ICD-10 Strategy How to Operationalize in a Hospital Environment. HFMA Region 11 Healthcare Symposium January 21, 2014

Transcription

1 ICD-10 Strategy How to Operationalize in a Hospital Environment HFMA Region 11 Healthcare Symposium January 21, 2014

2 Agenda Introduction Industry Trends for ICD 10 Implementation Panelist ICD 10 Experiences Discussion on Current Hot Topics Q&A 2

3 Today s Panelists Chris Armstrong, RHIA, MBA Principal Deloitte Consulting LLP ICD 10 National Consulting Leader for Deloitte s Health Care Provider practice More than 25 years of experience in the health care industry Extensive industry experience in the revenue cycle, operational management roles, and corporate director of information systems Bret Kelsey Chief Revenue Officer Lucile Packard Children s Hospital Executive Sponsor over Lucile Packard Children s Hospital s integrated ICD 10 program Over 25 years of Revenue Cycle experience and has held leadership positions in community hospitals, health systems, Children s Hospitals and Academic Medical Centers. Extensive experience in revenue cycle transformation, process improvement, cost reduction, and a track record of maximizing yield and reimbursement Danielle Reno, MHA, CCS, CCS P CHC ICD 10 Program Director Sutter Health Leads ICD 10 efforts for Sutter Health, a 25 hospital not forprofit integrated delivery system based in Northern California Previously served as a Commissioner on the national AHIMA Council on Certification for Health Information and Informatics Management (CCHIIM) 3

4 INDUSTRY TRENDS 4

5 Industry Trends It is critical that providers focus on ICD 10 remediation efforts that will facilitate a smooth transition. Just as important, providers must continually verify that their payers, vendors and trading partners are all equally prepared for the transition to minimize disruption to business and finances Who will not be ready? Impacted Stakeholders Providers State Health Health Plans Vendors Federal Health 5

6 Looking Ahead Efforts must be prioritized over the next nine months, with an emphasis on understanding highest areas of risk to appropriately allocate time and resources Key Priorities KPIs (pre and post go live) Training and Education Measure performance to identify successful implementation Prepare employees with appropriate skills and knowledge Payer Collaboration/Readiness Physician Engagement Prioritizing Testing Strategies Cross mapping Solutions Dual Coding Strategies Vendor Readiness Computer Assisted Coding Reports Remediation Utilize and leverage partnerships Validate buy in from clinical staff Identify leading practice approaches to test readiness Create solutions to cross walk ICD 9 to ICD 10 Code in both ICD 9 & ICD 10 Assess risks associated with vendors Optimize coding ability with limited coding resources Revise current reporting to incorporate ICD 10 changes 6

7 INSIGHTS & LESSONS LEARNED 7

8 Lucile Packard Children s Hospital 8

9 Lucile Packard Children s Hospital About Our Hospital Academic Children s Hospital with 311 beds Over 650 physiciansmany are Stanford School of Medicine Faculty Satellite pediatric units and telemedicine services expand our current facility 2012 Facts & Figures 4,500 births 80,000 inpatient days 13,000 discharges 160,000 clinic visits About Our Network Our patients are infants, children, adolescents and expectant mothers throughout the US and internationally Packard Children s Health Alliance is a network of community physicians affiliated with LPCH, extending from Central California to North of San Francisco Awards and Recognition 10 of 10 Highly Ranked pediatric specialties in the US News & World Reports Ranked as one of the nation s top pediatric hospitals by U.S. News & World Report Heart transplant patient successes were recently profiled on Dateline NBC in June

10 LPCH Implementation Timeline Today Work Stream Q1 Q2 Q3 Q4 Q1 Q2 Q3 Clinical Operations Decision Support and Managed Care Information Services Non HIM Revenue Cycle & HIM Coding Physician Adoption & Training Legend : Formal Kick Off Reflects ICD-10 go-live date 10

11 LPCH Financial & Payer Analysis APR-DRG Impact analysis conducted Work-to-Date Payer contracts reviewed for ICD-9 carve-outs and potential impact Renegotiation of Payer contracts (with ICD-9 specific requirements) initiated Conducted payor survey initiative to determine payor readiness Key Activities Set Up and Outreach Data Selection and Coding Test Planning Claims Analysis Feedback to Program and Continuation Initiated payer surveys with top payers Conducted meetings with payers to communicate desire to conduct financial and technical testing Natively coding 1,000 test cases Test cases identified by MDC / APR DRG frequency Key test data variables included: Top DRGs UB Bill types Visit types Inpatient, Profee & Ambulatory claims Paper & Electronic Identify test data requirements Identify dates and schedule and initiate test environment planning Communicate clearing-houses for technical testing Define expected outcomes Submit natively coded claims Payer runs claims Collaborative analysis conducted Completed In Progress Not Started Analyze results Refine contract negotiation plans Refine technical testing plan Refine testing plan and Initiate iterative testing cycles 11

