Analytics can mitigate ICD-10 downside
We spoke with Greg Krantz, director of provider solutions at MedeAnalytics, from the 2015 AHIMA Convention and Exhibit in New Orleans. The mood there on Wednesday was one of cautious optimism, laced with uncertainty, he said.
"People are bracing for ICD-10," said Krantz. "People don't know what the impact is going to be."
One thing that does seem certain, however, is that even the most well-prepared health organization, with the most well-oiled technology and well-rested staff, can probably expect to see at least a minor hiccup in performance.
Smart analytics will be critical to making sure that setback is as minor as possible. As ICD-10 becomes the new reality, providers will need to suss out trend lines and spot outliers, fixing problems as they see them. They'll have track coding and billing efficiency and ensure accurate physician documentation. Benchmarking – internally and compared with peers – is essential.
"What we anticipate is a drop in performance, over a number of different metrics," said Krantz. "Beginning at the beginning, we'd expect denials to increase, case mix index to drop, CC/MCC capture rates to drop. And then for some of the more revenue cycle-related metrics, AR days, discharged not final coded days, discharged not final billed days, we expect a spike in those efficiency metrics."
Across the board, on both the clinical and financial side, "there's going to be an impact on performance as clinicians just basically get used to the new specificity required and the coders, even though they've been preparing, (find that) in a real live environment being able to translate the the documentation in a timely fashion is going to be a challenge," he said.
This is where the work of all these past many years can make or break: "Some of the smaller facilities that maybe haven't spent as much time, money, resources on the preparation, there's going to be a much larger impact," said Krantz. "Certainly, the larger organizations that have had system-wide training and dual coding preparation, I think the impact is going to be mitigated."
In both cases, however, vigorous follow-up can help blunt any adverse impact from ICD-10.
"Understanding the trend from ICD-9 to ICD-10 is the first thing," he said. "For August-September to October-November, what does the trend line look like for case mixes? Where are you trending after ICD-10? If our predictions are right, we're going to see a drop in performance across the board, but you won't understand it if there indeed is a drop in performance. That's the first thing."
The second key: if there is a drop in performance, "how does that compare to a peer group? How does that compare to others experiencing the ICD-10 transition for a like hospital? We're able to use our benchmarking – we actually benchmark against our own internal client base, several hundred facilities across the country," said Krantz. "A lot of people have been using MEDPAR (Medicare Provider Analysis and Review), which is Medicare inpatient claims data from CMS, for benchmarking. That is 12 to 18 months old. As of October 1, that's not relevant anymore. It's ICD-9 performance."
Finally, just as important as benchmarking against peers is benchmarking against yourself, he said: "We've got data going back two years: So in January 2016 you can compare your case mix index to January of 2015 and you can see a trend, of Jan.-June 2016 compared with 2015."
Some hospitals "will be able to do some rudimentary data crunching to figure out where opportunities lie," said Krantz. "But if they don't have the capabilities to drill down into those opportunities and find out specifically what physicians need to be trained and educated, and what claims from need to be focused on in a medical record audit, it'll be difficult to be able to stay on top of it, day to day."