3M Health Information Systems

3M Health Information Systems
ICD-10 Largest Impacts and Strategic Planning Discussion © 3M All Rights Reserved.

She has been published with
Barbara Zellerino is a Solution Strategist for 3M Health Information Systems. She has more than 20 years of nursing, quality and case management experience. In her current position, she consults with physician groups and hospital administration, to implement effective documentation improvement programs, coding best practices, ICD-10 preparation, data quality assurance, and performance management programs. Prior to joining 3M, Ms. Zellerino was Director of Quality for St. Mary's Medical Center in Evansville, IN Ms. Zellerino received her nursing training at Eastern Kentucky University and earned her Masters in Healthcare Administration from the University of Southern Indiana. She has been published with American College of Medical Geneticists for her work in developing international quality indicators for clinical genetics Indiana Civil Litigation Review for her analysis of the Indiana Malpractice Act. © 3M All Rights Reserved.

3M ICD-10 Coding Experience
Under contract with the Center for Medicare and Medicaid Services (CMS) Developed the ICD-10 Procedure Coding System (PCS) Developed the General Equivalence Mappings (GEMs) Preformed the initial conversion of MS-DRGs to ICD-10 International ICD-10 Experience Developed and/or Maintain MS-DRGs, CPTs, APs APR DRGs, EARGs Potentially Preventable Events: Readmissions, Complications, Admissions, Visits, Services 3M Episode Solution – One of four awardees of CMS bundled payment contract © 3M All Rights Reserved.

Biggest Change in HealthCare in 30 Years
ICD-10 is an unfunded regulatory event However… ICD-10 can be funded with careful planning and execution © 3M All Rights Reserved.

Impact to Entire Organization
HHS anticipates short-term productivity issues during the first 6 months after implementation Resources and Work Disruption HIM- Education Costs and Time, DNFB, Process Updates (Superbills, etc) Physicians- Education Costs and Time PFS- DNFB and Accounts Receivables, Billing/Clearinghouse Rejections Decision Support – Translation and Mapping, Database Storage Budget Conversion resources IT Systems- Inventory, Upgrading to 5010, Vendor Readiness, Testing, Revenue Cycle Departments - Processes, Other Departments- Quality, Case Management, Utilization Review, Clinical Documentation Improvement Programs, Clinics, etc.

Hospital Implementation Timeline for ICD-10
2010 2011 2012 2013 2014 5010 Electronic Transmission 1/1 ICD-10 National Implementation Date 10/1 Steering Committee Responsibilities/Tasks Focus/Effort Awareness & Discovery Preparation Implementation Reaction & Recovery Project planning and management Documentation Improvement – Physician, CDIP specialist education and implementation Gap Analysis – systems, coding, documentation Risk/Opportunity Assessment – Translation, analysis, service line impact System and tool automation – EHR, automated CDIP, automated coding Training – Coder, documentation improvement specialists, physician Software testing – 3M and other vendor Payer integration and testing Reaction plan Training Physician education Coding & Billing Department Refresher

Largest Impacts Associated with ICD-10
Productivity Impact to Coding Process 2 Translation Needs To Support ICD-10 Coding © 3M All Rights Reserved.

1 Productivity Impact to Coding Process
© 3M All Rights Reserved.

Global use of ICD-10: Catching up with the industrialized world
Experienced between 32-50% reduction in coder productivity the first six months. Robert E. Nolan Group Iceland Norway Sweden Finland Denmark Poland Canada Ireland Germany UK Czech Republic The Netherlands Austria United States France Switzerland China Japan Thailand Costa Rica Venezuela Colombia “We wish we would have taken advantage of the time that we had!” Singapore Brazil 3M has over 20 years of experience implementing ICD-10 throughout the world. We have helped each of these countries implement I-10 in some format. Here are some things we learned: Canada saw huge productivity decreases in the first six months. It took quite a bit of time to fully recover to get to the same productivity levels. (See "Implementing ICD-10: A Canadian Perspective from the Front Line,“ Revenue Cycle Strategist (HFMA publication), February 2009, p. 3.) Australia told us that they wish they would have taken advantage of the time they had and started their efforts sooner. Australia Argentina New Zealand 11

What You Need to be Addressing Today
Understanding Impact of Coding Productivity Develop a mitigation plan to support loss of coding productivity Strategic Advantage to Consider Consider implementing computer assisted coding products to improve efficiency of coding, costs and backlogs Develop Mitigation Plan - Secure backlog coding services now for 2013 Timeline: Now. Implement computer assisted coding to be live prior to 4th Qtr 2012 to leave last 12 months to devote to integrated testing of all software to determine/assure ICD-10 ready. © 3M All Rights Reserved.

