How will ICD-10 affect productivity?

We’re back with more insights gleaned from our ICD-10 survey administered around the 2011 NAHC Annual Show.

Daymarck's Carie Wright (right)
surveying a home care professional
at NAHC 2011 in October.

One of our survey questions asked if you thought ICD-10 conversion would cause a decrease in productivity. 57% answered yes. And the average response of how long this decrease would last was 7 months.

The impact on productivity is one of, if not THE, biggest challenge of ICD-10 conversion. While there will be an initial learning curve and a need for a culture change that requires more specificity and communication, the impact on productivity can be minimized with proper planning and preparedness.

Agencies that have prepared for conversion well in advance should actually see a minimal impact on productivity. If an agency waits to the last minute however, this decrease can last even more than 7 months.

To help make sure you have a smooth transition with little impact on productivity, we’ve developed a helpful list of 10 things you should be doing now to prepare.

ICD-10 versus OASIS-C: Culture Change versus Process Change

When we asked home care professionals if they thought ICD-10 conversion would be more problematic than OASIS-C conversion in our latest survey, 58 percent answered yes. In fact, 25 percent said ICD-10 conversion would be extremely more problematic than OASIS-C.

We wholeheartedly agree and here’s why: 

Conversion to OASIS-C was a process change in which clinicians had to learn a new set of standardized questions. ICD-10 on the other hand will require a culture change— one where clinicians must increase their written, narrative descriptions when assessing a patient. It’s not a matter of what box do I check, but completely changing the way they document.

Currently, some agencies do great narrative summaries. These agencies will have less of a culture change, but will still need to change terminology and some focuses. Many agencies, however, do a poor job at documenting. They may not see the need for it and want to focus their time on the patients, not paperwork. These agencies will have the most difficult time, as they will need to learn to document more, spend more time and effort writing narratives, be more specific and use the right terminology.

Overall, ICD-10 will require much more training for all parties, and a lot further in advance than OASIS-C. It will cause a decrease in productivity, even for the most trained agencies, as they become more vigilant to make sure they are doing everything correctly.

While you can’t totally avert all the problems associated with ICD-10, with proper preparation, you can significantly offset them. With OASIS-C, many did no training whatsoever until just a couple months before. This can’t be done when instituting a cultural change. With proper planning and training, and by addressing any current documentation issues beforehand, you can tailor your ICD-10 training to address these issues so they don’t become a much larger problem after conversion.

To learn more about what you can do right now to prepare for ICD-10 conversion go to: 10 Things You Should Be Doing Right Now to Prepare for ICD-10.

10 Things You Should Be Doing Now to Prepare for ICD-10

As a remote coding agency focused on home care, we know and understand the importance of ICD-10 and its specific implications for home care agencies. We’ve been thinking about it since 2007. In fact, it was one of our reasons for starting Daymarck. Implementation may not be until October 2013, but home care agencies need to develop a plan now to make sure they are fully prepared.

Here are 10 things that you should be doing right now:

1)   Start talking to all your vendors (point of care, EHR, billing, etc.) to see what they are doing to prepare. They should be able to tell you their clear plan leading up to implementation.

2)   Take a look at any planned provider or system changes and decide if you should do them before, during or after ICD-10 implementation. Ask yourself how this change will be impacted by ICD-10.

3)   Identify your current coding work flow (who is doing how many codes) and what impact ICD-10 will have on it. Then decide what your new workflow process will be.

4)   Decide how you will train your staff on ICD-10. Will it be in-house or external? If you are a Daymarck customer, our training resources will be available to you so you don’t have to worry about this.

5)   Take a hard look at your personnel and determine if they are up to the challenge. This may mean you will need to hire new people or use an outside partner. Make sure your staff is committed to the change and not just doing it to keep their jobs.

6)   To ensure people are committed to the transition, communicate and start conversations about ICD-10 and its benefits and impact with your staff. Communicating with clinicians should be a very strong focus, as many are not up to speed on the necessity and reasoning for the change to ICD-10.

7)   Determine how ICD-10 will impact your budget. Budget constraints can include decreased productivity, training costs, and longer time getting Request for Anticipated Payments (RAPs) out meaning decreased cash flow.  For smaller agencies with limited cash flow, delays in getting RAPs out can be detrimental.

