ICD-10 Still a Priority: Don't Lose Ground! Join us for AHA's Annual

48 Pages·2012·8.43 MB·English

SPRING 2012 www.arkhospitals.org
ICD-10 Still a Priority:
Don’t Lose Ground!
Join us for AHA’s
Annual Meeting in
Washington, D.C.
AA MMAAGGAAZZIINNEE FFOORR AARRKKAANNSSAASS HHEEAALLTTHHCCAARREE PPRROOFFEESSSSIIOONNAALLSS
Spring 2012 I Arkansas Hospitals 1
2 Spring 2012 I Arkansas Hospitals
PAGE 17 PAGE 20 PAGE 26 PAGE 46
Arkansas Hospitals FEATURED SECTION
ICD-10 – Still A Coming Reality!
is published by
Arkansas Hospital Association
419 Natural Resources Drive • Little Rock, AR 72205
501-224-7878 / FAX [phone] ICD-10 29 Medical Loss Ratio Final Rule Affects Insurers
www.arkhospitals.org
8 HHS Announces Intent to Delay Compliance Date 30 NLRB FInal Rule Spurs Lawsuit
Beth H. Ingram, Editor 8 ICD-10 Still a Priority: Don’t Lose Ground! 30 Instructions for Medical Resident FICA Refunds
Nancy Robertson Cook, Managing Editor
9 Here Comes Trouble
Features
BOARD OF DIRECTORS 12 Five Strategies to Tackle ICD-10
Larry Morse, Clarksville / Chairman 31 OIG Provides Compliance Training Videos, Podcasts
14 Good Things to Say About ICD-10
Doug Weeks, Little Rock / Chairman-Elect 32 What We Learned in Jan. 26 RAC Workshop
David Cicero, Camden / Treasurer
James Magee, Piggott / Past-Chairman NewsSTAT 32 A Year of Extreme Challenges for Hospitals
Kirk Reamey, Clinton / At-Large
17 AHA Annual Meeting May 6-9 in D.C. 34 PDS Enhances Revenue Without Adding Resources
Chris Barber, Jonesboro
Darren Caldwell, DeWitt 19 Brown is Vice President of Quality and Patient Safety 36 Hospitals’ CLABSI Data Now Available to Public
Kristy Estrem, Berryville 19 Arkansas HEN: What it Means to Hospitals 37 Arkansas’ Stop BSI Project Results Remarkable
Lisa Evans, Little Rock
Earl Goatcher, Clinton 20 2012 AHA Diamond Awards: Call for Entries! 37 AAHT Regional Meetings Announced
Tim Johnsen, Hot Springs 20 Mid-Management Course Honors 15 Graduates 39 Arkansas Methodist’s Chateau on the Ridge
Walter Johnson, Pine Bluff
Ed Lacy, Heber Springs 22 Mid-Management Healthcare Leadership Series 41 Taming a Hospital Crisis: 7 Rules of the Road
Jim Lambert, Conway
22 MedPAC Recommends FY 2013 Payments
Ron Peterson, Mountain Home Legal Note
Lynn Smith, El Dorado 23 Ashley County Medical Presents Health IT Efforts
Melody Trimble, Fort Smith 44 Required Disease Reporting Allowed Under HIPAA
24 Fiscal Session Packed with Intense Debate
EXECUTIVE TEAM 26 AHA’s 2011 PAC Contributions Recognized Quality/Patient Safety
Robert “Bo” Ryall / President and CEO 27 Save the Date for Summer Conference 44 FDA Proposes Legislation for Drug User Fees
W. Paul Cunningham / Executive Vice President
27 Webinar to Define FEMA Reimbursement Protocols 45 Quality Measures for Medicaid-Eligible Adults
Beth H. Ingram / Vice President,
Educational and Membership Services 28 Governor’s Quality Award Deadline April 2
Tina Creel / Vice President, AHA Services, Inc. 28 Help Arkansas Save Lives! Medicare/Medicaid
Don Adams / Vice President,
45 FAQs About Medicaid RACs Available Online
Rural and Mental Health Services
Elisa M. White / Vice President and General Counsel 46 CMS Newsletter Addresses Recovery Audit Issues
Jodiane Tritt / Vice President, Government Relations 46 Final Rule for Release/Use of Medicare Claims Data
Pam Brown / Vice President,
46 Reminder: Part A Claims Issue
Quality and Patient Safety
DISTRIBUTION
Arkansas Hospitals is distributed quarterly
Departments
to hospital executives, managers, and trustees
throughout the United States; to physicians, 4 From the President
state legislators, the congressional delegation,
and other friends of the hospitals of Arkansas. 5 Education Calendar
6 Arkansas Newsmakers and Newcomers
To advertise contact Cover Photo
Greg Jones Aerial view of the
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501/221-9986 ext.105
[email protected] Photo courtesy
www.pcipublishing.com Arkansas
ThinkNurse.com Department
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Tourism
Spring 2012 I Arkansas Hospitals 3
F R O M T H E P R E S I D E N T
Quality and How It Affects Our Hospitals
In recent weeks, the Arkansas Hospital national HEN contract by CMS to support
Association has, with both foresight and their Partnership for Patients campaign.