2 Translation Needs to Support ICD-10 Coding

Understanding Impact of Code Translation Perform inventory system wide of all ICD-9 codes utilized to determine translation needs Begin review of charge tickets/superbills to assure completeness and accuracy in ICD-9 before you translate to ICD-10. Develop a plan/resource commitment to accomplish list translation Strategic Advantage to Consider Consider utilizing a code translation tool to reduce FTE requirements and manual labor to translate list Begin translating Lists of Codes for appropriate applications (software/ paper) Timeline: rd Qtr. and 4th Qtr. as code freeze in place © 3M All Rights Reserved.

Who Does ICD-10 Impact? The impact of the transition to ICD-10 is far reaching… Federal Government Programs Physicians Hospitals Health Plans & HMO’s Electronic Health Records Practice Management Systems Billing Accounts Receivable Productivity Loss Patient Access (Inpatient Ambulatory and Clinics) Lab/Radiology Other Ancillary services Pharmacy Physician Order Entry Image Management Supply Chain Mgmt HIM/Utilization Review Bar Coding Billing Claims Fraud and Abuse Customer Service Reimbursement EOBs/ EOCs Network Contract Actuarial Rating Underwriting Membership Utilization Review Benefits Contracts EDI OCR ERA / EFT Reporting Data Warehousing Medicare Ohio Medicaid Other Medicaid agencies Plus Health Plans functions minus Network and Rating Data Warehousing for statistical reporting Supplemental Health Industry Organizations Major State Government Programs Specialty Providers Health Care Tools & Decision Support Veteran’s Hospitals Federal Hospitals Nursing Homes Home Health Providers DME Providers Hospice Mental Health Providers Substance Abuse Providers Physical Therapy Providers Drug Manufacturers Supply Chain Companies Third Party Administrators Workers Comp Auto Liability Self Admin Employers Clearinghouses Programs that address health needs of the poor and uninsured University Medical Centers Children’s Health Programs Student Health Programs Department of Corrections County and Rural Health Programs State Public Health Agencies State Funded Medical Schools State Employee Health Programs Predictive Modeling Health Coaching Personal Financial Tools, e.g. FSA, MSA Federal, State and local authority collection of diagnosis data from Clinical provider for epidemic and new disease analysis

Superbill Conversion Example
Converted Orthopedics Superbill 49-Pages Original Orthopedics Superbill 2-Pages

3 Specificity and Physician Documentation to support ICD-10 Coding

Clinical Documentation Review of Claim/Code Volume of Codes that Cannot be Translated Identify High Volume Trends (codes, specificity, etc) Documentation Review of these Codes for Accuracy and Specificity Assess performance of CDI program against benchmarks; move to advanced performance to aid in cost offsite of ICD-10 transition Strategic Advantage to Consider Assess current documentation under ICD-9/MS-DRGs and the current Revenue Opportunity Implement/enhance Clinical Documentation Improvement Program. © 3M All Rights Reserved.

Physician Documentation Behavior Review medical records today to determine if clinical content exists now that would allow you to code in ICD-10 at the highest specificity Strategic Advantage to Consider Utilize Trends from medical record review to begin to Educate and Change Physician Behavior Now Utilize a CDI program/software to begin querying physicians NOW for additional documentation so this becomes a learned behavior Consider CAPD to supplement physicians content into EMR and use real time queries in the process to gain greater specificity from the physicians Timeline: Now for CDI, CDIS; CAPD ready early 2012 © 3M All Rights Reserved.

How do you look when you translate ICD-9 to ICD-10?

What is your current dollar opportunity?

