Following the ICD-10 transition, real interplay between all stakeholders begins with the patient being the true focus.
For many of us in the healthcare industry, reaching the ICD-10 transition on October 1 has been a long journey.
With each movement of the date, the questions would arise from our stakeholders-“What’s the value in this change? Won’t the date just move again? Why don’t we just wait for ICD-11?” Many wrestled with similar issues during these delays, such as re-engaging leadership teams and impacted stakeholders, keeping training fresh, and the impending budget changes. We also needed to re-evaluate what may have changed between each delay within our own business processes and systems.
Now that October 1 has come and gone, given the amount of investment most hospitals, health systems, payers and pharmacy benefit management (PBM) groups put into the transition, the question on everyone’s mind is: “What is next?”
The first few weeks after the transition have been relatively quiet within the industry. Our teams have scanned blogs, tweets, trade publications and contacted colleagues at payers, providers and specialty pharmacies to share our experiences. Based on the feedback, many of us are having a relatively quiet initial transition. Early reports describe initial issues as manageable and localized. However, it is important to watch how the transition unfolds among smaller health plans, individual and small group providers, and community or rural hospitals who may find it more difficult to weather some of the bumps that will be part of stabilization.
Some hospitals and health systems, as well as payers and IT vendors, have created special teams dedicated to addressing issues quickly. Whether in the form of command centers, war rooms, or task forces, the effect of having clinical, operational and technical leadership quickly on-hand to address issues as they arise has increased confidence within the health ecosystem for addressing issues and providing support. The next stage of transmitting information for authorization and payment and working among health systems, payers and PBMs is only just beginning.
Over the next few months, we will be seeing the real interplay between the health ecosystem-providers, payers, pharmacies-and the patient. Because of the lag time between when care is received, when it is billed and when it is reimbursed or denied, there are still many tests to come. The key for us as executives will be to track our key financial and operational performance indicators and take timely, decisive actions, keep a pulse on the morale of our most impacted employees and show leadership and support, and focus on communications both within our walls and among ourselves.
Providers will continue to require coaching on documenting to ICD-10 level specificity and the importance of providing it from the time care is being authorized, all the way through the patient’s treatment plan. Payers will need to clearly articulate why claims are being denied and, if they are being denied due to an ICD-10-related issue, be able to quickly provide information and support back to the provider community. PBMs and pharmacies also may require new or additional information from both providers and payers to manage any additional issues that arise because of the transition.
Overall, it is important that we show a spirit of collaboration and responsiveness in this next stage of the ICD-10 transition, with the end goal of keeping patients in focus and ensuring that they are not impacted in the transition to ICD-10.
Suzi Grizancic is principal, EY Americas Advisory Health Care.