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

Response to American Medical Association’s Opposition to ICD-10 Implementation

On November 15, 2011, the American Medical Association’s (AMA) House of Delegates voted to vigorously stop the implementation of ICD-10.

AMA president, Peter W. Carmel said, "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care. At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be – on their patients."

While we agree the transition to ICD-10 codes will be a major undertaking and result in added costs up front, our stance is that ICD-10 transition is both beneficial to the healthcare arena and long awaited. AMA stance that they are opposing this so physicians can keep their focus on the patients is not justified. While physicians have to document diagnoses for each patient encounter, this ultimately would not change the physicians focus on their patients.  They rarely are responsible for the final submission of codes prior to billing. This should be the responsibility of certified medical coders to ensure accuracy.

Several studies have been conducted weighing the costs and benefits of ICD-10 conversion. A study sponsored by the National Committee on Vital and Health Statistics (NCVHS) and conducted by the RAND Corporation evaluated the cost of training, productivity loss and system changes versus the benefits of going to a “superior code” set[1]. It concluded that the benefits outweighed the costs associated. Benefits included those to providers such as more accurate payment and fewer rejected claims, as well as patient benefits including improved disease management and timelier intervention of emergent diseases, such as SARS, which cost the Asian economy more than $10 billion.

Additional reasons why transition to ICD-10 is crucial include:

·    Endorsed by the World Health Organization (WHO) all the way back in 1993, ICD-10 is currently used in all other industrial countries around the world. With all countries on the same system, the WHO and Center for Disease Control (CDC) can have more accurate and consistent health records which are critical to ensure the quality of care, sound management, health financing and administration of health systems.

·    Since the implementation of ICD-9 in 1979, many new diseases and diagnoses have been discovered. The current ICD-9 system of three-digit categories and no more than 10 subcategories can no longer accurately track why people seek medical treatment.

We urge the AMA to direct its attention to other pressing issues in the healthcare arena, and focus on solutions. One such issue is the current law that prohibits nurse practitioners and other advance practice providers from ordering and managing patients under home care.  There are currently bills in Congress (H.R. 2267) and Senate (S. 227) to amend this law, recognizing the shortage of primary care physicians and an aging population in need of chronic care. There have been other bills introduced in the 111^th Congress.  Both these bills died because they were not addressed before the end of session. The AMA has historically slowed progress of expanding the roles of nurse practitioners on both state and federal levels by consistently requesting additional studies and discussions on various NP issues.  Even when there is clear evidence based data showing expansion of the advanced practice nurse roles have significant cost benefits while delivering safe patient care. A recent study by Dobson, DaVanzo & Associates shows the cost savings over 10 years to be $309.5 million dollars to the Medicare system by using nurse practitioners to order and manage home care patients.[2] AMA’s official support of this overdue legislation would help facilitate getting these bills pushed through Congress and the Senate.

The second issue in need of the AMA’s attention is opposing Medicare Advisory Commission’s (MedPAC) recommendations to add copays to Medicare home care episodes.  Medicare home care service copays has been advanced in Congress as a means of deficit reduction as well as a means of limiting the growth of Medicare home health expenditures. Some Medicare Advantage (MA) plans have imposed home health copays. Copays are regressive, in-efficient and fall most heavily on the poorest and oldest Medicare beneficiaries.

The National Commission on Fiscal Responsibility and Reform (2010) recommended a uniform 20 percent copay and a uniform overall deductible of $550 for all Medicare services combined, including home health care. In January 2011 the MedPAC voted to recommend a home health copay (as much as $150 per episode) for episodes not preceded by a hospital or nursing home stay as a means to encourage beneficiaries to control utilization of care. Once again, the AMA’s strong opposition to these recommendations would have a larger impact on patient’s receiving care through proper healthcare access.

It is well accepted that ICD-10 will allow for quicker and larger medical care advancements. While the AMA may try to stop or delay ICD-10, we strongly believe it will and should be implemented. Health and Human Services (HHS) has already delayed implementation by two years to give institutions and providers additional time to prepare for this transition. We see a low probability, as well as little benefit, of it being delayed any further. AMA's opposition of ICD-10's implementation will only further delay the American healthcare industry from keeping up with the rest of the world.

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[1] http://www.rand.org/pubs/technical_reports/2004/RAND_TR132.pdf

[2] http://www.congressweb.com/nahc/docfiles/20110923_Dobson.pdf

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. 

Call to Action: Stop Co-Pays and Across-the-Board Cuts

An offer put forth by a majority of the Democrats on the Joint Select Committee on Deficit Reduction (the “supercommittee”) has caused a firestorm of criticism from many Democrats on the Hill, along with senior and disability advocates. Their $3 trillion deficit reduction blueprint includes $400 billion in Medicare savings, equally divided between provider and beneficiary cuts, and $100 billion in Medicaid savings over 10 years. This offer is a “grand bargain” with Republicans who would have to agree to match spending cuts with new tax revenues. Republicans have countered with a $2.2 trillion proposal, which reportedly would include substantial Medicare and Medicaid cuts. Republicans have not yet agreed to increase taxes, so members of the supercommittee appear to be at a stalemate. However, they may strike a deficit reduction deal by their November 23 deadline.

