Over the past few years, we have seen rapid change in health care and specifically in eye care. Unfortunately, changes are often slower than the demand or need, and we often have mediocre results at best.
One of the buzzwords that is very popular in corporate and leadership development circles over the past few years is “change management.” We can all agree that the need to change and the speed of change both continue to increase. Change was once a way for companies to thrive or gain a competitive advantage-now it is a necessity in order to survive.
Over the past few years, we have seen rapid change in health care and specifically in eye care. Unfortunately, changes are often slower than the demand or need, and we often have mediocre results at best. As the October 1 implementation date of the new ICD-10 coding system rapidly approaches, our offices like many others are scrambling to make sure we are ready. Our ability to manage the change will be critical to our survival.
I have talked with many doctors across the country, and the overwhelming sense is that no one is fully ready for the change. More troubling, many doctors have not even started the process. For those of you in this situation, hope is not a strategy, and the time to start is now. No matter where you are in preparing for ICD-10, the countdown has started. Barring some miracle delay, the change is inevitable. At least we know what needs to be done, and we have a deadline.
Related: Many ODs unprepared for ICD-10
The World Health Organization (WHO) is a specialized agency within the United Nations (UN) that focuses on international public health. The tenth edition of the International Classification of Diseases (ICD-10) coding was initially endorsed by the World Health Assembly in 1990 and first used by World Health Organization member states in 1994.
If it seems that the United States is rushing to implement ICD-10, we are actually more than fashionably late to the implementation party. The system, already adopted by most UN member states, is a way to universally collect and monitor health information across member states. The ICD system in general provides a way for member states to monitor national rates of morbidity and mortality, the primary indications of health status. Within each country, the ICD system is used as a standardized way to allocates resources and reimbursements.
The Department of Health and Human Services published its final ruling to adopt ICD-10 in the United States on January 15, 2009, with an implementation date of October 1, 2013. That date has been delayed twice with a new implementation date of October 1, 2015. It looks like ICD-10 is finally going to be implemented, so it is time to get ready.
Next: 6 steps to prepare for ICD-10
Below is our step-by-step approach to ICD-10 preparedness and implementation
For us, the first step in preparing for ICD-10 implementation has been doing the homework and trying to understand the real obstacles to implementation. When a systematic change as big as ICD-10 conversion happens, there is a tremendous amount of information and misinformation being propagated. Finding credible and reliable sources for information is critical.
I am skeptical of the multitude of e-mails that I receive from companies touting how they can prepare us for ICD-10 with fees ranging from $199-$2,999. My mantra is always, “Go to the source.” In this case, the Centers for Medicare and Medicaid Services (CMS) is the authoritative source for ICD-10. If you want the real deal and the history of ICD-10, go to CMS.gov, and everything is available to you. The next time you are in a lecture or presentation and hear some wild comment or claim regarding ICD-10, ask for the reference. If it is anything other than CMS, caveat emptor.
Our second step in preparing for ICD-10 was basic project management of identifying and assigning key roles. The two key people in our preparation have been my billing manager and IT manager.
I am blessed with a talented and conscientious billing manager who is the spearhead of our preparation for ICD-10 billing. She has been diligently working toward ICD-10 conversion for the past two and a half years. We were gearing up for the initial implementation date of October 2013 before the reprieve that delayed implementation until October 2014, then it became October 2015.
If you have not been working at it that long, not to worry. You have time but need to assign the roles and get started today. Most of our preparation has been in watching videos and webinars on the basics of ICD-10 and preparing a training plan for the rest of the staff and doctors. If you have a smaller office, you may want to put together your training plan so that everyone watches the videos and training materials at the same time.
The second key person in our preparation has been our IT manager. Again, I am blessed with an IT person who has a wide range of knowledge and expertise. He has diligently kept our systems updated so that when the time comes to upgrade our software to the ICD-10 compatible version, we will be ready. For me, this is the most difficult piece in the puzzle. Understanding how overnight we switch from ICD-9 to ICD-10 and how much of the coding will occur in the system is the great unknown at this point. Making sure your system is compatible with new software that incorporates ICD-10 is a must-do now!