bold decision-making by our board of
The goal of the campaign is to help
directors, made a heightened commitment
hospitals reduce harm by 40 percent and
to quality as it affects our hospitals.
preventable readmissions by 20 percent
As you may know, the AHA has put over the next two years.
into place a Patient Safety and Quality
But it’s really more than that. It’s
Program to move us beyond participation
improving the outcomes and hospital
in the occasional national collaborative
experience for our patients; it’s helping
(important work, like our Stop BSI and Stop
our hospital staffs navigate the many
CAUTI programs) and into a full-court
quality mandates, measures and data
press regarding quality in our hospitals.
submission requirements that seem to be
We have just brought on board our ever-growing. And ultimately, it will mean
new vice president for quality and patient improvement to each hospital’s bottom
safety. Pam Brown is both a clinician line, as hospital-acquired infections are
and an expert in the area of hospital reduced and readmissions prevented.
quality, coming to us from a leadership
I am humbled by the courageous
role at our state’s Quality Improvement
decision our board made, shining a
Organization. Her background makes
spotlight on quality and growing our
her a uniquely perfect fit for this new
efforts in that direction…humbled because
position, and her expertise will be allowed
our board had the foresight to see what
to shine as she builds and puts into place
was coming and entrusted our staff with
the AHA’s new quality program.
the responsibility of working with and for
Our board members knew that our hospitals in this very important area.
hospital reimbursements are more and
Every AHA member hospital will
more linked to performance, quality and
benefit from the new Patient Safety and
patient safety. Putting into place this new
Quality Program. Watch for news on
quality program, creating a new position
how the AHA can help your hospital in
to lead it, and putting Pam into the
its quality efforts, and how we will work
leadership role show their commitment
together to improve the daily hospital
both to the improvement of patient safety
experience for our patients, their families,
in Arkansas and to helping our hospitals
our physicians, professional medical staffs
(of all sizes) make their way through the
and our employees.
maze of governmental quality measures
and requirements. Today, hospitals are “all about” quality.
With our new focus in that direction, I
Pam will have her hands full over the
expect we’ll all see big improvements in
next few months as she works on behalf
Arkansas, both for our patients and for
of all our member hospitals and leads our
our hospitals’ profitability.
