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ICD-10 Workshop:

ICD-10 Workshop:. Marci Burke, Director, Program/PMO Mark Scherling , IT Program Manager David Theis , Project Manager. Reflection: The Storm is Coming. Preparing for the Storm. Have an Emergency Plan Practice the Plan Listen for Warnings Recognize the Signs Take the Threat Seriously.

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ICD-10 Workshop:

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  1. ICD-10 Workshop: Marci Burke, Director, Program/PMO Mark Scherling, IT Program Manager David Theis, Project Manager

  2. Reflection: The Storm is Coming

  3. Preparing for the Storm • Have an Emergency Plan • Practice the Plan • Listen for Warnings • Recognize the Signs • Take the Threat Seriously

  4. Agenda ICD-10 Overview Provider Readiness & Workshop Non-Provider and Ancillary Staff Readiness System, Report, and Form Remediation Readiness Plans for Key Roles and Other Entities Next Steps

  5. ICD-10 Overview

  6. ICD-10 Leadership Executive Program Sponsor Tim Panks Program Advisors Katie LeBlanc Shelly Walters IT Sponsor Stan Martin Clinical Sponsor Dr. Joseph Colorafi Optum 360 Sponsor Emily Rafferty Program Director Marci Burke ICD-10 PMO Marci Burke Jonathan Weeks Tawnya Infantino HIM / Coding Chair Brian Dessoy IT Lead Nataiya Waller PM MJ Murphy Gonzalez • Provider / Clinical • Chair • Dr. Chandrasena • IT Lead • Kevin Barbee-Acute • Mark Scherling-Amb • PM • MJ Murphy Gonzalez Home Health Chair Paul Giles IT Lead Mark Scherling PM Chris Cruise Revenue Cycle Chair Jennifer Igel (Acute) Steve Scharmann (Amb) IT Lead Nataiya Waller-Acute Mark Scherling-Amb PM Chris Cruise Organizational Readiness PM, David Theis 6 **blue text = Optum360 employee

  7. ICD-10 code sets: • Represent an 800% increase over • ICD-9 code sets • Will be alphanumeric in nature and • include an alphabetic lead character • Logical; organized by core concepts • Changes to code sets include: • Inclusion of a character to • indicate laterality • More clarity around severity of • illness or injury, as well as, an • initial or secondary occurrence What Changes from ICD-9 to ICD-10? The magnitude of ICD-10 vs. ICD-9 code sets is significant Structural changes will provide specificity and clinical detail capturing advances in medical technology

  8. Why does Dignity Health care about ICD-10?

  9. ICD-10 Strategies for Key Roles Strategy Goals: • Implement education to ensure critical roles prepared to comply • Identify strategies that minimize productivity impacts • Prepare systems to support transition and minimize impact

  10. Who has assisted with strategy and validated our work?

  11. ICD-10 Delay

  12. ICD-10 Delay Response Key Considerations Mitigation Strategies • 11 Billion exposure if we are not ready • Shift majority of work “just in time” to minimize risk of future delays • Focus on work that benefits Dignity Health today • Provided opportunity to look at processes and make improvements • Additional technology: Cerner and CAC

  13. Benefits of the Delay • Technology • 26 Facilities live on Cerner EHR • Computer Assisted Coding (CAC) for 23 Acute Facilities & Ambulatory • Additional upgrades and features to existing applications • Improved Plan • Streamlined Activities • Shifting more activity to centrally-led team

  14. Pre-Delay Committee Structure • Historical Structure: • Facility Liaison (HIM Director) oversaw committees for: • HIM/Coding, Patient Access, Patient Financial Services, Clinical, Quality • Central ICD-10 PMs provided support to HIM Director & committees • Challenges: • Complex project plan • Duplication of effort with Optum360 transformation • Overlap of centrally-led activities

