ICD-10-CM and ICD-10-PCS are on their way to a place in the U.S. healthcare system. What does this mean to you today?

In November 2003 the National Committee on Vital and Health Statistics (NCVHS) submitted a letter to Health and Human Services Secretary Tommy Thompson calling for the adoption of ICD-10-CM and ICD-10-PCS as replacements for the current uses of ICD-9-CM. In this letter, NCVHS stated that ICD-10 could better accommodate advances in medicine, reduce the number of rejected claims, and improve reimbursement, care quality, safety, and disease management. In addition, there is widespread support for ICD-10 throughout the healthcare industry and indications are that the federal government is moving toward publishing a notice of proposed rulemaking (NPRM) – a key first step in the adoption process.

While everyday use of new code sets from ICD-10-CM and ICD-10-PCS is still at least two years away, healthcare organizations should begin preparing now. An implementation plan established three years in advance of the scheduled implementation date within the requirements of HIPAA is necessary to ensure a successful transition to ICD-10-CM and ICD-10-PCS. This plan is a road map for what your healthcare organization can do to set priorities for the various stages of the transition.

Three Years Out

• An implementation planning team to explore any changes required in work flow, information systems and claims processing
• Start the initial education process to raise awareness about how improved systems will impact your operation

Team Design
As with any other major undertaking, putting together a team to oversee the implementation is key to success. Members of your planning team should at least include senior management, medical staff, financial management, health information management, and information systems (IS) management. This group will develop the organization’s plan and identify the actions, accountability, and deadlines for the various steps required to accommodate and benefit from the new and improved code sets. In addition, this plan should include estimated budget needs for each year leading up to implementation for early financial planning. Work products from this group will result in a task list and timeline to assure everyone is ready for the transition. Another charge to this group is to determine what information requirements exist that require linkage of data stored in the current code sets to data stored in the ICD-10-CM and ICD-10-PCS systems of the future.

Preliminary Educational Needs
Another major component of the first stage is education. The effect of implementation of new code sets is not limited to coding professionals or billing personnel, but overarches the entire organization, since diagnosis and procedure codes are data elements used to meet a variety of facility information requirements Colleagues throughout the organization need to be aware of the ICD-10 transition team as a resource for factual information and regulatory updates that may affect department operations. Every department should be made aware of the process and the impact to workflow and data retrieval. Key to an effective implementation process is the education of information systems personnel concerning the technical aspects of the ICD-10 systems. They will need to understand the logic and hierarchical structure of ICD-10-CM and ICD-10-PCS. Clinical personnel and support staff will need knowledge of the differences between the code sets that reflect the services they provide, the effect on their work, and the time frames involved.

Two Years Out

• Identify and budget for any required changes in computer system and information technology to accommodate and benefit from the increased specificity and improved features of the ICD systems.
• Assess, budget for, and implement clinician and staff education in identified areas
• Coding professionals should be aware of ICD-10-CM and ICD-10-PCS structures and be planning for more in depth training to be prepared for the implementation date (24 months from the final rule).

Information System Changes
Building on the work completed in stage one, a more detailed analysis needs to occur in the second year of preparation. A budget for the required changes must also be established to determine 1) what software changes are needed? 2) What overall computer system changes are required to accommodate multiple coding systems and applications? And, 3) What needs to be done to increase system storage capacity to support required coding systems for an adequate period of time?

Clinician and Staff Education
Implementation of any new coding system requires educational programs for clinicians responsible for documentation, Health Information Management and coding professionals, and a growing number of data users throughout the healthcare industry. The range of users and settings for which programs have to be designed and provided is much wider for ICD-10-CM than ICD-10-PCS which affects only hospital inpatient reporting at this time. Focused clinician education continues in those areas in need of improvement to take advantage of the increased specificity and features of ICD-10. In addition, reanalysis should be undertaken to determine the success of earlier efforts and assist in refocusing educational programs.

One Year Out

• Implement required computer system and software changes
• Conduct a follow-up assessment of documentation practices as a basis for ICD-10 code assignment
• Conduct Intensive education of the organization’s staff with direct code assignment responsibilities

Initiating computer system and software applications at this point allow time for testing and troubleshooting before the "go live" date. A full reassessment after education is useful to verify that goals are being achieved and the impact on loss of productivity due to system changes is minimized. A follow-up assessment of documentation practices, after the clinician education is complete, is essential to determine where improvements have occurred and where enhancements are necessary to ensure against loss of reimbursement or loss of critical data due to inadequate data capture to support code selection at the highest degree of specificity and accuracy.

It is virtually impossible to make changes of this magnitude without encountering some obstacles and setbacks. The key to managing the process is a good map that establishes "mile markers" to identify steps and priorities early. This method enables everyone to plan and prepare, thus minimizing problems.

The American Health Information Management Association continues to advocate and provide useful tools and programs in a time of change. Visit www.ahima.org for more information and help in getting from "here" to "there" with new coding systems.

Rita Scichilone, MHSA, RHIA, CCS, CCS-P, CHC, is Director of Coding Products and Services at AHIMA.