Hospital Engagement Network (HEN),
creating work plans with and for each of
our 46 member hospitals that joined the
HEN. The Arkansas HEN, as you’ll read
in later pages of this magazine, is part
Bo Ryall
of a 33-state group cooperating under
President and CEO
the leadership of the Health Research &
Arkansas Hospital Association
Educational Trust, which was awarded a
4 Spring 2012 I Arkansas Hospitals
EDUCATION CALENDAR
March 28, Little Rock April 25-26, Little Rock
2012 Hospital Medicare General Update Workshop Basic Emotional First Aid Crisis Response Training
March 29, Little Rock April 25-27, Hot Springs
Crisis Communications Workshop Society for Arkansas Healthcare Purchasing and
Materials Management Annual Meeting
March 30, Little Rock
Hospital Emergency Preparedness Workshop April 27, North Little Rock
AONE Spring Conference
March 30, Little Rock
2012 Healthcare Management Institute May 6-9, Washington, DC
American Hospital Association Annual Meeting
April 3, Little Rock
Hospital Staff Development Forum May 11, Little Rock
Arkansas Association for Healthcare Quality 2012
April 11-13, Hot Springs
Spring Conference
Healthcare Financial Management Association
Spring Annual Meeting May 16-18, Little Rock
Arkansas Association for Healthcare Engineering
April 17-18, Hot Springs
Annual Meeting
AFMC Quality Conference
May 24, Little Rock
April 24, Little Rock
Arkansas Association for Medical Staff Services
Mid-Management Series, “Assuming Leadership”
Spring Conference
Program information available at www.arkhospitals.org/events.
Webinar and audio conference information available at www.arkhospitals.org/events.
Spring 2012 I Arkansas Hospitals 5
ARKANSAS
NEWSMAKERS
NEWCOMERS
and
John Baker, Ph.D., Professor of Health Policy and Directors from 1999-2001 and was a Fellow in the
Management, Fay W. Boozman College of Public American College of Healthcare Executives.
Health, retired in December 2011. He had been a mem-
ber of the Health Services Administration faculty since Lucinda DeBruce, RN, has been named CEO
1980. Before the program was moved to UAMS in 2006 of Vista Health Services in Texarkana. Previously,
he was the founding faculty member and Chairman of DeBruce was the chief executive at Springwoods Behav-
the Graduate Program in Health Services Administra- ioral Hospital in Fayetteville, Psychiatric Solutions-Tex-
tion at UALR for 16 years. The Program is one of sev- as West Oaks Hospital in Houston and Pinnacle Point
enty nationally accredited graduate programs in health Hospital in Little Rock.
services administration.
Mark Enderle, MD has been named medical center
Governor Mike Beebe made the following appoint- director of the Veterans Health Care System of the
ments to the Governor’s Trauma Advisory Council: Ozarks in Fayetteville. He most recently held the posi-
Kathryn Blackman, vice president of patient clinical tion of senior medical officer within the Office of Qual-
services, St. Bernards Medical Center, Jonesboro; Keith ity and Performance of the VA in Washington, D.C.
Moore, assistant vice president/night administrator,
Baptist Health Medical Center – Little Rock; and Donnie Frederic, FACHE, has been named CEO
Christi Whatley, vice president, St. Joseph’s Mercy of St. Mary’s Regional Medical Center in Russellville
Health Center, Hot Springs. These appointments will effective January 16. He was most recently president
expire July 1, 2013. R.T. Fendley, senior associate hos- and CEO of Louisiana Medical Center and Heart Hos-
pital director, UAMS, was reappointed to the Council. pital. Prior to accepting that position in 2009, Frederic
served in leadership positions in three Arkansas facili-
Jeff Curtis, former CEO of HSC Medical Center in ties: Arkansas Heart Hospital in Little Rock, North-
Malvern, died December 29 from cancer. Jeff had a west Health System in Springdale and Bates Medical
long career in healthcare administration, having served Center in Bentonville (now Northwest Medical Center
a residency and as night administrator at Baptist Health Bentonville). Frederic succeeds Mike McCoy who has
System in Little Rock; president and CEO of the Mal- been named COO, a position that will enable him to
vern facility for 13 years; and as associate director of work more closely with staff on a daily basis. McCoy
operations for Greenwood (MS) Leflore Hospital before has been with Saint Mary’s for 27 years, having served
his health declined. He served on the AHA Board of as CFO and CEO. •
6 Spring 2012 I Arkansas Hospitals
Spring 2012 I Arkansas Hospitals 7
I C D - 1 0
HHS Announces Intent to Delay
ICD-10 Compliance Date
As part of President Obama’s years from the compliance date ini- and the nation implement these
commitment to reducing regula- tially specified in the 2008 proposed important improvements to our
tory burden, Health and Human rule. HHS will announce a new healthcare system.”