  15. New Structure • New Structure: • Centrally-led ICD-10 Provider/Clinical Group: • Clinical and Quality • Dignity Health and Optum360 management is leading: • HIM/Coding, Patient Access, Patient Financial Services • Benefits: • Centralizing process and job aid development • Leadership and roll-out from Optum360

  16. Roles and Responsibilities * Other will be defined in future slides.

  17. Our Accomplishments Assessed over 150 applications and hundreds of instances; Upgraded 54 applications (multiple instances) at 39 hospitals and over 125 clinics; Remediated 84% of in-scope application reports Developed & implemented education plans for 40,000 learners Identified productivity impacts, resources, and mitigation Created and are implementing remediation strategies for:

  18. Workshop Goals • Identify how local sites can increaseprovider engagement • Clarify scope for systems, reports, and forms remediation • Review readiness plans for impacted staff, vendors, and payers • Identify any gaps in our strategies • Work together to prepare for transition

  19. Providers ICD-10 Readiness

  20. Provider Impact • Problem/Opportunity: • ICD-10 requires increased specificity in documentation • Lack of specificity will result in increased queries • Anticipated Impact: 10-20% short-term productivity loss* • Solution: • ICD-10 Education • Clinical Documentation Education • Technology (available over time) * Helping Physicians Succeed (Alex et al., 2011)

  21. Impacts Of Changing From ICD-9 To ICD-10 Additional documentation specificity may result in: Appropriate payment:  accurate payment for new and complex procedures, fewer rejected claims and better claims adjudication More detailed physician profile:  detailed representation of the complexity and quality of care provided, which will affect pay-for-performance programs (e.g., value-based purchasing) and risk-adjustment methodologies (e.g., mortality rates) Research opportunities:  more detailed information will enable data mining and create research opportunities which will benefit public health

  22. Addressing Physician EngagementPhysician Champion Network • Membership: 50 Physician Champions • Includes Acute and Ambulatory • Roles/responsibilities: • Foster engagement & peer-to-peer communication • Reviewing education strategy & curriculum • Coordinating training for providers • Engaging providers in CDI program

  23. Clinical Documentation ImprovementCentralized ICD-10 Program-Provided Education for Providers Clinical Documentation Improvement is beneficial now, regardless of when ICD-10 is implemented. • CDI Training foremployed and non-employed physicians, nurse practitioners, physician assistants, residents and fellows: • Acute In-Person: October–February 2015 • Acute and Ambulatory WebEx: February 2015 • Ambulatory In-Person: “Documenting Patient Acuity” (HCC) January-March 2015 at select locations • HCC’s associated with Medicare Part C, Capitated contracted – managed HMOs.

  24. Education for Providers: CDI VideosCentralized ICD-10 Program-Provided • CDI Videos for CME credit • 5 to 8 minute videos • ICD-9 and ICD-10 relevant documentation guidelines on severity and acuity • Marketed by CMOs, VPMAs, and ICD-10 Physician Champions

  25. ICD-10 Education for ProvidersCentralized ICD-10 Program-Provided Education is offered just-in-time to ensure retention prior to ICD-10 implementation. • ICD-10 Education foremployed and non-employed physicians, nurse practitioners, physician assistants, residents and fellows: • eLearning: May – September 2015 • In-Person ICD-10 Training: July – September 2015

  26. Documentation AssessmentCentralized ICD-10 Program-Provided Clinical Documentation Improvement benefits us today and in an ICD-10world • Clinical Documentation Improvement • Physicians identified via analytics and local leadership • Assessment by Optum360 CDI consulting staff • Physician-specific and specialty specific results shared with physicians and each facility

  27. Community Physician OutreachCentralized ICD-10 Program-Provided • Training and Tools for Community Physicians • Outreach with Market Development Representatives begins January 2015 • 1 hour WebEx presentation and 5-page Guide • Topics: • Overview of ICD-10 • Financial Planning • Education for Physicians and their Staff • System, Report, and Form Readiness • Payer and vendor Readiness

