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ICD-10’s impact on staffing

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   By Joe Gurrieri, February 2012

Planning and partnership now brings relief in 2013.

The May 2011 “HIMSS VANTAGE Point Survey” showed that 33 percent of respondents felt the greatest challenge their organizations face in converting to ICD-10 is the lack of staffing resources, especially clinical coders. Identified as one of the top five “gotchas” of ICD-10 implementation, coder concerns have grown beyond health information-management (HIM) directors and garnered significant attention within executive suites.

AHIMA conducted an informal survey of association members in 2011 regarding coding priorities. Only 49 percent of respondents told AHIMA that their departments were fully staffed. The biggest problem was a lack of qualified candidates. As the 2013 deadline approaches, we expect coder shortages to worsen. Finding qualified medical records professionals will surely be an executive issue – unless it’s addressed now.

Providers fall into three different groups with regard to ICD-10 preparation and their coder staffing approach. The first group is still doing nothing. They are waiting for someone else to give direction and initiate the ICD-10 process. This is called the ivory tower approach, although some call it the “head-in-the-sand” approach.

The second category, which encompasses the majority, is where executives, HIM directors and ICD-10 committees are beginning to conduct assessments, create timelines, survey vendor readiness and line up outside partners for backup coder staffing. They are giving coders anatomy and physiology and/or medical terminology coursework. Furthermore, they are sending coders to AHIMA’s ICD-10 train-the-trainer program.

The third school is the most advanced. They are already testing ICD-10 readiness. These early adopters plan to begin ICD-10 coding in January 2012. Dual coding, or the coding of cases in both ICD-9 and ICD-10 classification systems, will be performed. Coders are being trained now to support the effort.

All three approaches agree they will eventually need staffing help. First, there is the need for coverage while internal coding staff is being trained. And training may be extensive: between 50 and 480 hours depending on the coder’s existing knowledge set and experience. Secondly, there is an anticipated major drop in productivity at go-live on Oct. 1, 2013. Lastly, there will be an ongoing drop in productivity with ICD-10 that will require permanent staffing increases.

According to Kerry Johnson in 2004’s, “Implementation of ICD-10: Experiences and Lessons Learned from a Canadian Hospital,” initially, charts completed per hour dropped from 4.62 (ICD-9) to 2.15 for ICD-10. Productivity improved somewhat 10 months later to 3.75 charts per hour. That translates to a 54 percent drop in productivity on initial go-live and about a 20 percent ongoing decrease in productivity.

These numbers are consistent with our observations and those of many of our clients and prospects. Many feel that they will need to double the number of coders that they currently utilize to protect revenue streams and buffer the potential of some ICD-9 coders retiring.

Many providers are partnering with coding services companies now, while qualified resources are available. Remember that all coding companies must also take their existing ICD-9 coders offline and out of day-to-day production for training. Several approaches are being explored, and it is important to understand which one the coding company will take.

One approach is to start a whole new coding force dedicated solely to ICD-10. For example, our firm is training 40 brand new ICD-10 coders every four months to build a competent, well-trained ICD-10 staff. Of course, the potential downside of this approach is the coders are all new and inexperienced. The upside is that they have no bad habits or previous baggage to correct.

To mitigate the inexperience issue, this new team of “ICD-10 only” coders will work exclusively in the new classification system. Existing ICD-9 coders will be trained in small groups and then shadow the ICD-10 team to gain hands-on experience. Lastly, another group of coders will not be trained on ICD-10 until after ICD-10 go-live.

With this three-step approach, a coding team can gain the experience they need without missing their day-to-day production or revenue goals, and have a solid pool of experienced personnel ready for 2013.

Other providers are throwing up their hands and outsourcing the whole thing. “By transferring the entire coding department and need for coder training to an outside partner, we are relieving our organization of the entire coder staffing worry,” says Pedro Melendez, CEO, Hospital General Menonita, Cayey, Puerto Rico.

Five-year outsourcing agreements that get the provider well past the ICD-10 deadline and free them up to deal with other healthcare issues are common in this scenario. However, if providers wait until 2013 to contract for a complete outsourcing agreement, the partnership will be very expensive, if even still available.

Of course there are providers who believe they can do it all themselves. They view ICD-10 as a lesser problem, more of a minor shift. They will do some minimal training and then just flip the switch and be fine. The upside of this approach is lower cost and minimal disruption, if they are right. If they are wrong, the revenue impact could be substantial – if not fatal.   

Joe Gurrieri, RHIA, CHP, is VP and COO of H.I.M. on CALL Inc. For more on H.I.M. on CALL Inc. click here.



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