Optimal Readiness

One of the main concerns regarding the looming transition to ICD-10 is the expected loss in coder productivity, with experts forecasting a drop of 50 percent or more. Health Information Management (HIM) departments that are minimally prepared will likely see productivity fall even more than that, and those that prepare best should fare much better. The following frequently asked questions we’ve received at IOD and our answers point the way toward mitigating coder productivity loss for HIM directors who are well on their way to training and want to do all they can for optimal readiness, as well as those who suspect they might be behind in preparing for the October 2015 ICD-10 transition date.

Q: What will cause the expected 50 percent drop in coder productivity with ICD-10 — the newness of the new code set or its increased complexity?

A: It is newness and complexity rolled into one. In moving to ICD-10, coders aren’t simply working with a greatly expanded code set. They are also expressing the information in charts differently, with a much greater amount of information within individual codes. Coders who learned to think in ICD-9 now have to learn to think in ICD-10, and it’s a bit like mastering a far more complex language. The productivity drop associated with newness will fade with familiarity, but complexity has long-term implications that will preclude a return to the same productivity levels seen under ICD-9.

Q: Is it possible that some HIM departments will see much less than 50 percent productivity impact?

A: Interestingly, almost all HIM directors believe that’s the case! A few months ago, we held a webinar with 175 HIM managers who had not yet trained their coders in ICD-10 or were in the early stages. Almost all participants — 89 percent — anticipated an initial productivity drop of less than 50 percent. Nearly half said they expect an initial drop of only 10 to 20 percent and a quick return to current or near-current levels.

coder productivity

Since IOD provides more than 100 coders to healthcare organizations across the United States every day, we felt we needed to find out what the ICD-10 productivity drop would be for ourselves. We set up a controlled environment, and had coders code a similar set of charts in ICD-9 and ICD-10 — this gave us a data-based understanding of productivity and accuracy gaps, by coder, down to the DRG and MDC level. Our findings align with Texas State University’s Stanfill study, with coders taking on average 69 percent longer to code the same record in ICD-10 compared to ICD-9. It’s clear that HIM directors who expect less impact from ICD-10, and who take a casual approach to readiness as a result, are setting themselves up for a potentially rude awakening.

Q: How can the loss of productivity best be mitigated?

A: The most efficient and effective way to mitigate productivity loss is to pinpoint the specific causes — I cannot emphasize that enough. Far too many HIM directors take the approach of having all coders dual-code everything — which is itself a hit to productivity — coders spend a great deal of time repeating what they have already mastered. But taking a more specific approach will show that each individual coder has different challenge areas. Identifying specific gaps for each coder, and working with them to close those gaps, minimizes time wasted, maximizes focus and accelerates efficient learning and retention. There will also be commonly shared challenges, and four or five identifiable procedures may be the cause of half the productivity loss within a given group. Fix what commonly is causing problems and you’ll likely close your productivity gap by half. Then, solve the rest by focusing on individual issues.

It is important to remember that ICD-10 productivity will always lag ICD-9 somewhat due to complexity. In our study, this amounted to a 20% persistent gap that we closed by adding an additional coder.

Q: How can the financial impact of productivity loss be minimized?

A: That’s a matter of setting priorities according to each skill gap’s relationship to billing importance. While one or two particular DRGs may have the greatest actual skill gap, it’s critical from a revenue cycle standpoint to identify the skill gaps that relate to high billing frequency or high dollar amounts, and address them first. We found, for example, that solving smaller skill gaps related to cardiology had a greater impact on revenue than the larger skill gaps related to childbirth.

Q: What can be done in addition to focused ICD-10 training to improve coder productivity?

A: Take a look at any non-coding tasks that have crept onto coders’ plates and see if they can be eliminated or assigned to other personnel. Some organizations have become highly enamored with data collection and assume coders can collect a myriad of data while they’re in the records, which can become a surprising time-sink. If the data is needed and that really is the best way to collect it, fine, but eliminating anything that’s not really needed or moving data collection to lower-cost resources gives the coders relief.

Q: Along with addressing specific ICD-10 issues, is there anything else that can add efficiency to training?

A: Continuous improvement at a steady pace, rather than a rush as the deadline nears, will deliver natural efficiencies. It’s like studying throughout the school year vs. cramming right at the end — we know which delivers the best long-term retention. Preserve the investment you have already made in ICD-10 training with regular scheduled training that both keeps it fresh and builds on it. A steady drumbeat of practice leading up to the transition is good not just for speed, but also for accuracy — less interrupted repetition means more ingrained familiarity.

Q: What would you say to the HIM director who hasn’t begun ICD-10 training in earnest?

A: Don’t panic, but don’t delay any longer. The previous delay was a reprieve, an acknowledgement that to the industry was not adequately prepared to make the transition to ICD-10. To count on another delay is to risk being caught in a situation that could cost healthcare organizations millions of dollars in lost and delayed revenue. In our study, we saw how quickly a coding backlog generated millions of dollars in delayed revenue when projected against a 200-bed hospital. Gaps in accuracy amounted to millions more in lost revenue.

The other implication in waiting is that the talent pool will become more scarce. Every healthcare organization will be competing for competent ICD-10 coders as the deadline gets closer. Taking the time now to train your staff so that they become proficient in ICD-10 is critical.

Coding obviously has a critical role in the revenue cycle — it’s not a choice area for taking chances.

We simply cannot continue to operate in an ICD-9 world for long. We ran out of codes long ago. We’ve managed to electronify patient data, but the records that contain that data are in an outdated format. It provides less information than we need for so many critical health initiatives, and it lags behind world health systems with which ours is ultimately compared. The U.S. healthcare system absolutely will move forward. Those who are best prepared to sail smoothly through the ICD-10 transition when it arrives will be best positioned to support their organizations’ positive financial outcomes.

Barbara Allen is general manager of HIM Services for IOD Incorporated.

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