins.com/article_topics/articles/good-to-great.html

10. Suggested Training Audience 10

11. Suggested Training Levels 11

12. Phases of ICD-10 Implementation • Assessment • Carefully select your assessment team • Define ICD-10 stakeholders and align expectations • Awareness education is needed prior to Assessment • Spend time outlining scope and vet with process owners • Approach the assessment from a business process workflow perspective • Streamline your reporting, create document repository such as Microsoft SharePoint • Conduct feasibility studies on opportunities that are strategic to determine if “nice to have”, process improvement for later, or required for compliance • Ensure stakeholders are thinking holistically in developing recommendations http://www.himss.org/content/files/EXP_Health_Playbook_II_Critical_Success_Factors.pdf 12

13. Phases of ICD-10 Implementation • Operational Implementation • “It’s better to measure twice and cut once” • Ensure an integrated project schedule is developed and approved • Be persistent in contacting vendors for readiness preparedness • Monitor Subcommittee progress • Don’t be afraid to escalate issues 13

14. Phases of ICD-10 Implementation • Testing • Identify existing testing plans that can be built upon for ICD-10 testing • Engage stakeholders across functional areas in developing test plans • Approach end-to-end testing plans by business process workflows • Specifically for IS system changes, vendors are making more than just ICD-10 change and as these changes ripple through the organization the desire is to be proactive instead of reactive 14

15. Phases of ICD-10 Implementation • Transition • Engage your Audit Committee to perform project health checks • Foster collaboration among all stakeholders • Joint Ventures – awareness training, meetings, check status of remediation, offer guidance/support • Some vendors already have ICD-10 compliant software (start testing now if you can) 15

16. ICD-10 Organizational Costs Estimated Organizational Cost by Bed Size Carmichael, Angela. “ICD‐10‐CM/PCS: What Every Hospital Needs to Know Now.” PowerPoint presentation. Georgia Hospital Association Audio Conference, Telnet 2673. 12 May 2011 16

17. Implementation Project Expenses Sullivan, Tori. "Budgeting for ICD-10: Hardware Costs Should be Peaking Next Year, Contract Support Rising." Journal of AHIMA 81, no.9 (September 2010): 30-33. 17

18. Budget Development • What worked? • Conduct budget working sessions with individual functional area stakeholders to examine the impact of ICD-10 • Creation of Capital and Operating budget – multi-year, pre- and post-implementation (including contingencies) • Develop methodology for estimating vendor system costs (high, medium, low impact) • What didn’t? • Absence of sample budget modeling tools • Out-of-date industry financial estimates • Obstacles to avoid… • Tunnel vision (all locations/in-scope areas; e.g., hospitals and physician practices) • Not considering potential budget cuts and other impacts • Not considering for a disruption to cash flow and increase in expenses 18

19. Budget Maintenance • What worked? • Develop a budget request/approval process • “Accounting for ICD-10 Conversion Costs” • A blog has been posted stating the ICD-10 accounting rules; although must follow your organization’s policy • What didn’t? • Make sure you understand your organization’s accounting rules or your budget allotment could suffer • Obstacles to avoid… • Not determining how the organization wants to track costs upfront (e.g., sunk costs, estimations, actual, etc.) • Not reviewing costs allocated to the project http://cpa-scribo.com/accounting-for-icd-10-conversion-costs/ 19

20. Plan of Action – Alternate Perspectives • Project Management Perspective • Program not Project • Communication, Communication, Communication • Identify Champions across locations and functional areas • Conduct education on Project Management Processes • Leverage previous work performed to assist with preparations • Identify competing priorities and resource constraints as soon as possible • Allow associates access to information about the project and a place to submit questions • Continually conduct Risk Assessment activity 20

21. Plan of Action – Alternate Perspectives • Emerging Best Practices • Training & Education • Timing of Go-Live • Governance Model • Clinical Documentation Efforts • No Paper Forms • Accelerating Movement to EHR • Determining Coder Productivity/Capacity Right Now • Dialogue with Large Commercial Payers • Process key strategic decisions before planning • Measurement and tracking of Key Performance Indicators (KPIs) across upstream, midstream, and downstream processes in the revenue cycle 21

22. Preparation is Key Early Preparation • A well-planned, well-managed implementation process will increase the chances of a smooth, successful transition. • Experience in other countries has shown that early preparation is the key to success. • An early start allows for resource allocation, such as costs for systems changes and education, process evaluation and change, as well as staff time devoted to implementation processes, to be spread over several years. Supporting Continued Urgency • Switch focus to Clinical Documentation Improvement • Engage Non-HIM Stakeholders • WIIFT • Report Readiness • Use this time wisely!! • …keep your foot ‘on the gas’!! 22

23. ICD-10 Steering Committee Comprehensive assessment (including gap analysis and System Inventory) Roadmap to guide implementation planning Clinical Documentation Assessment Claims analysis to identify top impacted specialties Educational Needs within Organization Identify top specialties and education to physicians Implement education/documentation improvement plan for ICD-10 (“ICD-9 improvement”) Open communication channels with system vendors and payers Collaborate/combine efforts to maximize resource utilization Keep yourself educated and in tune with the latest ICD-10 news Attend industry conferences to collaborate with providers, payers, and vendors Buy-in from the top-level down throughout the organization ICD-10 cannot wait for Electronic Health Records & other health IT initiatives to be completed Start early enough so that thorough testing can be performed Continued urgency is a must! There is still plenty of work to do! What I Know for Sure… 23

24. Implementation: ‘Self’ Status Questions • Do you fully understand the outcome of the impact assessment and are able to initiate resolutions? • Do you continue to evaluate effect on data analysis? • Are you monitoring Trading Partner readiness? • Have you implemented your Training and Education Plan (Awareness)? • Do you update and reassess the project as necessary? • What are your plans to continuing assessing CDI practices? • Have you reviewed your reimbursement impact? • Have you developed Risk Mitigation Strategies to minimize transition problems? • Have you developed plans to mitigate decreases in productivity and quality? • Do you continue to expand the ICD-10 Communication Plan? AHIMA – 2011 Clinical Terminology/Classification Practice Council AHIMA – 2011 Clinical Terminology/Classification Practice Council 24

25. The Delay was a Gift of Time! • Take a deep breath • Get organized • You CAN do this http://www.icd10monitor.com/index.php?option=com_content&view=article&id=501:take-a-deep-breath-get-organized-you-can-do-this&catid=48:icd10-enews&Itemid=106 25

26. Thank You!! Nicole D. Harper ndharper@stvincent.org 317-583-4171