ICD-10 Fallout at Smaller Hospitals
“Though it is too early to measure revenue cycle impacts, the challenges that some hospitals are having may equate to financial disruption by the end of the year.”
That’s a line from a recent HealthDataManagement article that examines how some smaller hospitals that weren’t able to fully prepare for ICD-10 may realize negative financial performance—even as larger hospitals report a (to this point) fairly seamless transition.
This is no surprise to many. In fact, we recently blogged about how, although early signs were positive, it was too early for celebration. Here’s a bit of what we said:
Many providers are likely thinking that they listened to the right advice, educated and trained their staff, tested and readied their systems and protected their cash reserves in the face of what was coming. Now let’s get on with it!
We applaud such exuberance. Yet it would be a mistake to relax too much and assume that all your prior preparation is a guarantee for success. Even the best-prepared providers are going to hit snags—some of which could have significant consequences (think non-compliance, slow payments, denials, tons of rework, etc.).
While we were focused mostly on coding in our post (and that is certainly a component of the article), what struck us the most was the lack of physician readiness:
Despite extensive educational offerings by most hospitals to their physicians, many physicians have taken little or no advantage of them. We know of one five-hospital system in which the physicians finally agreed last week to participate in intensive training (beyond one past introductory session. They began the specialty-based sessions, focused on tailoring their documentation of procedures and diagnoses to meet the specificity requirements of ICD-10, during the last week of October.
In another 2-hospital system, many of its physicians had only participated in one two-hour web-based session despite the availability of other modules. In speaking with several colleagues, the problem of inadequate documentation improvement by physicians, even when training has been made available, seems fairly common.
There it is again. As was the case with EMR implementation, physician resistance seems to be a stumbling block. Many are scrambling to fix the problem, but as the article states, “…finding an affordable training solution that is available immediately is a challenge.”
Okay, back to coding. There were issues here, too, among them the practice of offshore coding, highlighted in the excerpt below:
It seems that, in at least some cases, these organizations have oversold their capabilities and are relying on overtime to address the quantity of charts. The quality of that coding is suspect. We recommend that if a hospital is using an off shore shop for some of its coding, the hospital should “overcode” at least a portion of their charts at first to ensure that they are getting the quality needed.
The takeaway of all this? While there is much good initial news to report industry wide since October 1, it’s still early and there are sure to be—as the HealthDataManagement article clearly points out—continuing issues to deal with.
Long story short, there are challenges associated with ICD-10. It's new. There are unknowns. Regardless of whether you're a large or small hospital, we're ready to help you prepare and execute a plan for what is inevitably ahead. We'd love to share our rock star coders, our years of proven experience, and our top-down revenue cycle mindset with you.