8)   Cultivate the relationship between coders and clinicians as ICD-10 will force them to work more closely together. Good relationship and communication between these two groups will help overcome decreased productivity. While these two groups may have different goals, encourage them to think of the big picture.  

9)   Decide how you will overcome a decrease in productivity. Our recent survey showed the average decrease will last 7 months. With decreased productivity and the same staff, you will either get less assessments out per day or force personnel to work longer hours which can lead to burnout. Have a plan to make sure both your staff is taken care of and your assessments are getting done.

10)Take a deep breath. It may seem overwhelming now, but with proper planning and communication, we’ll get through it together. And when it’s all said and done it will be great for the industry.

Help Home Care Help Healthcare

We hope this helps as you and your organization think about conversion to ICD-10. As a leader in the home care industry, we are dedicated to helping make home care a big part of the answer in solving our country’s healthcare challenges. This monumental shift to ICD-10 is a big step to improving our operations as an industry and will improve the level of care that this nation needs.

ICD-10 Survey

Please visit the results of our ICD-10 survey administered during the National Association for Home Care and Hospice Show in October 2011. It should give you more insight into the challenges and opportunities as we transition as an industry to ICD-10. Go to http://www.daymarck.com/icd10/.

Myth Dispelled: ObamaCare ≠ ICD-10

A recent Forbes article sheds even more light on a widespread ICD-10 myth: That ICD-10 is a product of "ObamaCare."

Although this is a common misperception, ICD-10 and Health Care reform (aka “ObamaCare”) are completely unrelated. ICD-10 conversion was decided upon by the Bush Administration in 2008. President Bush then granted a 2-year delay on implentation in his final days in office, delaying it from October 2011 to October 2013.

How common is this misunderstanding? We asked home care professionals if they thought the two were related in our ICD-10 survey at the 2011 National Association of Home Care and Hospice Annual Convention. Here's what they said:

• Nearly a third (32 percent) answered yes that Health Care reform and ICD-10 were related. 
• Another 29 percent said they were unsure. 
• The remaining 39 percent answered correctly, that the two were unrelated.

So what does this misconception mean for home care? That people are not well informed on the reasons for and long history behind ICD-10.  Without this knowledge, home care professionals may not take conversion seriously resulting in lack of preparation and decreased productivity.

Knowledge is power. So start having conversations at your agency about this myth and the reasons for ICD-10.

For more results of our ICD-10 survey go to: http://daymarck.blogspot.com/2011/11/icd-survey-results-are-in.html

Many Clinicians Still Doing the Coding

In our recent survey of home care professionals about ICD-10 conversion, we asked who at your organization was doing the medical coding. Results showed that 23 percent of home care agencies still have clinicians assigning and sequencing diagnosis.

While this number seems to be slowly declining, it is still far too high. The problem with clinicians doing coding is that their main focus should be on patient care. They are dealing with compliance issues that relate to patient care, and shouldn’t be worried about coding compliance issues as well. Clinicians are also not certified and typically receive little orientation training on how to properly assign codes. This means more room for error and potential for inaccurate payments.

Coding in the home health arena is complex. Home health care coders must gather information for coding from multiple sources, be familiar with inpatient procedure codes, late effect codes, and know how to read discharge information, rehab reports and more. Home health coders are also responsible for coding both acute and post-acute diagnoses. On top of everything a clinician is doing every day to care for patients, this can be overwhelming and detrimental to agencies.

On top of these current challenges, these clinicians will have to learn a whole set of new codes for ICD-10 conversion. Significant time and costs will need to be allocated to get these clinicians properly educated on the new system. There is also a greater chance of decreased productivity if clinicians are wearing both hats. Our ICD-10 survey revealed 57% of people thought conversion would cause a decrease in productivity, with an average decrease lasting seven months. With clinicians doing coding, this could significantly increase the length of decreased productivity.

The benefits of lifting the burden off of clinicians and hiring coders or a remote coding firm are plenty. More accurate payments. Better patient care. Improved compliance. Less burn out on employees. Peace of mind.

And with ICD-10 approaching, what better time to make the switch?

ICD-Survey: The Results Are In

The results are here on the first ever ICD-10 survey dedicated to the home health community. We had more than 235 home care professionals—including clinicians, coders, and administrators from all types of organizations— give us their opinions about ICD-10 and let us know what they are doing to prepare. They responded to the survey either online or in-person at the NAHC Annual Convention between September 13- October 7, 2011.

