The transition to the U.S. adoption of the ICD-10 Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) is in full swing and organizations across the entire healthcare landscape — providers, payers and vendors — are realizing just how large an endeavor it is. As such, many in the provider community are seeking best practices and proven strategies that can help streamline their efforts.

So Siemens partnered with two leading-edge customers to develop this Top 10 list of best practices for ICD-10 readiness. As the second installment of the ICD-10 article series, we interviewed three experts from two forward-thinking health systems that are ahead of the curve and already executing their ICD-10 strategies:

Peggy Lynahan, 
Program Manager, ICD-10 Program at Christiana Care Health System 






Kathy Westhafer, RHIA, CHPS, 
Program Manager, Clinical Information at Christiana Care Health System






Donna Coomes, MBA, RHIA, CSS, 
Corporate Director of Health Information Management, Mountain States Health Alliance. 

Invest the time to build support across your organization. This was the approach taken by Christiana Care. For the first year after the ICD-10 requirements were known, Lynahan and Westhafer worked with senior executives — a top-down approach — to develop support for the upcoming transition and help ensure the initiative was viewed strategically, rather than as a compliance project. 

“ICD-10 should be about doing what’s right for the patient. Not what makes your organization compliant,” says Lynahan.

Virtually every facet of an organization — from clinical care to billing to registration — is touched by the ICD-10 initiative. It’s critical to establish a formal structure to help ensure all of the pieces are working together toward a common goal. For Mountain States, this meant assembling a steering committee with a number of smaller work groups — including ICD-10 Education, Forms, and Physician Communications — that report up on a regular basis. 

“Our steering committee has representation from across the organization and is led by our Director of Compliance, which emphasizes and helps support the idea that ICD-10 is an enterprise-wide initiative,” says Coomes.

If you have not done an ICD-10 impact assessment, get it done now. An impact assessment is a gap analysis of what systems and processes you have in place today and determines the impact ICD-10 will have on each of them. Westhafer advises going through a formal partner selection process and securing the services of a knowledgeable third-party organization to lead this effort. 

“It boils down to timing,” says Westhafer. “The deadline is fast approaching and there is more information to be collected than most organizations can handle with their existing resources. If we were alone on this, it would have taken Christiana Care months and months to gather the information our partner captured in just a few weeks.”

Electronic surveys are a great way to reach out to your staff, gather initial impressions, take a snapshot of current understanding, and help the strategic planning process. 

“We developed and sent each department head at Mountain States a formal survey that conveyed the details of ICD-10 and helped them determine how it would impact their department and what training would be required to make that transition,” says Coomes. 

The first survey was well-received and the responses offered the necessary information to begin developing training schedules and formats. Coomes anticipates leveraging additional surveys leading up to the Oct. 1, 2013 compliance date.

Even the best ICD-10 strategy will fall short unless there are clear and documented action plans that are communicated across the entire organization. This, however, requires coordination and consistent messages. To accomplish this, Christiana Care’s Lynahan and Westhafer tapped their Communications Department to develop an awareness campaign for staff across the health system. They also organized a retreat — inviting cross-departmental representatives to participate — and asked them to give short presentations on their various initiatives that are impacted by clinical documentation. 

“This interactive format was instrumental in creating the opportunity for open discussion on the need for these initiatives to integrate and consider the impact of ICD-10 on each department and initiative,” says Westhafer.

It’s important to remember that there is more than one audience to include in outreach efforts. Christiana Care, for example, extended its communications plan to a larger audience beyond its medical staff. 

“We don’t assume that our efforts around ICD-10 will go so smoothly that our patients won’t notice any changes,” says Lynahan. “For example, if we get closer to the deadline and realize that billing may be delayed, we want to work with our Christiana Care community and patients. It is important to let every one know what’s happening and that ICD-10 is an enormous change for healthcare.”

Don’t train anyone on ICD-10 until they are ready for it. For Mountain States, no detailed training will begin until nearly one year prior to the Oct. 1, 2013 compliance date. Coomes plans to start small with anatomy and physiology training sessions for coders at the end of 2011, but the heavy-duty coding training won’t begin until six to eight months out. 

“This ‘wait until they’re ready’ approach is also applicable to physicians, who typically don’t accept change until it’s absolutely necessary,” says Coomes. “So we will have super users — trained and prepared — ready to bring our physicians up to speed about six months before the compliance deadline.” Although a “wait until they’re ready” approach is sound advice for some organizations, be sure to assess your staff’s ICD-10 readiness and take action when necessary. Depending on your current readiness status, training now may be the best approach.

Coomes suggests you take a close look at staff benefits and be cognizant of retention efforts. Many coders, for example, have the option of working from home. This model, however, is a deterrent if your plan is to take a train-the-trainer approach when it comes to ICD-10 readiness, as the trainer is required to commute to a facility. This, in turn, places additional emphasis on well-defined job descriptions for new hires and retaining talented coders.

“You will be making large investments in recruiting and training coders for ICD-10, so you’ll want to examine your retention efforts,” says Coomes of Mountain States. “Good coders are hard to find and in high demand. Protect that investment with incentives that encourage loyalty.”

Coomes expects a productivity loss of anywhere between 30-45 percent at Mountain States in the first six months after the transition to ICD-10. As such, she is staffing accordingly — particularly with coders — to ensure the resources are ready when the time comes. 

“Plan for the worst-case scenario,” says Coomes. “That way you can minimize the productivity impact to your organization.”

Both Christiana Care and Mountain States suggest reaching out to payers and vendors — now — to establish lines of communications that can be used throughout the transition period. This offers you a better sense of where they are in their ICD-10 transition initiatives. In turn, you will be better able to mitigate risk and develop alternative action plans should one of them be unable to meet the Oct. 1, 2013 compliance date. 

As always, Siemens will continue to provide updates throughout the transition time leading up to the ICD-10 compliance date, and don’t forget to frequently check the Regulatory Infopedia for updates and additions. New updates that were added this summer include our Siemens Report Card and various product-specific frequently asked questions (FAQ) documents. For more information, please contact Rhonda Taller at rhonda.taller@siemens.com.