ICD-10: A Common Language for Monitoring Ebola and Other Global Health Threats

As the fourth American Ebola patient, a physician serving in West Africa, was flown to the U.S. for emergency care this week, I was reminded that public health also wins from the implementation of ICD-10.

According to World Health Organization (WHO), the latest Ebola outbreak has killed almost 2,300 people in five West African countries. Medical workers have been hit hard by the Ebola epidemic. As of late August, more than 240 healthcare workers had developed Ebola and more than 120 had died.

The Patient’s Side of Telemedicine

Last week, I had the opportunity to visit Good Samaritan Clinic in central Honduras. The clinic supports the primary care needs of 90,000 people within the municipality. Access to specialists is few and far between so Good Samaritan recently implemented telemedicine technology (computer, camera, imaging, and internet) to connect with specialists in the US. Access to these specialists is made available at no cost through the “Global Partnership for TeleHealth (GPT).”

Telemedicine is often defined as “the use of information and communications technology to deliver healthcare, particularly in settings where access to medical services is insufficient.” Better overall patient care and improved outcomes are cornerstones of telemedicine. As a result, many hospitals and health systems are deploying telemedicine as a way for rural patients to have access to healthcare services that they would not be able to obtain otherwise.

Staying the Course with ICD-10 Preparations

I was fortunate to participate in an HFMA webinar mid-April regarding ICD-10 readiness and the impact of the ICD-10 delay. During this webinar, HFMA staff reviewed the results of a February survey of hospital revenue cycle leaders. This webinar also included a panel discussion with revenue cycle executives from leading health systems. There was audience polling and quite a bit of interaction during the Q&A as you would expect given this hot topic.

There are five key takeaways I want to share:

AHIMA 2013 – Dreaming Big and Believing

From the moment I arrived in the Atlanta airport and saw the welcome banners celebrating AHIMA’s 85th anniversary and announcing the theme for this year’s Convention, “Dream Big and Believe,” I felt Kathleen Frawley’s presence. As many of you know, Kathleen was serving at AHIMA President and Chairman before her sudden passing this summer. She inspired the theme “Dream Big and Believe” and touched all of us with her passion for the HIM profession she loved.

Healthcare Executives Narrow in on Clinical Data

Last month, 3M Health Information Systems hosted our bi-annual Summit for healthcare executives in Park City, UT. This Summit brings together executives from many of the largest health systems throughout the United States to discuss issues they face and how 3M can help them achieve their organizational goals. It is a wonderful opportunity for peer-to-peer networking and information sharing.

Throughout the three day Summit, a few common themes emerged. When boiling the themes down, it became clear that each theme involved the need for large health systems to acquire, accurately document, organize and finally, fully utilize clinical data.

HIM Leaders Rise to the Challenge of Transitioning to Accountable Care

The transition to accountable care impacts executives throughout the entire healthcare industry. HIM leaders are no exception. Earlier this week, 3M hosted a Summit of corporate-level HIM Vice Presidents and Directors in Salt Lake City. These HIM leaders discussed the challenges they are facing and how their roles are evolving as a result of their health system’s participation in an ACO. The most significant change is a shift in their focus away from the inpatient acute-care environment to the enterprise management of information.

Key discussion topics the group explored during the Summit include:

• Challenges of record management in an ACO
• The role of HIEs in accountable care and population health
• Nuances and challenges of ACO compliance programs
• Creating data governance programs across the continuum of care
• The future of payment reform
• Big data and analytics
• Integrating disparate systems and the role of HIM

Let’s dig a little deeper into some of these topics:

Susan White and Lisa Knowles Hit Home Run at AHIMA ICD-10/ CAC Summit

While the Baltimore Orioles played the Toronto Blue Jays at Camden Yards last week, I was across the street listening to industry leaders speaking at the annual AHIMA ICD-10 and Computer Assisted Coding (CAC) Summit. One presentation which stood out was titled, “The Role of Technology and the HIM Professional in Ensuring Data Integrity,” co-presented by Susan White, PhD, Clinical Associate Professor at Ohio State University, and Lisa Knowles-Ward, RHIT, Director of Coding at the Cleveland Clinic. They reported the results of research recently completed by the AHIMA Foundation and the Cleveland Clinic. This research was funded by 3M and examined how CAC technology in the hands of the AHIMA-credentialed coder can improve data integrity.

RAC Audit Relief May Be On the Horizon

There is some good news on the horizon for HIM professionals buried in RAC audit requests and appeals. Last week, the much-anticipated Medicare Audit Improvement Act of 2013 was introduced into Congress. Hooray!

We all know the problem. :  According to the AHA, 75 percent of appealed RAC denials are overturned in favor of hospitals and providers. That is three out of four denials!  Unfortunately, these appeals can take months (or even years) before a decision is made. As HIM professionals know, the inefficiencies of the RAC program are resulting in a significant waste of valuable resources.

Industry Accelerating Efforts toward ICD-10 Transition

Last month, AHIMA received a letter from CMS confirming their commitment to the October 1, 2014 compliance date for ICD-10.  This commitment was reinforced during last week’s HIMSS conference where Marilyn Tavenner, Acting CMS Administrator, communicated that ICD-10 would not be delayed further.

We are seeing industry associations such as AHIMA, HFMA and HIMSS now accelerating their efforts to prepare their members for the inevitable ICD-10 transition.    ICD-10 readiness through industry collaboration and testing was a key agenda topic the last two weeks at both the HFMA Dixie Conference and the HIMSS Annual Conference.

During HIMSS, it was especially rewarding to see over 100 industry stakeholders get up for an early 7:30 a.m. meeting of the HIMSS/WEDI  ICD-10 National Pilot Testing Task Force.  This group has been working hard over the last few months pulling together health systems, physician groups, associations, clearinghouses, payers, vendors and consultants with the common goal of executing nationwide collaboration and end-to-end testing of ICD-10.    Rex Health, Cleveland Clinic, Banner, BCBS, Wellpoint, AmeriHealth, 3M  and AHIMA are a few of the participating organizations engaged to ensure end-to-end testing of ICD-10 can be accomplished and best practices identified over the next 12 months. 

EHRs and Compliance: Is HIM at the Table?

As I travel around the country meeting with hospital executives and HIM professionals, I often ask whether or not they believe HIM is “at the table,” working with hospital leadership to plan and implement organizational strategy. More often than not, the answer is yes. There are many reasons for this.

Government initiatives. Many initiatives (e.g., ACO creation, pay-for-performance, quality measures reporting, ICD-10) are driving senior leadership to recognize that recently implemented EHRs often contain unreliable data. As a result, HIM professionals are being called upon to evaluate the impact of poor EHR design on the physician documentation shortfall. HIM is leading efforts to design templates and queries to enhance physician workflow and support documentation and compliance requirements. What’s more, executive leadership is frequently looking to HIM to spearhead “copy and paste” guidelines to maximize patient safety and improve compliance. Increasingly, organizations are funding software tools to identify documentation patterns that detect “copy and paste” issues that could lead to inaccurate coding.