12 LPCH Revenue Cycle Sample KPIs In addition to tracking traditional Revenue Cycle KPIs, there are ICD 10 specific metrics that should be monitored ICD 10 Specific Metrics Quantify Payor Impact (financial) Managed Care Contracts Revised (process) Monitor Payor Readiness (process) Claims Rejections Related to ICD 10 Codes (numerical volume) Expected Payer Remittance (ICD 9) vs. Actual Payer Remittance (ICD 10) (financial) Traditional Revenue Cycle 12

13 LPCH Revenue Cycle KPIs: Things to Consider 1. Identify ICD 10 metrics (to indicate ICD 10 implementation progress) and general operational metrics that may be impacted by ICD 10 Set targets and thresholds 2. Establish tracking methodology for KPIs Verify system build can support specific metric generation Develop new reports, if needed 3. Start tracking early to establish baselines and trend results 4. Achieve KPI targets before Oct. 1st to mitigate the impact of ICD 10 Reduce A/R days Increase cash on hand Clean up denials backlog 13

14 Sutter Health 14

15 Sutter Health Overview Hospital Sutter Medical Network Employee Organization 24 facilities in Northern CA, split across 5 regions Integrated delivery system of hospitals, ASCs, medical groups, home health and more Services include trauma, transplants, research, cardiovascular and cancer Integrated, patientcentered physician network 5 Medical Foundations 5 Affiliated IPAs Over 5,200 primary care doctors and specialists $9.6B Northern CA based not for profit organization Annual statistics: 206K discharges 10M+ outpatient visits 47K+ employees Many large scale programs in flight (EMR, new construction, etc.) 15

16 Sutter Health: ICD-10 Areas of Focus ICD 10 Program Leadership: Executive Steering Committee, CORE, Enterprise, Regional and Program Leadership Clinical Documentation Improvement Program Work Groups Communications & Change Management Education Computer Assisted Coding (CAC) Testing Application Services Crosswalk Data & Online Services Vendor\Trading Partner Readiness Dual Coding Managed Care & Reimbursement Revenue Cycle \HIM Clinical Research & Operations IS Quality Center Technical Services Project Services 16

17 Sutter Health: Physician Education Awareness & Knowledge Building Established Meetings Leverage established physician meetings to generate physician awareness and complete physician education Online Courses Utilize existing Sutter Health Learning Management System for general ICD 10 awareness and specialty specific courses Enlist Physician Champions Physician Champions Determine and initiate individual physician champion roles and responsibilities Identify, educate, and develop physician champions for each facility to support training initiatives and provide peer level insight Communicate specialty specific training and facility specific events and resources Deliver Education & Build Proficiency Peer to Peer Training Utilize Physician Educators to provide onsite peer led training for general and specialty specific clinical documentation education Video / Application Technology Provide video and smart phone application tools to deliver documentation tips as well as recorded peer led trainings Lessons Learned Identify Physician Champions early and understand how to integrate them into the ICD-10 Program Planning logistics for thousands of Physicians to attend Peer-to-Peer Training takes time and organization Understand where to focus Physician Education by analyzing top DRG s, high volume procedures and potential net revenue impacts Leverage technology tools to help with documentation- Epic, CAC, etc. 17

18 Sutter Health: Physician Education Timeline 8/1/13: Awareness Video 11/18/13: Dual Coding 2013 Q Q Q Q Q Q4 7/1/13: Online Education 8/21/13: Began Specialty Specific WebEx Sessions 10/14/13: Began Peer to Peer Sessions 4/14/14: ICD-10 System Training 5/31/14: EPIC ICD-10 Clinical Functionality Go-Live 18

19 Sutter Health: ICD-10 Awareness Strategy Target Audiences Coders & Auditors Compliance Nurses Patient Access Patient Financial Services Physicians Regional Leadership Sutter Health Leadership What have we done? ICD 10 dedicated intranet portal Routine updates to SharePoint sites ICD 10 awareness video Where are we going? Monthly newsletters ICD 10 Tuesday talks: Q&A sessions arranged for stakeholders to dial in and ask questions ICD 10 specific inbox to field all inquiries Electronic communications Yammer (internal social networking site) Blogging 19

20 PANEL Q&A 20