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Should Hospitals Pull, Push, or Drag Physicians Toward ICD-10?


If hospitals create ICD-10 solutions and then impose them on physicians - and expect to pull the physicians into cooperation – good luck.

The question posed above assumes that physicians are the last, great obstacle to the ICD-10 transition. That may be the case if you wait until the last minute to get them on board.

For some, the approach is “physicians can wait.” Many hospital leaders appear to be of the opinion that detailed plans for any major initiative should be fully developed before presenting them to physicians.

Such an approach is likely rooted in past situations where physician endorsement of administratively popular plans was challenged over seemingly minor details. The resulting attitude that hospital administrations can do all the planning and development work and then gain support of the medical staff sets the stage for repeated failure.

Such failures have, in the past, been the source of frustration for both hospitals and medical staffs. So, it only follows that if the same process is attempted with ICD-10, the result may be catastrophic, particularly for hospitals.

We all realize that ICD-10 is a profound challenge to hospital management.

Ultimately diagnosis and procedure coding, as well as appropriate DRG assignment, are driven by physician documentation. Most hospitals have deficient infrastructure to assist physicians in achieving the most accurate clinical documentation under the current ICD-9 system.

The number of diagnosis codes will swell from the current 13,000 + to well over 70,000. If we can’t get it right now, what does the future hold? However, diagnosis coding is the easy part.

Hospitals will be required to code all inpatient procedures under ICD-10-PCS (Procedural Coding System). The number of procedure codes will swell from the current 4,200 to over 72,000. And here’s the issue: Unless the physician provides sufficient detail to code all seven digits of alphanumeric specificity for each procedure, the hospital will not be allowed to submit the bill to any payor.

Want to make it even more challenging? Physicians will continue to bill inpatient procedures for their professional billing under the CPT procedural codes (their current system). How motivated will they be to provide the more detailed information necessary for hospitals to submit their bills?

Let’s go back to my first question and break it down: pull, push, or drag?

If hospitals create ICD-10 solutions and then impose them on physicians - and expect to pull the physicians into cooperation – good luck.

Another alternative is to push physician leadership into solving the problem themselves, without the appropriate resources - another formula for failure.

Finally, can we simply pull the medical staff along kicking and screaming? This may, in fact, be the solution for many hospitals.

Let me build an all-too-real scenario that may well play out at many hospitals.

The ICD-10 implementation date for all providers is October 1, 2013, after which a hypothetical “Hopeful Hospital” expects all physicians to provide the necessary information for coding under ICD-10. However, surgeons and other procedural physicians are not “on-board.” They document for their professional billing. Surgeries and other procedural discharges cannot be coded and unbilled accounts build up rapidly. It is predicted that coder productivity during ICD-10 transition will also drop about 50 percent.

We now have a financial crisis for hospital management in that the revenue cycle is clogged like a bad septic system. Emergency management meetings are called and the solution put forth is to mandate that the medical staff cooperate or sanctions will be imposed.

With a change as profound as ICD-10, it is imperative that dialogue take place between hospital administration and physician leadership (now) to understand the underpinnings and rationale for ICD-10 as well as developing a collaborative approach to achieve success.

Physicians need peer-to-peer communication about the patient care benefits of adopting the standard of coding endorsed by most of the global community (ICD-10).

The general medical staff will need to be engaged within the next year in educational sessions regarding the appropriate support infrastructure for physician and hospital success.

I’m not saying that physicians will “learn” ICD-10, but we should empower physicians so that they can provide the information necessary for HIM professionals to accurately and completely code every medical record

So, the answer is don’t pull, push or drag - but rather lead: show physicians the benefits of ICD-10 for both their patients and their practice.

Paul L. Weygandtis the vice president of physician services for Atlanta-based J.A. Thomas & Associates, a firm that assists hospitals and physicians improve their clinical documentation. He can be reached here.

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