Services Secretary Kathleen Sebe- compliance date moving forward. ICD-10 codes provide more
lius on February 16 announced “ICD-10 codes are important robust and specific data that will
that HHS will initiate a process to to many positive improvements help improve patient care and
postpone the date by which certain in our healthcare system,” said enable the exchange of our health-
healthcare entities have to comply HHS Secretary Kathleen Sebelius. care data with that of the rest of
with International Classification of “We have heard from many in the world that has long been using
Diseases, 10th Edition diagnosis the provider community who have ICD-10. Entities covered under
and procedure codes (ICD-10). concerns about the administrative the Health Insurance Portability
The final rule adopting ICD-10 burdens they face in the years and Accountability Act of 1996
as a standard was published in Janu- ahead. We are committing to work (HIPAA) will be required to use
ary 2009 and set a compliance date with the provider community to the ICD-10 diagnostic and proce-
of October 1, 2013 – a delay of two reexamine the pace at which HHS dure codes. •
ICD-10 Still a Priority: Don’t Lose Ground!
Help for ICD-10 Transition Available on CMS YouTube Channel
Hospitals looking for additional
Hospitals looking for additional help in preparing for the
help in preparing for the U.S. health-
care industry’s change from ICD-9 to U.S. healthcare industry’s change from ICD-9 to ICD-10
ICD-10 for diagnosis and inpatient for diagnosis and inpatient procedure coding may
procedure coding may want to look
want to look in on a set of video slideshows relating to
in on a set of video slideshows relat-
ing to various ICD-10 National Pro- various ICD-10 National Provider Calls on the topic.
vider Calls on the topic.
Video slideshow presentations Information Management Asso- issues affecting all providers.
from the following previously aired ciation (AHIMA), and the Cen- • CMS ICD-10 Conversion Activi-
National Provider Calls are avail- ters for Disease Control and Pre- ties (http://www.youtube.com/
able on the CMS YouTube Chan- vention (CDC) – discuss ICD-10 cmshhsgov#p/search/2/IRD_
nel (http://www.youtube.com/user/ implementation strategies and ST_4dZ0) – May 18, 2011
CMSHHSGov). These video slide- planning, and the CMS Pro- CMS subject matter experts
shows include the call slide presenta- vider Billing Group discusses the discuss the ICD-10 conversion
tion and audio with captions; each Medicare FFS claims processing process currently taking place
call includes presentations by CMS guidance issued in August 2011. within CMS, including a case
subject matter experts, followed by • ICD-10 Implementation Strategies study from the Coverage and
a question and answer session. for Physicians (http://www.you- Analysis Group on their transition
• ICD-10 Implementation Strategies tube.com/cmshhsgov#p/search/3/ to ICD-10 for the lab national
and Planning (http://www.you- EEgafwrq1uY) – August 3, 2011 coverage determinations.
tube.com/cmshhsgov#p/search/4/_- CMS subject matter experts dis- Podcasts, complete audio files
wptI2TcWA) – November 17, 2011 cuss how physician offices can pre- and complete written transcripts
The ICD-9-CM and ICD-10 pare for the change to ICD-10 for for these ICD-10 National Provider
Cooperating Parties – CMS, the medical diagnosis and inpatient pro- Calls are also available on the CMS
American Hospital Association cedure coding and provide updates ICD-10 webpage at http://www.
(AHA), the American Health on national ICD-10 implementation CMS.gov/ICD10/Tel10/list.asp. •
8 Spring 2012 I Arkansas Hospitals
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by Gary Baldwin
Here Comes Trouble
Experts identify 10 reasons why ICD-10 could up-end the industry,
as well as five ways to soften the landing. And finally, a few nice
things to say about the coding scheme.