The Leadership Council of Aging Organizations (LCAO), a national coalition of more than 60 senior groups including NAHC that opposes increased Medicare cost shifting to seniors, is planning to conduct a briefing for Hill staff this Friday at November 4, at 11:00 AM, on the theme of Medicare and  “Skin in the Game.” This refers to the often-heard comment by some on the Hill that seniors need to pay more for Medicare services so they will have more “skin in the game.”  As we all know, seniors already have a lot of skin in the game, including the fact that their families and friends are already providing an estimated $450 billion in unpaid services a year to enable them to remain in their homes—costs that Medicare would have to pick up if they were in nursing homes or hospitals. 

In order to stop copays and across-the-board cuts, you can help blanket the Hill with our message. To send a message, go here. There you will find numerous studies, talking points, and a sample message that you can edit to include your experience and the negative impact home health and hospice cuts and copays would have on your patients. You can also call your elected officials. Find the phone numbers for elected officials in your state here. When calling, ask the receptionist to connect you with the person who handles Medicare issues.

Thanks for helping to making a difference! 

Why Do Post-Acute Providers Need Access Prior to Discharge?

By: Elizabeth E. Hogue, Esq.

Many post-acute providers; including home health agencies, private duty agencies, hospices, and home medical equipment (HME) companies, place a high value on use of coordinators/liaisons who regularly visit patient floors at hospitals and other inpatient facilities.  Some discharge planners/case managers do not understand why such access is needed, especially in view of the availability of various methods of communicating information to post-acute providers.  In fact, discharge planners/case managers may view the presence of post-acute providers as nothing more than a nuisance.  There are, however, several reasons why the use of liaisons/coordinators from post-acute providers in institutional settings is important.

First, visits by liaisons/coordinators to patient floors are important for the provision of quality of care for patients.  It seems increasingly clear that patients are at greater risk during transitions in care.  Such transitions include shift changes in inpatient settings as well as movement from one level of care to another.  Care transitions during which patients may be at increased risk also include transitions from inpatient care to post-acute care.  According to Standards of Practice for Case Management published by the Case Management Society of America (CMSA) in 1995 and revised in 2002 and 2010, case managers/discharge planners have a duty to assist clients in the “safe transitioning of care to the next most appropriate level.”

While discharge planners/case managers may feel that they communicate all necessary information to post-acute providers, it seems likely that the more communication there is prior to discharge, the more likely it is that the transition will go smoothly.  In order to help ensure a safe transition, coordinators/liaisons may be present on patient floors in order to talk directly with patients, to obtain more information from discharge planners/case managers, and to meet with families, especially primary caregivers, to help ensure that they understand their role in the provision of home care and hospice services.  Consequently, the activities of coordinators/liaisons on patient floors may help to provide optimum transitions to patients from hospital or facility to home, and may help to manage the risks of both hospitals and facilities and post-acute providers.

It is also appropriate for liaisons/coordinators to be on site to visit patients with whom the post-acute provider has an ongoing relationship to help ensure continuity and quality of care.  Home health patients whose episodes of care paid for by the Medicare Program do not end while patients are in the hospital or facility are still admitted to home health agencies and are still patients of the agencies.  Hospice patients remain admitted for hospice care even though they are hospitalized.  HME suppliers may maintain equipment in patients’ homes throughout their hospitalizations.  Coordinators/liaisons can best stay in touch with patients of their organization and their families by visiting them in inpatient facilities.  Post-acute providers need to have current knowledge about the clinical condition of patients, the availability of primary caregivers, the need for additional equipment and supplies, etc. in order to be able to continue to provide appropriate care upon discharge.  Providers are legally prohibited from rendering services to patients whose needs they cannot realistically meet.

Coordinators/liaisons may also need to be on patient floors because they receive referrals that do not come from anyone at the hospital.  Referrals may come from a variety of sources and may be received either verbally or in writing.  Examples of referral sources include, but are not necessarily limited to: discharge planners, hospital and facility staff members, physicians, patients, and patients’ friends and family members.  It is unnecessary for referrals to be received by the Agency in the form of orders from physicians or other practitioners.  Post-acute providers may, for example, receive referrals from family members who seek services for patients.  So coordinators/liaisons may need to be on patient floors in response to specific requests from family members to begin the process of coordination of post-acute services.

Based upon the above, liaisons/coordinators have legitimate needs to be on patient floors in inpatient settings.  While solicitation of patients is impermissible, violations of this prohibition by some post-acute providers should not interfere with the ability of post-acute providers to meet the legitimate needs described above.

© 2011 Elizabeth E. Hogue, Esq. All rights reserved. 

No portion of this material may be reproduced in any form without the advance written permission of the author.

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.