What the survey responses revealed is that home health care professionals are unprepared for ICD-10 conversion in October 2013. 76 percent of respondents revealed they have either not begun planning for ICD-10 conversion or are in preliminary stages of planning. Just 3% said they have developed a formal plan and are beginning to implement.

Our survey also revealed 70% have not begun to train employees on ICD-10. Twenty five percent have begun to train just a few key staff members and only 2% have had mass training.

We think these results illustrate that many are either underestimating the significance of ICD-10 conversion or perhaps don’t have the necessary resources to take action. We’re at a time where it’s critical for home care organizations to be in full planning and preparing mode so they can combat the negative effects conversion will likely bring.

Other key findings of the survey include:

·      59% of respondents feel converting to ICD-10 will be more problematic than converting to OASIS-C. 55% of those respondents think it will be extremely more problematic.

·      57% of respondents feel ICD-10 will cause a decrease in productivity for both clinician and administrative staff. The average response for how long this decrease in productivity lasting was 7 months.

·      46% of respondents were either not sure or do not think their vendors are appropriately preparing for ICD-10 conversion.

The biggest challenge of conversion revealed by respondents was educating clinicians and providers on the needs for more specific documentation (46%), followed by learning and implementing ICD-10 sets (28%). The biggest benefit of ICD-10 revealed was more-accurate payment (56%), followed by improved disease management (39%).

Ken Hooper, a principal of HC Healthcare Consulting, commented on the results, saying, “These findings are not surprising nor inconsistent with hospitals, but they are worrisome because people are behind the power curve. I’d also be interested to see what respondents are considering ‘preliminary planning,’ which may only consist of reading something about ICD-10.”

Over the coming weeks, we will take a deeper dive into the results of each question, revealing the implications for the industry right here on our blog. We also plan to conduct future ICD-10 surveys to measure the progress of preparations leading up to conversion in 2013.                        


Thanks for everyone who participated! We hope ICD-10 conversion is as pain-free as possible for everyone. Contact us to discuss how we can help. 

NAHC Wrap-Up

We hope you’re back in the swing of things after the 30^th Annual NAHC Annual Convention in Las Vegas a couple of weeks ago!

Daymarck team at NAHC 2011

We don’t know about you, but we thought it was one of the best conferences yet. During our three days exhibiting, we met hundreds of home care professionals from across the country and in all facets of the industry. We introduced our Pain-Free answer to coding and OASIS review to many, and heard feedback from numerous happy customers (here’s a video of one such instance).

Director of Business Development, Carie
Wright, conducting an ICD-10 survey

One of our favorite parts of this year’s show was learning what you thought of ICD-10 through iPad surveys in our booth. More than 230 of you shared your opinions and told us what you are doing to prepare for conversion. The survey spurred lots of great discussion and confirmed ICD-10 will be an important issue for the homecare industry leading up to conversion in October 2013. Stay tuned for the results of the survey which will be posted later this month.

A big thanks goes out to all who we got to meet at NAHC this year. And for those who couldn’t make it, feel free to check out our event photos, as well as this video from the show floor.

Please don’t hesitate to contact us any time to learn more about ICD-10 or discuss your home care coding needs.

NAHC Annual Meeting is Almost Here- Will you be there?

The clock is winding down, and the 2011 NAHC Annual Meeting is almost here! We’re looking forward to meeting all the home healthcare professionals in Las Vegas in just a few short days.

If you’re attending the show, we hope you will take a minute to stop by our booth (#862) and learn more about Daymarck’s Pain-Free answer to OASIS review and home healthcare coding. 

While you’re there, we also invite you to fill out our quick survey about converting to ICD-10. By participating, you will be eligible to win one of six casino-grade poker sets (a $150.00 value). Not attending? Don’t worry; you can fill out the survey now here.

You can also help us raise money for the Caring Institute by becoming a fan of Daymarck on either Facebook or Twitter by the end of the show. We’ll donate up to $1,000 to this deserving organization!

For those attending, we look forward to seeing you in Las Vegas! And if you can’t make it, stay tuned here and on Facebook or Twitter for updates during and post-show.