Industry sentiment on ICD-10 pliance at BlueCross BlueShield of the results. On the payer side of
spans the entire spectrum. At one South Carolina, Greenville. the industry, Minnetonka, Minne-
end, some describe it as a potential To assess industry adoption, sota-based UnitedHealth Group
train wreck. At the other, some say WEDI has conducted five national has inventoried over 700 systems
the intricate coding and nomencla- surveys since late 2009. Its surveys affected by ICD-10, including
ture system – which is mandated to constitute one of the few objec- “claims platforms, processing appli-
take effect industry-wide on Oct. 1, tive, annually benchmarked mea- cations and decision support tools,”
2013 – is the industry’s best shot surements available – and Daley says Ross Lippincott, vice president,
at improving the way it describes, acknowledges that WEDI members 5010 and ICD-10 programs. These
bills and pays for services. The are likely to be more information systems are busy: UnitedHealth pro-
skeptics fear a revenue cycle night- systems-focused than others. “Prog- cesses 300 million claims annually
mare in which payments are stalled. ress is being made, but not as fast as on behalf of 38 million members
The idealists envision a new era of we had hoped,” he says. enrolled in a variety of commer-
improved documentation, quality According to the WEDI data, cial, Medicare and Medicaid plans.
and outcomes. some two-thirds of payer and pro- “The systems are utilized across the
A large group in the middle has vider respondents have not even breadth of our organization,” Lip-
no time for theorizing, since they’re completed a full impact assessment pincott notes. And unlike the major-
already submerged in making the – the first, critical step toward ICD- ity of the industry, UnitedHealth has
transition. No one knows how 10 remediation, given the ubiqui- finished its impact assessment.
things will ultimately shake out, just tous nature of ICD-9. The impact On the provider side, the num-
as no one can lay claim to being fully assessment – which starts with an ber of affected systems can also
prepared. But even the most devoted inventory of systems housing ICD-9 be daunting. Oakland, California-
proponent of ICD-10 acknowledges codes – sets the stage for all future based Kaiser Permanente completed
that the path to attaining it is laden activities, Daley points out. And the its impact assessment last year. And
with pitfalls – if not land-mines. relatively low level of completion the sprawling integrated delivery
Following is a summation of 10 key worries Daley: “It’s a concerning system – which encompasses its
hurdles ICD-10 represents and a number because until you know own health plan, spans nine states,
primer of five lessons gleaned from what you have to do, you won’t and runs about three dozen medi-
organizations trying to make the know the resources it will require.” cal centers – identified some 190
transition as smooth as possible. Given the tangled nature of the systems requiring either replacement
healthcare revenue cycle, the num- or remediation, says Rob Alger, vice
FEAR FACTOR #1: ber of systems impacted by ICD-10 president health plan I.T. strat-
Industry Preparation can be enormous. Half of the 600 egy and the co-leader of Kaiser’s
ICD-10 replaces ICD-9 and will payers and providers surveyed ear- national ICD-10 transition effort.
thus serve as the backbone of clinical lier this year by TEK-Systems, an “About one-third of the systems are
documentation and billing. With that I.T. staffing firm, say that ICD-10 from the health plan, and two-thirds
in mind, Jim Daley has one overarch- has much broader impact than they are from the providers,” he says.
ing concern about the transition to expected. Sixty percent said their
the new coding system – industry project plan was still in develop- FEAR FACTOR #2:
readiness. He serves as the co-chair ment, compared with only 22 per- Vendor Readiness
of the ICD-10 workgroup at WEDI, cent who have completed it. The rest The multitude of systems that
a member organization that promotes either had not started writing their contain ICD-9 codes means that
electronic data exchange and stan- transition plan or did not know providers and payers will be
dards. “Organizations are aware of when it would be completed. beholden to software vendors to
ICD-10, but the problem is allocating Those organizations that have perform system remediation. Even
resources to it,” says Daley, whose completed their impact assessment homegrown systems will need
day job is director of IS risk and com- often get a jolt when they review continued on page 10
Spring 2012 I Arkansas Hospitals 9
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modification to support ICD-10 nal bandwidth to do the gap analy-
As Daley points
codes, which require up to seven sis,” explains Shiny George, director
alphanumeric characters compared of HIM informatics at the three- out, the transition
with as few as three in ICD-9. The hospital delivery system. “It’s critical
to ICD-10 affects
number of diagnosis codes will to take the inventory enterprisewide
expand from 13,000 to 68,000, and also identify reports, interfaces payer, provider and
with procedure codes ballooning and research databases with ICD-
software vendor alike.
from 3,000 to 87,000, according 9,” she says. “We want to make sure
to the Chicago-based American there are no orphans out there. We “Communication
Medical Association. want to make sure there is an owner
is essential,” he
Therein lies the value of ICD-10. for each application.”
