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END-TO-END TESTING IMPORTANT PART OF ICD-10 PREPARATION

By: Nicola Heredia, CHS Marketing Coordinator

The U.S. health care system has been working towards implementing ICD-10 for many years, and the system is due to be implemented October 1 of this year. Reports released show a mixture between health care entities working towards implementation and others that are either delayed or in denial that the deadline will remain in place.

Although there may be speculation that the compliance deadline is a hard start date, experts within the industry and officials for the Centers for Medicare and Medicaid Services, or CMS, insist that everyone must be ICD-10 ready prior to the October 1 deadline. Preparation is essential to avoiding delayed processing and payments.

According to the American Associate of Professional Coders, when the ICD-10 coding system was first implemented in Canada, the processing time increased for each claim. The average coding time increased from 15 to 33 minutes per claim. Turnaround times were delayed up to 70 days.

Although the system in Canada ultimately ended up being successful, the increase in claims’ processing time is one significant effect of the system change that the health care industry must be prepared for. Training and testing is a key aspect of the preparation to ensure that coders, hospitals and providers are comfortable with the changes prior to the compliance deadline.

With preparation underway throughout the industry, the CMS continues to promote end-to-end testing as a way to monitor progress. The first set of testing took place during the last week of January and overall, had positive results, according to CMS officials.

“The successful week of testing continued to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015,” said outgoing administrator for the CMS Marilyn Tavenner.

In total, 661 providers and clearinghouses participated and submitted approximately 15,000 test claims. Approximately 81 percent of the claims were accepted. The rejected claims consisted of invalid coding issues and 13 percent were non-ICD-10 related issues.

The first testing results demonstrated the importance in training coders, but it also brought up other issues that need to be addressed. In order for coders to do their job, clinical documentation is important to ensuring the illness and treatment plans are correctly recorded. If information is misinterpreted, it can lead to errors in the data and claims.

“Most of the issue that I’ve seen is a difference between ‘doctor-speak’ and the language of coding,” said Clinical Documentation Specialist Mandy Rogers, RN, in a Health IT Analytics’ article.  “Sometimes the physicians don’t quite get the difference between what the coders do and what we do, and they don’t always get why we’re querying them.  That’s where I’ve noticed the biggest gap of understanding.”

Ensuring that physicians and hospitals are cognizant of the importance in correct clinical documentation is just as important as getting coders prepared to implement the ICD-10 codes. Testing has uncovered different issues that need to be fixed prior to October 1, making this step a vital part of the preparation process.

“Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified,” said Tavenner. “And we will continue to do testing, especially in those areas we identify as needing improvement”

ICD-10 will inevitably affect every entity within the health care industry. Successful implementation will require providers, payers and physicians to work together in gaining a deeper understanding of how this system will operate as a whole.

Upgrading information systems and testing to uncover weaknesses are essential to be prepared for the ultimate compliance deadline.

LACK OF STANDARDS STALL MEASURING QUALITY OF CARE

By: Dennis Riedmiller, CBC from Riedmiller & Associates

Improving on patient care has long been discussed within the health care industry. Due to recent health care reform laws, quality and efficiency of care are being scrutinized to determine how a standard can be created and enforced.

The Affordable Care Act is a complex law, which covers many topics. When it was first enacted, the emphasis was placed on the need to provide insurance at affordable rates to Americans. Quality of care is increasingly becoming an issue as competition increases for hospitals and physicians, while patients become more knowledgeable of how the system works.

“The accomplishments of the last quarter century are real and significant,” said Margaret O’Kane, MHA, president of the National Committee for Quality Assurance, or NCQA, in an article published in EHR Intelligence. “In 1990, measuring quality was just an idea – today it is an everyday reality.”

Although there are measurements in place to track patient care, studies find that the standard varies from one survey or report to another. The lack of standard makes it difficult to compare one hospital to another, depending on the statistics they decide to publicize.

Reports Measuring Quality of Patient Care

There are different ways to look at the variations in reporting. The lack of consistency and metrics from one study to another makes it difficult to compare one facility to the next. It will also ensure that a hospital and physician group does not end up last on all of the reporting companies’ lists.

On the other hand, having companies report information in a variety of ways can make it easy for patients to seek information that is particularly important to them.

“If each hospital is good and bad at different things, then each patient will want to use the ratings that most directly address his or her issues,” Ben Harder, managing editor and director healthcare analysis for U.S. News & World Report, said in a Mobi Health News article. “If just one rating system existed, they would have less information to use in choosing a provider.”

Experts believe that once the reporting agencies are transparent about the information, then Americans will be able to weed through the results and make an educated decision. Although this philosophy may work now, developing a standard to compare patient care nationwide is essential to improving the quality of health care as a whole.

“You can bring payers and providers together, but we want to make it so the information is standard and people can make meaningful decisions,” reported Dave Mason, senior vice president at RelayHealth, in the Mobi Health News article. “Take quality, make it uniform and publish it. We’ll work through it, but the problem is no one wants to be on the bottom of the list.”


Developing a Standard of Care

Adjusting the mentality related to patient care is an important step to take to recognizing weaknesses within the American health care system. Developing an understanding of patient’s expectations as well as medical efficiencies can ultimately lead to more satisfied patients who are willing to participate in their health care.

Improving communication between physicians and their patients is one avenue that Harvard’s Beth Israel Deaconess Medical Center in Boston has taken to begin the process of assessing the care provided as a hospital.

According to a New York Times’ article, using the word “suffering” has been found by the facility to make doctors feel uncomfortable. Instead, physicians prefer to eliminate emotions when addressing patients and discussing their illness. Rather than saying a patient is “suffering from a disease”, doctors will state that a patient “has an illness or cancer”.

“These are harms,” Dr. Kenneth Sands, the chief quality officer at Harvard’s Beth Israel Deaconess Medical Center, said in the New York Times’ article. “They elicit suffering. They can be long lasting and they currently are largely unquantified, uncounted unrecorded.”

Although the verbiage may seem natural to physicians, there is an emotional side to illnesses that must be acknowledged in order to connect with the patient and avoid doing harm.

This hospital has also looked at ways to make the patients stay more comfortable by avoiding waking the patient up to check their vitals and limiting blood draws in the middle of the night, unless necessary. Although the changes may seem minor, they are a step in the right direction to make the entire medical experience more centered on the patient.

Developing a standard of care that all hospitals and physicians can be measured by is essential to ensure that the industry is held to providing a higher level of care. Reports attempt to assess the current situation are falling short and need to provide more information to alert the industry of weaknesses that need to be improved on.

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