Next: Train doctors and staff
We have now started our full-on training for all doctors and staff. Our training plan is twofold.
When we train, we want everyone in the office to have a baseline working knowledge of everything going on in the office. Whether it is a new piece of equipment or a new lens in optical, everyone needs the big picture. Our staff meetings are now very heavy on ICD-10 training that is primarily overview on what will happen during implementation.
The second piece of training is in-depth job specific training required for each person or department. Obviously, our billing team is ahead of the curve and already working to understand what is needed both from them and also what they need from everyone else.
Over the next months leading up to ICD-10, we have a detailed training plan for each section so that we can be as ready as possible. Many resources are available online for training, including the Medical Learning Network hosted by CMS (see box for more information).
In early July, our IT manager was able to obtain an advanced copy of the ICD-10 version of our EHR system. We are now in the process of getting our hands dirty playing with the software trying to understand the capabilities of the system. This in turn helps us plan more targeted and real-word training for staff and doctors. I highly recommend pushing your EHR provider to get you access as soon as possible so you can determine the limitations and capabilities in order to have focused training and realistic expectations.
Next: Use your resources
We have utilized the resources available from our affiliation with an optometric network, organized optometry, and peer-to-peer collaboration. Although CMS is the authoritative source for all things ICD-10, that does not mean we are not watching, talking, and listening to a multitude of other sources for tidbits and best practices.
Like many of you, we are part of a national group of affiliated optometrists in an optometric network and the resources, thought leadership, and value of knowing others are in the same boat as we are is invaluable. We have taken advantage of training programs and materials as well as sharing best practices within this group. Organized optometry at both a national and state level has also provided valuable resources and forums to assist with implementation. Finally, we are members in a study group with six other offices from around the country. We get together every six months to share ideas and best practices. Our next meeting in August will be geared around ICD-10 and a sharing of thoughts, ideas and counseling around ICD-10 and the way forward.
In preparation for ICD-10, we made a visit to the bank. Despite best-laid plans by our entire team, it is prudent to have a contingency plan in case things are not as smooth as we would like. To that end, we have worked with our bank to establish a specific line of credit for each office just in case we see a significant decrease in revenue from a disruption in the payment cycle as ICD-10 is implemented. We hope this is not necessary, but when October 1 arrives, I will sleep better knowing that we do have a plan to maintain cash flow just in case.
Next: Looking ahead to implementation
By the time you read this article, we will be in the 45-day countdown toward ICD-10 implementation. At that point, you will still have time to do all of the things above and get prepared for ICD-10. In all honesty, starting now may even be a benefit because you will have a sense of urgency and access to the latest and most reliable information.
As we look forward and execute our training plan and system upgrades, the next big milestone will actually be implementation day on October 1. Our plan is to go all out and treat it as just another clinic day-albeit with an all-hands-on-deck mentality. Initial focus will be on maintaining continuity of patient care and realizing if our EHR system is not responding to patient information input or coding. We cannot dwell on that during clinic but must remain patient focused and sort out the problems at the end of the day when patient care is completed. We anticipate challenges and will approach the day with a positive mindset and fallback plan. Past the stress of “flipping the switch” and being ready for October 1, the next big milestone will be in the days following implementation.
No matter how good the plan, EHR, and implementation on October 1, a key to success will be a post-implementation evaluation. We will gauge success as the billing department starts scrubbing the first claims to see if they are done correctly. The next step will be to see if the claims transmit through the clearinghouse without glitches. Finally and most important will be close monitoring for timely payments for the correct amounts. We always monitor our insurance and patient accounts receivable, but on September 30 we will run a baseline accounts receivable to benchmark against in the weeks and months that follow.
Ultimately, the post-implementation evaluation is more critical than all of the work that leads up to implementation. It would be irrational and delusional to think we will get it all right, and everything will be perfect. Our ability to monitor, evaluate, and readjust after implementation will be paramount.
I hope this is much to do about nothing, and we all have a simple and easy transition to ICD-10. Our ability to manage the change will be a test to our practices, our profession, and our healthcare system.
By the way, ICD-11 is ready to be released by the World Health Organization in 2017.