“ICD-9 falls short in many places,” Deloitte is on track to finish the says, adding that
explains Wendy Wittington, M.D., inventory soon, says George, who
vendors need to be
chief medical officer at Anthelio chairs the Philadelphia-based health
Healthcare Solutions, a Dallas-based system’s ICD-10 oversight commit- forthcoming about
firm that provides outsourced labor tee. At that point, the health system
their transition
to I.T. departments. “We have many can formulate its action plan for
more diagnoses and more sophisti- 2012 and beyond. plans to ICD-10
cated procedures. The more specific For large health systems, the sys-
compatibility.
we can become about understanding tem inventory is never quite done.
what is going on with a patient, the Partners HealthCare, a Boston-area
better we can do comparative effec- delivery system with 12 hospitals, when ICD-10 comes will be a chal-
tiveness research.” completed its core inventory in lenge,” she says. “One of my own
And while Wittington champions 2009. “If you have ICD-9 in any staff says she may retire. Even with
ICD-10 as a vastly improved clinical system, you need to put it on the ICD-9 it’s hard to find good coders.”
vocabulary, she says that physician list,” says Bernice von Saleski, direc- The workforce issues related to
practices with EHRs may be in for tor of PHS coding and member of ICD-10 are not lost on Angie Com-
a rocky transition. “EHRs based on the Partners 5010/ICD-10 steering fort, senior director of coding ser-
ICD-9 will need a switch out,” she committee. “We are mainly worried vices, at Franklin, Tennessee-based
contends. “I don’t have complete about homegrown systems. We have Community Health Systems, which
confidence in all the vendors that it a lot of intelligent doctors who may operates 132 hospitals in 29 states.
will be smooth. There may be a cou- have created databases with ICD-9 Serving as chairperson of Communi-
ple that will get it right. But since so and who are not aware of ICD-10.” ty’s ICD-10 executive steering com-
much in our transition to the EHR mittee, Comfort says more training
hasn’t been smooth, it’s hard to have FEAR FACTOR #4: for physicians and coders is a given.
faith. I say ‘show me.’ If we don’t Productivity Hit “Physician documentation across
wake up as a provider and physi- A given in the industry is that a the country will have to improve,”
cian community and understand the steep drop in work output will occur she says. “Coders will need to know
transition has to happen, it will be – particularly on the part of coders more anatomy and physiology.”
painful and ugly.” who will be called on to interpret
physician documentation and apply FEAR FACTOR #5:
FEAR FACTOR #3: the appropriate codes under ICD-10. Dual Processing
‘Shadow’ Systems And physicians, too, will be called ICD-10 takes effect in October
A “complete” systems inventory on to perhaps document with even 2013. But for a period of time after,
is difficult to achieve, particularly greater specificity than they do now. both ICD-9 and ICD-10 will be in
in research hospitals where depart- The likelihood of diminished play. That’s because claims will be
ments may have deployed systems productivity has numerous ramifica- based on the date of service, not the
and created databases away from tions. If physicians can’t see as many date of transmission. So claims for
the watchful eye of the I.T. depart- patients, fewer services are generated. services performed before the cut-
ment. And creating the inventory If coders can’t complete as many off, but dispatched after it, would
in the first place can be a daunting charts, fewer claims go out the door. still go out in ICD-9. And adjudica-
challenge. That’s one reason the George at U-Penn is preparing for tion of those services would also be
University of Pennsylvania Health the hit by building relationships with affected in a similar fashion.
System outsourced the gap analy- outsourced coding vendor compa- The idea that both code sets will
sis to a consultancy, in this case, nies, such as Green Bay, Wisconsin- be used is what keeps Ken Bradley
Deloitte. “We did not have the inter- based IOD. “Finding good coders up at night. He’s the vice president
10 Spring 2012 I Arkansas Hospitals