The ICD-10 PlayBook: Hitting IT Out of the Park!

Over 1,600 people attended yesterday’s webinar on the launch of the new ICD-10 PlayBook, a cross-industry resource spearheaded by HIMSS. The PlayBook required the active participation by all the operating departments at HIMSS – from web to legal, education, communications, and more. The effort to create a useful program required strong internal input and structure and senior management buy-in.

It also required an extensive external campaign. Let me explain.

The ICD-10 PlayBook contains content from other associations, not just HIMSS. These groups are relying on HIMSS to provide a trusted home for their content and an efficient communications channel for the provider community in particular.

But, to gather all the content, and agree on transformational strategies that are outlined in the ICD10 PlayBook, we had to gather the groups, and for this, we used the HIMSS G7 thought leadership platform. Aided by Vanderbilt Center for Better Health, we were able to bring over 20 associations and 45 executives together to discuss the content, design and message of the PlayBook.

At launch, Tori Sullivan, Chair, HIMSS ICD-10 Task Force, applauded the new resource; she led participants through the PlayBook and highlighted some of its outstanding features, including the PlayBook’s structure. The content will “morph,” but it will do so along the timelines established by topic area as the industry advances toward the October 2013 ICD-10 industry-wide GO LIVE date!

After Tori’s presentation, Tyson McDowell, CEO, Benchmark Revenue Management, and Chair, HIMSS Revenue Cycle Improvement Task Force, reviewed the impact of ICD-10 on the revenue cycle. He strongly recommended that providers budget for building a data warehouse that merges financial and clinical data, creating a model that can compare before and after - and do it “for a period of years.” He also advised that providers hire an analyst and cross train them between ICD-10 and revenue cycle, plan for some level of outsourcing (more demand on talent than available talent pool), and communicate with lenders and rating analysts – critical for securing financial sustainability during conversion.

Ross Lippincott, Vice President 5010 & ICD-10 Programs, UnitedHealthcare, then focused on the newly released HIMSS G7 Advisory Report and a perspective of ICD-10 transformation from one of the largest health plans in America. He discussed how the high level of engagement by all the industry groups lead to great idea scanning, including how to structure the ICD-10 PlayBook “version 1” and what’s needed in the next version on how to grow the “PlayBook Community.”

Lippincott suggested that there could be a “5-year stabilization period” after ICD-10 implementation. Thus, there is a critical need to mitigate financial risks. He echoed McDowell’s comments that a financial baseline is required, establishing a bridge plan with a bank, reserving 6 months of cash flow and develop contingency plans, if drops in revenue occur.

From an operational perspective, incremental effort for translation will require re-working work flows, delays in authorizations and higher claims rejections. Staffing resources will be sorely stretched to support research and reimbursement.

Mitigation must start with a baseline – from both financial and operational perspectives – and knowing that baseline for each payer is also important. Workforce training was mentioned over and over as a critical part of risk mitigation. There is an aging workforce, shortage of ICD-10 coding skills and time for training inexperienced staff…not too mention competing priorities with other legislative mandates like 5010, meaningful use, operating rules and other areas.

Lippincott felt that having coders brush up on anatomy and physiology is critical in preparation for ICD-10. He anticipates the hardest hit areas are physician practices. They will have to increase level of medical records documentation across all settings. Software changes are required.

There are, believe it or not, positive benefits too. While it will take time to “ingest” all the new codes, ICD-10 will enable more specificity with treatment programs, opportunities for new reimbursement models and reduced administrative expenses.

Tori ended the call with a specialized panel of hospitals, consultants, banks and HIMSS staffer, Juliet Santos, Senior Director, Business-Centered Systems. Attendees posed many questions; these are a just a sample:

1. What are some ICD-10 issues to look for when designing workflow for Meaningful Use for EMR/EHR initiatives?
2. How does driving ICD-10 compare to the challenge of HIPAA-compliant transaction changes?
3. Do you have any tools to evaluate anatomy and physiology skill sets of coders?
4. Are there any plans on part of any government entity (ONC, maybe?) to create a ICD-10 code translation web service (or maybe share a database) so that each hospitals wouldn’t need to recreate code the translation table in their EHRs?
5. As an HI director at a small children’s center (mostly long-term care with some short-term rehab programs) that is reimbursed per diem, what advice do you have to prepare for ICD-10? 

After months of planning, this new industry resource has come together to help equip providers with tools for ICD-10 transformation. Continuing industry input is high and the ICD-10 PlayBook will grow, content will change frequently and critical communications from health plans to providers in particular will be posted as well as industry events around ICD-10. 

Make sure you visit the ICD-10 PlayBook on the HIMSS website.