  28. Job Aid for Providers: ICD-10 Virtual CodebookCentralized ICD-10 Program-Provided Available May 2015 Easy to use Search by code or clinical terms Speech Recognition Documentation Tips Favorites Internet access not required Available on Apple or Android

  29. ICD-10 Virtual CodebookSearch Functions

  30. ICD-10 Virtual CodebookResults

  31. Physician Engagement The challenge of engaging physicians in ICD-10

  32. Competing priorities • Today physicians are faced with countless demands on their time, so it is easy for ICD-10 to be pushed to the bottom on the agenda. • Two additional items also create complications: • Medicare and Stark Regulations • Competing ICD-10 Training

  33. Regulations Prevent Physician Compensation for Training Medicare anti-kickback regulations and Stark self-referral regulations prevent Dignity Health from providing monetary compensation to physicians that may have a referral relationship with Dignity Health.  Regulations permit Dignity Health to provide compliance programs to health care providers provided that programs are not offered based on volume or value of referrals or other business generated by referring physician.

  34. Competing ICD-10 Training OfferingsSite Led - Physician Education Reciprocity • Many physicians will be asked to participate in ICD-10 Training from different medical systems: • VPMAs and Medical Staff Leadership are in charge of working with physicians at their facilities to determine specifics on reciprocity training agreement. • ICD-10 Program provided a template to ICD-10 Physician Champions. • Reciprocity is based on MEC guidelines per facility.  • ICD-10 Program recommends and encourages all physicians take the Dignity Health ICD-10 training.

  35. Workshop Questions • How do local sites encourage provider participation? • CDI Videos • ICD-10 in-person training • ICD-10 eLearning • Who should Centralized ICD-10 Communications work with at your local site?

  36. Providers: ICD-10 Roles and Responsibilities * ICD-10 Program provided a recommended template for the MEC resolution; however, passage of resolution is facility specific.

  37. System, Report and Form Remediation ICD-10 Readiness Corporate and Local Scope

  38. System, Report and Form Impact • Problem/Opportunity: • ICD-10 requires updates to applications, reports, and forms that contain ICD-9 codes • Need to address the “gap” between what the centralized ICD-10 Team is remediating and the remediation needed at each local site • Solution for Addressing the “gap”: • CFO, ICD-10 Facility Executive Champion, identifies a local leader at each facility to lead the remaining effort. Role includes: • Bring together departmental leadership • Drive day-to-day site committee activity • Escalate issues/risks to site leadership • Manage and communicate project status to site leadership

  39. Partnering for Success CFO-Selected Committee Chair

  40. What systems, reports or forms need ICD-10 remediation? Any system (application), database, interface, registry, or bolt-on that includes ICD-9 diagnosis or procedure codes Any report that includes ICD-9 diagnosis or procedure codes Any form that includes ICD-9 diagnosis or procedure codes

  41. Remediation Overview Generally, remediation includes: • Implementing any patches or upgrades for ICD-10 from vendor • For custom software, reports or forms: • Expanding ICD-9 fields to allow for alphanumeric with 3-7 characters, with an alphabetic lead character; Decimal after the 3rd character • Potentially mapping ICD-9 codes to new ICD-10 codes within report selection statements • Updating report filters if necessary • Testing/Validation of anything adjusted for ICD-10 • Ensuring ICD-10 changes are in place prior to October 1, 2015

  42. Scope Definition:ICD-10 Program or Local Site

  43. Methodology to Identify ICD-10 Program Scope Phase 1: First draft of Impacted Applications List (IAL) finalized. Corporate-supported systems data collected by 5010 team; initial impact assessment began Interviews conducted with support teams/vendors/local sites to add to the 5010 listing Priorities assigned based on ICD-9 availability and usage as outlined by business partners Additional interviews with support teams and managers to verify information

