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The ICD-10 ProjectA Mission Critical AOP Goal

for FY13

John D. Halamka MD

Katherine Dallow MD, MPH

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FY13 Annual Operating Plan

Improve the Health & Well-Being of Patients, Families, Employees Through Innovative Clinical Care, Education, & Research

System

Advance as a system of care

Clinical Care

Education

Research

People

Engage and develop our people every day

BIDMC Fiscal Year 2013

Operating Plan:Information Systems

True North

Grow and enhance a market-leading system of care…

… that delivers the highest value…

… by creating and sustaining a culture of continuous improvement…

… through engagement, development, and support of our employees, physicians, patients & families

Owner/ Date

• Develop, standardize, improve transitions among sites of care

• Respond effectively to the needs of our network and affiliates

• Achieve optimal alignment between physicians & hospitals

• Enhance wellness and safety

• Promote & support a culture of service excellence and continuous improvement

• Optimize & support learning & development

Key Opportunities Leader Partners Deliverable/Goal Departments impacted?

Achieve Meaningful Use Stage 2

IS, Nursing, AmbulatoryCertification by October 1, 2013 and Attestation by December 31, 2013. Includes EMAR

All

Implement ICD10 IS, Nursing, Ambulatory, HMFPExecute 5 workstreams specified in ICD-10 plan, remediate clinical and financial systems. Includes Clinical Documentation Imrpvoement

All

LIS Go live IS, Nursing, Pathology, Ambulatory

Phase 1 go live All

Implement Compliance Priorities

IS, Compliance, HR LMS go live, security initiative completion All

Support ACO Needs IS, HMFP, BIDPOImplement Care Management features in webOMR and business intelligence applications

All

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2

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Cost

Continuously improve our ability to adapt to changes in the healthcare

environment

Maximize efficient utilization of resources:

•Staff•Equipment & supplies•Space•Diagnostic testing & treatment

Quality

Ensure reliability

•Implement processes that measurably decrease harm/defects

•Improve reliability though standardization

•Measurably improve patient & family experience

Value = &

International Classification of Diseases, 10th Revision

1st revision introduced in 1900 International comparisons of mortality Used in USA for medical reimbursement Two parts –

ICD-10-CM covers diseases and injuries ICD-10-PCS covers procedures

Federally mandated cutover Oct 1, 2014

Codes are the language of healthcare and will impact virtually all areas of healthcare.

Payers

Finance

Clinical CareQuality Reporting

ITICD-10

ICD-9 CodeAssignments

2.7M~

HIM Inpatient

400,000

HIM Outpatient

500,000

Fee Ticket, ED,Radiology, LabOrders, RadOnc

1,800,000

Typical Fiscal Year

Where are we currently using ICD codes?

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Applications AffectedEncoding Software Case Management

Case Mix Systems Clinical Protocols

Medical Record Abstracting

Test Ordering Systems

Billing Systems Clinical Reminder Systems

Registration & Scheduling Sys

Performance Measurement Sys

Accounting Systems Medical Necessity Software

Decision Support Systems Disease Management Systems

Clinical Systems Provider Profiling Systems

Utilization Management Aggregate Data Reporting

Quality Management

Diseases and Injuries

ICD-9-CM ICD-10-CM

3 to 5 characters 3 to 7 characters

14,500~ codes 79,500~ codes

Lacks detail Very specific

Lacks phase of care Initial, subsequent, and sequela

Lacks laterality Left versus right codes

ICD-9-CM Code for finger injury is 915.8ICD-10-CM Code is:

S60440A External constriction of right index finger, initial encounter

S60440D External constriction of right index finger, subsequent encounter

S60440S External constriction of right index finger, sequela

S60441A External constriction of left index finger, initial encounter

S60441D External constriction of left index finger, subsequent encounter

S60441S External constriction of left index finger, sequela encounter

S60442A External constriction of right middle finger, initial encounter

S60442D External constriction of right middle finger, subsequent encounter

S60442S External constriction of right middle finger, sequela encounter

ProceduresICD-9-CM ICD-10-CM

3 to 4 numbers 7 alpha-numeric

3,860~ codes 72,100~ codes

Not up-to-date Reflects recent terminology and devices

Lacks laterality Left and right

Lacks detail Details body part, approach, device, qualifiers

Generic terms for body parts Detailed descriptions for body parts

ICD-9-PCS for knee replacement 81.54 ICD-10-PCS is 0SRD0JZ

Character DescriptionName of section 0 – Medical and Surgical Section

Body System S = Lower Joints

Root Operation R = Replacement

Body Part D = Knee Joint, Right

Approach 0 = Open

Device J = Synthetic Substitute

Qualifier Z = No Qualifier

Clinical Service Impact Examples Emergency Department

37,000 more injury, poisoning, external causes codes Anatomic specificity for fractures

Obstetrics Several codes driven by trimester

Neonatal-Newborn Severity of conditions, e.g. prematurity Congenital conditions

Orthopedics Laterality Expanded list of device complications

Pulmonary Severity of asthma More specific mechanical ventilation times

Neurology Dominant/non-dominant side impacted

Financial Impact 57 percent of hospital revenue from inpatients

ICD codes DRG DRG payment Single code can swing case by $10,000 or more

Outpatient codes explain medical necessity Quality measures

AHRQ Patient Safety Indicators Hospital Acquired Conditions Value Based Purchasing

Acuity settlements for BIDCO pay-for-performance

Acuity Adjustment/DxCG BIDCO Global Payment Contracts BCBS, HPHC, Tufts, Medicare–Pioneer ACO Global budget for all medical expenses (in and out

patient), with shared savings if below target budget Budget is adjusted up or down based on

population acuity level (DxCG) Acuity level is determined by ICD codes

accumulated in a given calendar year Value resets to demographics only on January 1 ICD-10 vastly expands the potential number and

specificity of these acuity adjusting codes

Quality Metrics

Inpatient and Outpatient Readmissions, Diabetes, Cardiovascular, Depression,

Cancer Screenings, Antibiotic Avoidance in URIs, Vaccinations… and much much more

Accurate ICD coding is essential for documenting both diagnosis inclusion and exclusion criteria

Risk no credit when the work is done appropriately Risk non-compliance when comorbidities are omitted

Case Management

Disease and comorbidity based algorithms Optum/IPro software Definitions of risk based on claims - financial and disease

based (ICD coded) information

BIDCO Nurse Care Managers BIDCO Clinical Pharmacists Inspiris NP CarePlus Home Visit Program-ACO Disease Management Programs

Workload Impact Dual coding

Some payers may not be ready Some payers not covered by HIPAA Claims-in-progress October 1, 2014 Get-acquainted period for coders Historical or other operational needs

Superbills (aka Fee Tickets) Over 900,000 visits per year have codes

checked on paper

Impact on Superbills

Original Orthopedics Superbill2-Pages

Converted Orthopedics Superbill49-Pages

ICD-10 Transition Project

Steering Committee-------------------------

Steve FischerJohn Halamka

Technology-------------------Steve Herzog

Payer/Contracting----------------------

Beth O’TooleKaty Coughlin

Workflow/CAC------------------

Ed GrabJohn Powers

SEI Consulting

Education/CDI-----------------------Gerry Abrahamian

Luisa Dileso

CoordinationCouncil

----------------------APG, BID-N, BIDCO,

Milton

Work in Progress

Workflow maps Payer and vendor “readiness” surveys Inventory of impacted systems Educational curriculum for coders and

clinicians Pipeline and Bridge programs planned Evaluations of computer assisted coding Discussions with major technology partner Statewide coordination through MHDC

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Questions