The ICD-10 Project A Mission Critical AOP Goal for FY13

1. The ICD-10 ProjectA Mission Critical AOP Goal for FY13 • John D. Halamka MD • Katherine Dallow MD, MPH 1 1

2. FY13 Annual Operating Plan & Value = 1 2 1 3 4 5 Improve the Health & Well-Being of Patients, Families, Employees Through Innovative Clinical Care, Education, & Research Use #s to show alignment to goals True North BIDMC Fiscal Year 2013 Operating Plan: Information Systems Grow and enhance a market-leading system of care… … that delivers the highest value… … by creating and sustaining a culture of continuous improvement… … through engagement, development, and support of our employees, physicians, patients & families Clinical Care System Advance as a system of care People Engage and develop our people every day • Quality • Ensure reliability • Implement processes that measurably decrease harm/defects • Improve reliability though standardization • Measurably improve patient & family experience • Cost • Continuously improve our ability to adapt to changes in the healthcare environment • Maximize efficient utilization of resources: • Staff • Equipment & supplies • Space • Diagnostic testing & treatment • Develop, standardize, improve transitions among sites of care • Respond effectively to the needs of our network and affiliates • Achieve optimal alignment between physicians & hospitals • Enhance wellness and safety • Promote & support a culture of service excellence and continuous improvement • Optimize & support learning & development Education Research

3. 1st revision introduced in 1900 International comparisons of mortality Used in USA for medical reimbursement Two parts – ICD-10-CM covers diseases and injuries ICD-10-PCS covers procedures Federally mandated cutover Oct 1, 2014 International Classification of Diseases, 10th Revision

4. Codes are the language of healthcare and will impact virtually all areas of healthcare. Quality Reporting Clinical Care Payers ICD-10 Finance IT

5. Fee Ticket, ED, Radiology, Lab Orders, RadOnc 1,800,000 ICD-9 Code Assignments 2.7M~ HIM Outpatient 500,000 HIM Inpatient 400,000 Typical Fiscal Year

6. Where are we currently using ICD codes?

7. Applications Affected 6

9. ICD-9-CM Code for finger injury is 915.8ICD-10-CM Code is:

11. ICD-9-PCS for knee replacement 81.54 ICD-10-PCS is 0SRD0JZ

12. Emergency Department 37,000 more injury, poisoning, external causes codes Anatomic specificity for fractures Obstetrics Several codes driven by trimester Neonatal-Newborn Severity of conditions, e.g. prematurity Congenital conditions Orthopedics Laterality Expanded list of device complications Pulmonary Severity of asthma More specific mechanical ventilation times Neurology Dominant/non-dominant side impacted Clinical Service Impact Examples

13. 57 percent of hospital revenue from inpatients ICD codes  DRG DRG  payment Single code can swing case by $10,000 or more Outpatient codes explain medical necessity Quality measures AHRQ Patient Safety Indicators Hospital Acquired Conditions Value Based Purchasing Acuity settlements for BIDCO pay-for-performance Financial Impact

14. Acuity Adjustment/DxCG • BIDCO Global Payment Contracts • BCBS, HPHC, Tufts, Medicare–Pioneer ACO • Global budget for all medical expenses (in and out patient), with shared savings if below target budget • Budget is adjusted up or down based on population acuity level (DxCG) • Acuity level is determined by ICD codes accumulated in a given calendar year • Value resets to demographics only on January 1 • ICD-10 vastly expands the potential number and specificity of these acuity adjusting codes

15. Quality Metrics • Inpatient and Outpatient • Readmissions, Diabetes, Cardiovascular, Depression, Cancer Screenings, Antibiotic Avoidance in URIs, Vaccinations… and much much more • Accurate ICD coding is essential for documenting both diagnosis inclusion and exclusion criteria • Risk no credit when the work is done appropriately • Risk non-compliance when comorbidities are omitted

16. Case Management • Disease and comorbidity based algorithms • Optum/IPro software • Definitions of risk based on claims - financial and disease based (ICD coded) information • BIDCO Nurse Care Managers • BIDCO Clinical Pharmacists • Inspiris NP CarePlus Home Visit Program-ACO • Disease Management Programs

17. Dual coding Some payers may not be ready Some payers not covered by HIPAA Claims-in-progress October 1, 2014 Get-acquainted period for coders Historical or other operational needs Superbills (aka Fee Tickets) Over 900,000 visits per year have codes checked on paper Workload Impact

18. Original Orthopedics Superbill 2-Pages Converted Orthopedics Superbill 49-Pages Impact on Superbills

19. Coordination Council ---------------------- APG, BID-N, BIDCO, Milton Steering Committee ------------------------- Steve Fischer John Halamka Education/CDI ----------------------- Gerry Abrahamian Luisa Dileso Payer/Contracting ---------------------- Beth O’Toole Katy Coughlin Workflow/CAC ------------------ Ed Grab John Powers Technology ------------------- Steve Herzog SEI Consulting ICD-10 Transition Project

20. Workflow maps Payer and vendor “readiness” surveys Inventory of impacted systems Educational curriculum for coders and clinicians Pipeline and Bridge programs planned Evaluations of computer assisted coding Discussions with major technology partner Statewide coordination through MHDC Work in Progress

21. Questions 18