  44. Methodology to Identify ICD-10 Program Scope Phase 2: 2nd Assessment due to ICD-10 Implementation Date Delay, Impacted Applications List (IAL) Updated Validated IALthrough additional assessments and interviews with support teams, business partners and local sites Consolidation explored if deployed at more than 1 facility IAL reviewed to identify applications previously documented as decommissioned or ready for archive Reviewed applications slated for decommission due to EHR, Optum360 or other implementations (these were removed from scope) Continued Assessments: The centralized ICD-10 Program has governance process for assessing and approving scope changes Applications slated for decommission or replacement due to EHR, Optum360, Ambulatory or other implementations New scope as a result of new software implementations or acquisitions of new clinics prior to the July 1, 2015 cutoff date

  45. Example of Impacted Applications List (IAL)

  46. Application Remediation Overview • Centralized ICD-10 Program Team remediation includes: • Corporate-supported applications with ICD-10 impacts and functionality usage confirmed by the ICD-10 Team • Systems not being decommissioned or replaced by another system prior to July 1, 2015 • Local Site remediation is required for: • Locally supported applications, databases, interfaces, registries, screen-scrape technology, bolt-ons or customized software with ICD-9 codes which are notlisted in the IAL (i.e. not managed by corporate IT) • Work with your vendor or local expert to remediate • Leverage list of ICD-10 applications that your site identified previously located in your packet Centralized ICD-10 Program Remediation is on-track. Locally managed application remediation efforts are anticipated to be small and low risk. If you need help with a specificsystem (application) not listed within the ICD-10 IAL, send an email to the ICD-10 Program Team at: ICD-10@DignityHealth.org

  47. Reports Remediation Overview Need help with a specific report not listed within the ICD-10 Program-remediated reports list? Centralized ICD-10 Program Team remediation includes: • Vendor-supplied standard reports in the ICD-10 Program IAL • Reference your packet for reports which are not standard, but have been assessed by the ICD-10 Program Team and have potential to be in scope Local Site remediation is required for: • Customer defined (custom) reports that include ICD-9 diagnosis or procedure codes (which arenotlistedin the ICD-10 reportremediation list in your packet) • Queries within corporate-supported systems listed in the IAL that include ICD-9 diagnosis or procedure codes • All reports in locally supported applications, databases, or registries that include ICD-9 diagnosis or procedure codes • Work with your vendor or local expert to remediate these reports. These may be managed by Local IT or Application Experts in the Department.

  48. Reports Remediation Help • Option 1: Work with your ICD-10 IT Project Manager to better understand what ICD-10 is remediating to identify gaps and determine your next steps. • Option 2: Open a Help Desk Ticket • The ICD-10 Program will assess whether or not ICD-10 or Corporate IT will be able to accommodate the request. • IMPORTANT: We recommend all requests be submitted as soon as possible, but no later than March 1, 2015. Start your assessments now. • How to open a ticket: • Effective February, you may call the help desk to open a ticket. • The ability to open a ticket via the help desk web portal will be available in early February. Further communication to follow when this method is available. • There is quite a bit of information you will need to have on hand when opening a help desk ticket….

  49. Opening a Report Remediation HD Ticket - Required • Facility Name • Service Area • Department Location Contact • Requestor Name • Phone Number • Email Address

  50. Forms Remediation Overview Centralized ICD-10 Program Teamremediation includes: None Local Site remediation is required for: • Paper Forms: Update Paper Forms that include ICD-9 diagnosis or procedure codes via your vendor or Microsoft Word. • Paper forms cannot be submitted to local IT or corporate IT for remediation. • Electronic Forms: Update Electronic Forms that include ICD-9 diagnosis or procedure codes via FormFast or similar software. • FormFast form update requests should be submitted directly to vendor. IT does not support FormFast forms outside of EHR armbands and labels. • Optum360 is centrally remediating PFS, PAS and HIM forms. • Forms Committees or Clinic Directors should identify and update any formsthat include ICD-9 diagnosis or procedure codes • Third Parties remediate their own forms. Your packet includes a 1-page instruction sheet on form remediation to return to third parties.

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