Clinical Documentation Effects
Readmission - Alternate Principle Diagnosis, Secondary Diagnosis Complications – Secondary Diagnosis, Present of Admission Mortality – Secondary Diagnosis PSI – Secondary Diagnosis, Present on Admission Core Measures – Alternate Principle Diagnosis HAC- Present on Admission ICD-10 – Specificity Compliance – RAC: early identification, verification, complete documentation UHC Scorecard Value Based Purchasing – CMS Baseline collection starts July 1, 2011 Specificity, Present on Admission, Alternate Principle Diagnosis

Improving Clinical Documentation Improvement Now
Benefits… 2-3% Case Mix Index * 20% increased productivity Knowledge of regulatory changes Increased SOI and ROM performance ICD-10 concepts included in edits ROI return less than 90 days Key Benefits of CDIS Increased CMI 2-3 %, with ROI in less than 90 days Increased productivity for CDI team by 20% Increased knowledge of CDI concepts from edits Increased quality indicator scores..SOI and ROM Increased compliance using the edits in Codefinder Increased surveillance of HACs and RAC issues ICD-10 concepts in CDIS allow early action/improvement of specificity (concepts in CDIS software now) Provides automation, tracking and reporting on process Management tools to identify weaknesses in process/performance * Based upon an average of results achieved by 3MTM CDI System Clients Improving Clinical Documentation Improvement Now Can Fund ICD-10

Passively Training Physician Documentation Behavior and Training Coders and CDI Staff

4 Education needs for Staff and Physicians

Staff Education Inventory all departments for staff requiring education and at what level (awareness, moderate or detailed) Determine source and timeline for educating staff Strategic Advantage to Consider Consider education that focuses on coding knowledge, anatomy and documentation concepts with multiple scenario coding and testing Train early and assure ability to continue to code and test over time with more complex cases Timeline: th Qtr, 3M will offer online education with modules and testing that can be licensed on annual basis. Will have content for Inpatient, Ambulatory, Physician Practice, CDI, and some general modules for awareness. Physician education should primarily be reinforced in 2013, but initial introduction can be now with queries on high volume concepts. © 3M All Rights Reserved.

ICD Education Programs
Google Results of “ICD-10 Training” = > 268,000 Hits AHIMA 2011 AHIMA Academy for ICD-10-CM/PCS (3 days) 2011 AHIMA Academy for ICD-10-CM (1 1/2 days) AAPC 2 to 3 Day Boot Camp or On-site Training Additional Training on Anatomy and Pathophysiology Advanced Courses Many Others 3M ICD-10 Education Web based – Unlimited Users 24/7 Access Pre and Post Test, Module tracking 11 Scenario Based Diagnosis Modules 11 Scenario Based Procedure Modules with applicable Anatomy and Pathophysiology © 3M All Rights Reserved.

5 6 Process Changes in Functional Areas System Readiness

ICD-10 Assessment Activities
Assess the need to translate medical necessity/LCDs/NCD’s and pre-authorization lists to ICD-10 Assess the need to update medical necessity or ABN software Determine timelines for updates and testing insurance verification/authorization software Assess physician order forms/systems that will need updated Assess payer contracts/plans for renegotiation and need for translation of code lists Assess payment methodology impacts/determine financial impact once groupers available Determine denial management strategy Determine points of entry and who utilizes ICD-9 codes to determine educational needs Financial Operations Conduct departmental assessments to determine current ICD-9 code use (paper vs. electronic) Assess clinics, physician offices, satellite centers use of ICD-9 code use and determine educational needs Determine education/training needs for UM and Case Management staff Assess the need to update/translated physician and departmental charge tools (superbills, etc) with ICD-10 codes Determine ICD-10 impacts on quality reporting and information released to outside agencies Identify physician educational needs by service line Determine ability to build structured templates into EMR to assist physicians with documentation requirements Determine educational needs of physician office staff Clinical Operations

Identify timeline for coder education and transition timeline to begin coding in ICD-10 Identify service lines/DRGs/codes with the largest impact in ICD-10 Assess physician documentation issues in high volume service lines Determine productivity impacts associated with coding and need to practice in ICD-10 Determine software needs (code in two systems and store) Determine need for data dictionary to get to common language for data prior to and after ICD-10 transition v HIM/Coding Operations Develop implementation approach options Align with vendor plans Align with strategic programs Define key initiatives and projects Estimate implementation cost Create implementation roadmap Review and validate v Roadmap Development