Many famous people have suffered Alzheimer's disease: British statesman Winston Churchill, actors Rita Hayworth and Charleton Heston. Most recently our nation’s beloved former President Ronald Reagan died after suffering from Alzheimer’s disease for ten years.

An estimated 4 million Americans currently have Alzheimer's disease. During the 1960s, researchers considered Alzheimer's disease a rare disorder. But during the last 30 years, scientists have recognized that it's fairly common, in fact, it is the leading cause of age-related dementia. According to a large survey of retired individuals, the risk of Alzheimer's disease changes considerably during the elderly years:

• From age 65 to 74, about 3 percent of people are affected.
• From age 75 to 84, the figure rises to 19 percent.
• And for those 85 and older, Alzheimer's afflicts 47 percent.

Structured activity-intensive programming may include pet-therapy to stir fond memories and illicit response.

Alden, a premier provider of subacute, skilled nursing and residential services is responding to the growing need for quality Alzheimer’s care. Based on the latest research from The RUSH Alzheimer’s Disease Center and the Alzheimer’s Association, Alden has developed the Pathways Program. "The core of our Pathways approach is structured activity-intensive programming. Virtually anything that happens in a resident’s day from dressing and grooming in the morning, getting together for meals, strolling around the dedicated secured unit and/or courtyard, performing success oriented tasks or simply reminiscing represents an opportunity to reinforce a resident’s sense of identity and purpose." Stated Robert Molitor, Chief Operating Officer. "Through specific training in Alzheimer’s disease and related dementias for all of our staff, our goal is to create "dementia-capable facilities which includes an enhanced secured unit in a minimum of twelve Alden facilities. Even our therapy staff have participated in the latest training to ensure that we can meet the rehabilitation needs of these residents that we are privileged to serve. Alden is well-positioned to provide quality care for this fast growing segment of our population. By staying abreast of research and providing ongoing education in the latest therapeutic approaches for encouraging individuality and accommodating behavior changes that often accompany memory disorders, Alden is ready to meet residents’ needs today and tomorrow."

Before a resident moves in even for a short stay, a comprehensive assessment occurs to include a mini-mental status exam, an overview of daily routines, likes and interests and a life history. From this information, the program director, staff and the resident develop a personalized care plan that reflects the resident’s preferences and capabilities. "Most of the residents come from home, where they have been lovingly cared for. We consider families to be our partner. In fact, we display photos of residents and their families, along with staff, on our Pathways Partners In Caring wall located on each Pathways unit" stated, Ronja Cole, nurse practitioner and Alden’s Director of Clinical Services. "These photos along with Alden’s Pathways of Life sensory stimulation activity stations and a highly structured environment allow each resident to flourish and stir fond memories for residents and families alike.

To learn more about this innovative Alzheimer’s program, please call Alden Management Services at (773) 286-3883 or visit the company’s website at www.thealdennetwork.com.

More than a decade after the closing of St. Anne’s Hospital, the 114,000 residents of Chicago’s West Side once again have a new place to go for dependable quality healthcare and new opportunities for skilled jobs. Residents recently joined Mayor Richard M. Daley, Cook County Board President John H. Stroger, Jr., State Representative Calvin Giles, Alderman Emma Mitts and others for a ribbon-cutting ceremony marking the official opening of the Austin Wellness Center.

(l to r) Alderman Emma Mitts, President John H. Stroger, Jr., Mayor Richard M. Daley, Executive Director of the Westside Health Authority Jacqueline Reed, Alderman Isaac Carothers, LISC/Chicago Program Director Andrew Mooney, and State Representative Calvin Giles cut the ribbon on the new Austin Wellness Center on Chicago's West Side.

"The Center is the first human services building constructed anew in the Austin neighborhood in forty years," said Jacqueline Reed, Executive Director of the Westside Health Authority, the non-profit organization that developed the center. "Austin residents knew better than anyone else what they needed most – jobs and healthcare, and today I am proud to say this center provides both."

"Everyone involved with this center should be very proud of what they’ve accomplished," said Mayor Richard M. Daley. "They have created a new community anchor and improved the quality of life of the people who live here. Thanks to grassroots efforts like the Austin Wellness Center, the West Side is growing stronger, safer and healthier every day."

The Austin Wellness Center, at the corner of Chicago Avenue and Cicero Avenue in the Austin community, is a brand-new 28,500 square feet, two story building, housing both a clinic and dialysis center, with additional space for retail and a proposed employment training center.

In addition to serving Henderson’s and other residents’ healthcare needs within their own community, the Center also addressed another serious concern – jobs. Construction of the center generated 100 permanent and 52 construction jobs, 32 of those going to local residents because of the Westside Health Authority’s commitment to hiring minorities and community members. In fact, thirty-seven percent of the project’s subcontractors were from Chicago’s West Side, while 55% of the subcontractors overall were African-American. The number of jobs will be further enhanced by the proposed Employment and Training Center, which is expected to train residents and small businesses in computers and give them access to an employment database.

To learn more about the MHA program at National-Louis University, call 1-888-NLU-TODAY (658-8632) or visit www.nl.edu.