ICD-10: Analyze Productivity, Build Speed and Confidence
Published in Coding Edge – February 2011
Learn how to increase the amount of charts you’ll code in ICD-10.
By Corrie Alvarez, CPC, CPC-I, CEDC
The United States is one of the last countries to adopt ICD-10-CM code sets, which is scheduled to occur Oct. 1, 2013. We can use this lag time to learn from other country’s implementation lessons and experience a smooth transition with few surprises.
For example, when Australia adopted ICD-10 in 1999, the country suffered an unexpected productivity loss as high as 25 percent, which did not return to normal levels until six to 12 months after implementation. Imagine what a 25 percent loss in productivity that endured six to 12 months would mean for your practice today. An awareness of this likely impact and a solid plan to deal with it will ensure your practice survives ICD-10 implementation rather than become a casualty of war.
Every practice needs to evaluate productivity. How else are we to know how to budget or determine staffing models? How else can we establish expectation levels for our staff?
Let’s begin by looking at how to develop a good sound productivity model. Every model begins by determining the inputs. In the coding world, this is the different type of source documents received for coding. You may receive electronic or paper documents, handwritten or transcribed. You also may want to divide records by specialty or claim type. For example, evaluation and management (E/M) documents could be one category, radiology reports could be another, etc. Different services take different skill sets to code. For example, an E/M encounter probably would take more time to measure and code than a routine X-ray. Each type and/or grouping should be listed separately to evaluate its significance to your productivity model.
Once you have categorized the different inputs, you need to understand how each one is handled. A flow chart is useful for a good overview, but a written procedure is critical. If you do not have these documents, ask the staff to explain the process. Then create a flow chart (your visual tool) and a standard operating procedure (your written tool). There are several software programs you can use to create flow charts: Excel, Word, or Visio are a few examples. This step may take you several days if you are to represent your current procedure accurately. At this point (however tempting it may be), try not to make any changes. Determine your baseline as it is. Later, when you’re ready to make improvements, you can measure the difference. This will enable you to capture your savings.
Next, follow the flow chart and actually observe the coders in action. Watch at least two or three coders work with each input type (E/M services, lab services, etc.). Make sure you also time all action steps. This will be important for measuring the baseline.
During this step, you’re likely to find varying degrees of adherence to the standard operating procedure (SOP). Some variations may be valid. During my audits, I have found employees develop process shortcuts. Most were great process improvements but, unfortunately, often were not shared with the entire group. Other variations may not be valid. It’s important to identify both, so the procedure can be changed to reflect learned efficiencies, or to correct problems.
Keep in mind: This process can be very intimidating for staff. When meeting with them, emphasize that you are not there to point out their faults or deficiencies. Rather, stress that this is an important step to implementing ICD-10. This will help place staff at ease and make the task more pleasant.
Determine Productivity Baselines and ICD-10’s Impact
Once your observations are complete, re-evaluate the current process and make the necessary changes. At this point, record the productivity for each input type. When counting the documents completed per day, evaluate several different days over two to three weeks. Then average the production per day. Make sure you subtract any down time. Obvious down times are scheduled breaks (20-30 minutes per day) and staff meetings.
These steps are important for developing baselines. Without these baselines, you cannot determine the impact ICD-10 will have on productivity.
Once you’ve determined a baseline, the next step is to determine how much ICD-10 will impact productivity. One option for doing this is to take the work done on the prior day and have a trained ICD-10 coder from your group code the same charts again using ICD-10. Record the time the ICD-10 coder takes to complete the same amount of work your ICD-9 coder did the previous day. Repeat this process for several days to obtain an average. During this step, you may want to point out any documentation deficiencies you uncover to the team assigned to improving ICD-10 documentation. An increase in physician queries will impact productivity and create a backlog, so working closely with the documentation improvement team will benefit everyone.
Now is the time to make process improvements. Make the changes, re-measure using time studies, document the difference, and document savings. Don’t forget to update flow diagrams and change standard operating procedures. Follow up in a few weeks to make sure your changes are still in use. Sometimes, old habits are hard to break.
Bridge Gaps in Your Productivity Model
Once you have documented the time differences, you’ll need to create a productivity model. You will have to meet with the finance team to determine how you might bridge the gap. For example, you might offer overtime, and/or hire some temporary staff. When hiring temporary staff, you will need to decide how to utilize them best. For example, you might have them work on the ICD-9 backlogs while your team works on ICD-10.
If you plan to hire temporary staff, give yourself plenty of lead time. Train them on your system for at least 45 days before the implementation date. This also will give your current coders some time to practice their ICD-10 coding. Coders should practice taking several charts they have coded in ICD-9, and then code them in ICD-10. This should begin at least 120 days prior to implementation. Increase the amount of charts coded in ICD-10 each week. This will help them build both speed and confidence.
Creating a good productivity model takes a lot of time and effort. Start early and you will not only reap the benefits of your hard work but also prevent some of the productivity impacts others have encountered after transitioning to ICD-10.
Remember: The first six to 12 months will be a critical time for us all. Being well-prepared will be the key to a successful implementation.