Many providers have envisioned ICD-10 as a solid brick wall looming ominously in the distance: an unavoidable hurdle that blocks out the view of the world on the other side. While the most recent ICD-10 delay pushes back the big jump over the wall until October 1, 2015, healthcare organizations still need to work on exercising their muscles to prepare themselves for a successful leap when the time comes.
We started the ICD-10 implementation late. I know some organizations probably started about a year ago. We started about maybe six or seven months ago, because we were in the middle of our EHR implementation. So, we had a sequence of events here that’s probably not unlike many organizations that go through a lot technical upgrades and changes. ICD-10 promises to help with the revenue cycle. While that’s probably the long-term goal, the short-term challenges are going to be behavioral in nature.
It’s always really difficult to ask folks to change the way they’ve been doing things for thirty or forty years. The delay gives us more time for education, and it gives us more time for letting folks get accustomed to it. So from our perspective, it was a blessing in disguise.
Pushing off ICD-10 for another year will cost us financially, though. It’s probably going to add another six-figure number to the equation when we’re done, but we think that it’s probably worth it in the long run just because we don’t have to deal with all our implementations at the same time now.
Was Miami Children’s going to be ready for the 2014 implementation date?
We were going to be ready either way. Now we can focus on a patient accounting system and move forward. What we have done is delay the project, though. We were pushing very fast to get it all done, and it wasn’t going to have the same outcome as we will now with a little bit more time to get everything in order and settled down.
I don’t think we’re taking our foot off of the pedal as much as we’re just relaxing it just a little bit, just enough to understand that we’re not going to focus so much on the implementation, we’re going to focus on the readiness and the education of our physicians.
We want to make sure that we have a solid process and a solid workflow, so while we’ll continue to move forward as fast as we can, we don’t expect, in any way, to look at this as a one-year breather or say that just because it’s delayed, we don’t have to worry about it at all for another year. We need to work just as hard. Instead of doing a compressed seven or eight or nine month model, we’re now spreading it out over a one and a half year model. So, it’s the same strategy, just a little bit more depth to it.
What are the biggest challenges you’re anticipating at the moment?
Getting physicians to document better in exchange for better coding capabilities is not an easy task. We need to take some additional time to weigh all those issues and work with the physicians and train them better.
While ICD-10 is a hit on the back end, where the coders have to be trained and technologies have to be modified, those things are doable. It’s hard, but it’s doable. When dealing with physician adoption, it’s a really daunting task. It’s not impossible, but the more time we have, the better it is.
Has your recent EHR implementation prepared your staff for the rigors of the ICD-10 switch?
I think that’s a fair statement. I think that because of the proximity to that first EHR implementation it makes the idea of the change a little easier. But at the same time, it makes it just as hard because they just went through an implementation a couple of years ago and now we’re asking for another one.
They’re probably better prepared because they understand the complexities, they understand the upsides and downsides of an implementation, but also they’re probably tired of seeing implementations at the moment.
What’s your advice to other organizations trying to modify their timelines to meet the new implementation date?
Take a breather. Look at your plan. If you need to extend it out, which you probably do, do it. It’s going to cost a little bit more money, but in the long term, it probably will be a much better outcome.
A lot of people are gun shy, and they’re going back and saying, “Hey, we just can’t do this because we don’t have enough money for it.” They try to bring it in-house to save a little bit. But we’re not experts at this stuff. You do need help. You need to get the right consultants on board to help you do a good implementation, and you need to depend on them. I don’t think my staff, with the bandwidth limitations we have, can tackle something like this on their own.
And I stress again, the extra six-figures or a million dollars it may add to the costs for next year will be a drop in the bucket if things go bad. If you can’t code and get cash in the door, you’ll probably be looking for a new job. It’s a lot easier for a CIO to explain to the board that he needs another million dollars now than that he lost $50 million due to poor planning.
Date: June 10, 2014