The timing of ICD-10 may still be up in the air, but eventually, the transition will call for myriad of changes, some of which organizations should consider outsourcing, and some they should not.
"We look at it as a matter of scale or skill, and that's how you make your decisions," said Mark Williams, partner at PwC. "Scale: it's arms and legs and the ability to deliver it at the level it needs to be delivered. Sometimes, organizations can't do that, and that's when they need to bring in external resources. For skill, some organizations are more well-rounded than others, and they don't have deficiencies for the most part."
Williams breaks down, based on scale and skill, which pieces of the ICD-10 conversion healthcare organizations would be wise to consider outsourcing, as well as the one aspect that should not be left up to anyone else.
1. Do outsource financial modeling. Financial modeling is a big focus for ICD-10, and it's important to consider the impact "flipping the codes" will have on both payers and providers. "So for a payer, it's what that's going to do to the amount [they] pay on claims, or your medical loss ratio," Williams said. "For a provider, what's that going to do to how much [they] get paid for the services [they] provide. It depends on what side of the table you're on." Determining the impact the transition will have is a "complicated exercise," which includes many functional areas that drive the ultimate expense. "We think that's more of a skill-based need for outsourcing," he said. "Those skills are often not complete in an organization. The approach and method you have to follow on financial modeling isn't necessarily typical of what organizations do on a day-to-day basis."
2. Do outsource training. Although there's training surrounding ICD-10 and the new codes themselves, Williams pointed out training concerning the organization and the changes it will undergo to adopt the new code set. "It's a big element of the project and the training needs to be delivered at the right time; if you deliver it too early, people forget and then they're not interested." And if you're too late, Williams warned, employees won't have the time to "internalize it," and get it done on a broader scale. "Don't forget, there's always training going on in an organization," he added. "And usually, the corporate training departments aren't heavy. So training is a prime outsource function, more based on scale than skill. Scale it when you need it, right?"
3. Do outsource organizational readiness. This includes taking a comprehensive look at the organization to determine not only how prepared it is for ICD-10, but how likely it is to see success after the transition. "That's a pretty big and far-reaching look," Williams explained. "Sometimes, you'll have to go pretty deep, and that's more of a skill-based drive." Outsourcing this aspect of the transition offers another pair of eyes to assess the organization, since many don't have a single person who "understands the organization well enough to step back and take a look at it as a whole," he said. Some employees many know a particular area well, Williams added, "but maybe not the whole organization and every function in it."
4. Don't outsource post-compliance day monitoring and performance. The compliance date isn't the end date. "It's the start date because the organization needs to understand, based on the level of change they've undergone to implement ICD-10, how well did this thing perform based on [their] plan." It's important for an organization to address issues in real time and be able to detect and understand its weaknesses, he added. "You can't get into big claims backlog on the payer side, and you can't get into the big delays in billing on the provider side … you can't let the consultants run your business and become totally reliant on them. You have to run your business at some point; you have to own that."
Follow Michelle McNickle on Twitter, @Michelle_writes