Interview key stakeholders Conduct series of functional interviews to collect business/ system and v5010 opportunities and estimation factor counts Survey key vendors Define vendor compliance tracking approach Summarize impacts and opportunities Resolve gaps and conflicts Conduct cross-functional sessions v Strategy and Assessment Perform system inventory Determine vendor timelines/interface specs/testable software dates Assess billing software ability to utilize code by date of service Assess clearinghouse ICD-10 abilities Replicate the current environment and optimize with ICD-10 detail integrated into clinical, financial and operational systems across the enterprise v Systems Readiness

Functional Assessment Inventory all departments for use of ICD-9 codes and general processes that support gathering of data that in turn provides coding with correct information needed to bill claims Inventory contracts to identify if they contain ICD-9 codes; need to be re-negotiated prior to Oct 2013 Inventory all external data releases to determine if they will need to continue to code in ICD-9 or be transitioned to ICD-10 (research grants, HIEs, state agencies, etc.) Financial Impact of ICD-10 Budget planning Strategic Advantage to Consider Develop budget now for planning purposes Begin processes changes in departments Begin payor negotiation Determine mitigation plan if need to code in two different versions (I-9 and I-10) Develop roadmap with timelines and manage to them Timeline: Complete by 2nd Qtr 2011 © 3M All Rights Reserved.

Foundation for ICD-10 and Healthcare Reform
Computer-Assisted Physician Documentation Automated clinical documentation prompts at the point of care Foundation for ICD-10 and Healthcare Reform Automated Clinical Documentation and Coding 40%-50% productivity improvement for coding and documentation Sustains through ICD-10 Improves physician satisfaction 6 % CMI improvements * Automated coding and documentation at facility Computer Assisted Coding 30% coding productivity Documentation Improvement Software Additional 2-3% CMI improvement* 20% productivity for CDI specialist Computer-assisted coding and documentation Coding and Reimbursement 1% CMI improvement Clinical Documentation Improvement 3-4% CMI improvement * Ensures accurate, complete, and compliant coding and documentation We build upon our current proven tools and technology to bring you from where you are today to increasingly using technology to further automate your coding and documentation improvement across your service lines and to your physicians. The combination of automated clinical documentation improvement prompts at the point of service and autogenerated codes using natural language processing will mean that your documentation and the derived codes are compliant and complete, increasing CMI and productivity. *CMI Improvement assumes that starting point is limited or current documentation improvement program. *CMI Improvements based on starting point of limited to no documentation improvement program in place.

What are facilities doing?
ICD-10 Documentation Assessments ICD-10 Claims Analysis ICD-10 Education ICD-10 Financial Analysis Evaluation of Current CDI Program Computer Assisted Coding © 3M All Rights Reserved.

Hospital Implementation Timeline for ICD-10
2010 2011 2012 2013 2014 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D 5010 Electronic Transmission 1/1 ICD-10 National Implementation Date 10/1 Steering Committee Responsibilities/Tasks Focus/Effort Awareness & Discovery Preparation Implementation Reaction & Recovery Project planning and management 8 Documentation Improvement – Physician, CDIP specialist education and implementation 5,6,10,14 Gap Analysis – systems, coding, documentation 6,7,9 Risk/Opportunity Assessment – Translation, analysis, service line impact 6,7 System and tool automation – EHR, automated CDIP, automated coding 10,11,14 Training – Coder, documentation improvement specialists, physician 1,2,3,4 Software testing – 3M and other vendor Payer integration and testing Reaction plan Training Physician education Coding & Billing Department Refresher 3M provides interface specs 3M ICD-10 testable software 3M software converted to ICD-10 How 3M Helps: 3M™ Codefinder™ Software upgrade (no charge) 3M Consulting Services 3M ICD-10 Solutions Tools 1- Code Comparison Report (2009) 5- Clinical Documentation Improvement 10- Automated CDISystem (CDIS) 2- Coder training pathways/modules (2010) 6- Documentation & Coding Assessment 11- Automated Coding System (CAE) 3- ICD-10-CM Reference Codebook (2010) 7- ICD-10 Impact Analysis 14- Coding & Grouping Systems 4- ICD-10-PCS Reference Codebook (2011) 8- ICD-10 Readiness

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