October 2013

ICD-10 Mash-Up Thrives in Idaho
By Carolyn Gutierrez
For The Record
Vol. 25 No. 14 P. 30

In preparation for ICD-10’s October 2014 deadline, Idaho has launched a coalition composed of professionals from the Idaho Health Information Management Association, Idaho Medicaid, Boise State University, the Idaho Medical Association, St Luke’s Health System, the Idaho Hospital Association, and Regence BlueShield of Idaho. By sharing information and resources plus providing access to training, the Idaho ICD 10 Collaborative hopes to aid and support its workforce as the industry undergoes the daunting conversion to the new code set.

Readiness Survey
To assess the state’s standing in terms of readiness for the transition, the collaborative conducted a survey in February to hone in on potential stumbling blocks. The 159 respondents worked at physician offices (39%), hospitals (13%), clinics and/or health centers (11%), mental health facilities (8%), allied health providers (6%), ancillary services (5%), integrated health care organizations (2%), and assorted other entities, including post–acute-care and non–health-care settings (17%).

About 45% of the respondents represented offices with fewer than 10 staff members, while 31% represented organizations with a workforce ranging from 10 to 100 staff members.

Survey results showed that providers were in various stages of ICD-10 preparation, with 52% of respondents assessing system requirements and 17% at a testing or deployment stage.

Awareness Gap
The survey brought to light several factors standing in the way of a smooth transition to ICD-10, the most substantial being lack of knowledge (62%) and staffing and training capacity (54%), both of which are more likely to affect smaller entities. In the collaborative’s assessment of the survey, it notes that the state’s larger providers will be prepared by the 2014 compliance date. However, it also acknowledges that the “results indicate a knowledge and awareness gap regarding ICD-10 implementation, particularly in the smaller offices across the state.”

The collaborative speculates that the knowledge gap may be due in part to the remote locations of many of the state’s providers. This remoteness, combined with the gargantuan task of preparing for ICD-10 while tending to patients and day-to-day business operations, presents a clear challenge to smaller providers.

Adding to concerns about the awareness gap are the survey results showing that 54% of the respondents’ organizations had not yet developed an internal ICD-10 education/training program, with only 12% indicating their organization had initiated one and 28% being in the process of doing so.

The survey summary notes, “The Idaho ICD 10 Collaborative recognizes this as an opportunity to address the statewide gap by raising awareness, connecting stakeholders, and developing education, training and communication action plans. Over the next 6 months the Collaborative will reach out to providers who expressed specific needs via the survey as well as those who are interested in engaging in the work to close the gap.”

Competing Priorities
According to the collaborative, competing initiatives, such as the state health insurance exchange, EHR implementations, and various Centers for Medicare & Medicaid Services (CMS) delays, may push ICD-10 training onto the back burner. Only the most pressing issues garner immediate attention, and until providers choose to make ICD-10 education a priority, training at some facilities may be delayed for as long as possible.

The collaborative notes that many of Idaho’s critical access facilities, which constitute much of the state’s hospitals, lack extensive coding departments, making it difficult to pull staff members away from their daily workload to attend training sessions without impacting day-to-day operations. Meanwhile, larger health systems can handle ICD-10 training with less disruption.

Working With Payers
When asked to rank the information needed from payers according to level of importance, respondents listed a top three of coding guidelines, changes in processing, and payer ICD-10 conversion schedules. In addition, there was a preference for obtaining pertinent payer information through online manuals, educational tools, webinars, and open forum sessions. Physical manuals, mailed materials, in-person training, rep visits, and company meetings were information-dispersing methods that garnered lower rankings.

As for immediate training needs, the collaborative partners note, “We would like to see our smaller provider offices further along in the transition to ICD-10. However, as a collaborative, we are committed to filling the gaps as we find them when it comes to communication, education, and training and testing.”

ICD-10 Testing
Idaho already has begun testing the exchange of codes. “Based on our work, we know that some of our commercial payers in the state have begun testing with hospitals that are ready,” the collaborative says. “We have confirmed they have not yet begun testing with other entities.” Payers report that the testing thus far has been manual, and there has not yet been an exchange of electronic claims data.

The ICD 10 Collaborative says a testing workgroup plans to initiate a series of roundtable sessions to exchange ideas on how best to support the hospitals, payers, clearinghouses, physician offices, and other entities in need of assistance during the conversion.

Going Forward
The collaborative’s goal is to proactively disseminate information and resources as well as provide training opportunities and funding for ICD-10 educational events. The “train the trainer” program offered by the collaborative provides ICD-10 instruction statewide for just the cost of transportation and materials. The training can be tailored to target specific provider needs, such as programs for permanent staff or a workforce featuring a high number of freelancers.

The survey showed that 65% of the respondents have yet to develop an ICD-10 contingency plan. Only 2% of respondents already have one in place, while 9% report they currently are in the process of implementing some form of contingency.

Feedback from respondents underscored the awareness gap, with comments running the gamut from asking exactly what was ICD-10 to concerns about understanding its basics and the need for training assistance. Encouraging commentaries recounted software updates, burgeoning educational programs, and establishing testing plans.

“We believe as a collaborative that we have the right players at the table: the payers, providers, associations, coders, and testing expertise to help meet the needs of the state. Any provider that is willing to be proactive regarding the ICD-10 changes can get information and resources to assist them within the state of Idaho,” the collaborative says.

As the compliance date looms, it appears Idaho providers are set to meet the challenge. Thirty-eight percent of respondents indicated that they are very likely to be prepared for the ICD-10 conversion, while a marginally lower number (37%) answered that they will be somewhat likely to be ready. On the other side of the ledger, only 8% maintained they were not likely to be ready, while 17% reported they do not know.

The implementation of ICD-10 will tremendously impact all branches of the health care industry. The CMS has made it clear that the October 2014 deadline is intractable, creating a heightened sense of urgency for education and hands-on training. In that regard, Idaho appears to be in good hands.

— Carolyn Gutierrez is a freelance writer in New York City.