Supporting Physicians Practices and Clinics with a Plan Grounded in Expertise

1. Ensuring ICD-10 Transition Success Presentation to Palmetto Health September 28th, 2012 Supporting Physicians Practices and Clinics with a Plan Grounded in Expertise

2. Disclosures I am a consultant for The Advisory Board Company–Ben Beadle-Ryby

3. How ICD-10 Affects Physicians Background on ICD-10

4. Project Planning Spans a Breadth of Areas Large number of variables make it difficult to prepare for the future Source: Health Data Consulting

5. ICD-10 Codes Bring An Array of Differences ICD-10 codes are more specific than ICD-9 codes and are harder to classify Source: Advisory Board Research and Analysis; Milliman, ICD-10 Critical Success Factors, March 16, 2010 Transition Date: October 1, 2014 Lack of 1:1 Mapping for 80% of Codes Additional Documentation Required Example: Fracture of the Radius 1 of 33 ICD-9 Codes for Radial Fracture 4 of 1,818 ICD-10 Crosswalk Potentials ICD-9 CM ICD-10 CM 1,818 33 Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion Other open fractures of distal end of radius (alone) Representative Codes Representative Codes

6. How ICD-10 Affects Physicians Background on ICD-10

8. Physicians Juggle the Change to ICD-10 in both the Hospital and Physician Practice Physicians will be tasked with additional documentation and queries from hospital staff Hospital: Coding Challenges • Documentation • Additional clinical details must be noted • Queries • Additional requests from coders attempting to enter procedures and diagnoses into information systems • Additional requests from documentation improvement staff • Medical Records • New prompts to learn to enter codes

9. Challenges in the Physician Practice Area Coding challenges result in a number of financial and operational impacts • Coding Challenges • Code structure, number, detail, rules, sequencing, definitions & relationships • Increased documentation • Finding the correct codes • Training for physicians and staff • What it Affects • Practice Management System • Encounter Form/SuperBill • Staff Training Physician documents patient and procedure details Coder tries to crosswalk codes Increase in denied claims from payer

10. Codes Listed in Multiple Sections Create Confusion There are 155 codes relating to hypertension in 14 other categories besides ‘hypertension’ Excerpts From ICD-10: Tabular Index Codes pertaining to hypertension are strewn throughout the tabular index in 14 other categories

11. Impact on Operational Day to Day Management ICD-10 will result in structural changes that need to be made • Impact on Operational Management • Workflow disruptions • Training time • Coding productivity • Updates to Electronic Health Records Systems • Re-training and redesign of the SuperBill • What it Affects • Clinical Documentation • Public Health Reporting • Clinical and Quality Reporting • Encounter forms/SuperBills • Practice Management System • EMR • Office Practice Managers Create and Implement Strategies Early to Prevent Workflow Crisis The Traditional SuperBill Can’t be Populated with ICD-10 Codes

12. How Financial Coverage is Affected ICD-10 changes will impact revenue gains and losses for physicians • Impact on Financial Coverage • Harder to track performance based achievement goals • 10-20% estimated increase in denials • Processing rules • Remediation of medical policies • Crosswalk complications • Differences in authorization and referral triggers • Increased scrutiny of documentation to prevent fraud and abuse • What it Affects • Conversations with vendors • Conversations with payers • Budget for new or updated technology • Revenue from lost productivity and increase in denials Physicians Discuss ICD-10 with Vendors

13. Financial Implications for Small, Medium and Large Practices Cost of compliance to ICD-10 transition for small, medium and large practices Nachimson Advisors, October 2008 http://nachimsonadvisors.com/Documents/ICD-10%20Impacts%20on%20Providers.pdf Education Education Process Analysis Cash Flow Disruption Cash Flow Disruption Process Analysis Changes to SuperBills IT Costs Changes to SuperBills IT Costs Increased Documentation Costs Education Increased Documentation Costs Process Analysis Nachimson Advisors, October 2008 A “typical” small practice, comprised of three physicians and two administrative staff. A “typical” medium practice, comprised of 10 providers, one full‐time coder, and six administrative staff.   A “typical” large practice, comprised of 100 providers, with 64 coding staff comprised of 10‐full time coders and 54 medical records staff.  Cash Flow Disruption Changes to SuperBills Increased Documentation Costs IT Costs

14. The Silver Lining: A Positive Impact on Quality Outcomes Despite a long transition, expect benefits to be abundant in patient and quality outcomes Source: Smith P, et al., “Missing Clinical Information During Primary Care Visits,” JAMA, February 2, 2005293:565-571. • Impact on Clinical Outcomes • Understand the risk and potential complications for procedures performed • Link one hospital stay to another • Monitor resource utilization • Track public health of the community • Improve clinical, financial and administrative performance • Prevent fraud and abuse • Conduct research, and clinical trials Care Given But Not Documented Incomplete Chart Other Complete Chart

15. Robert M. Linnander Partner LinnandR@advisory.com 202-266-6189 Joe Corcoran, DO, FACOG Senior Director CorcoraJ@advisory.com 202-266-6482 Ben Beadle-Ryby Project Consultant BeadleB@advisory.com 202-266-5323 Please do not hesitate to contact your team with any questions or comments.