How do we get our user community and technology ready for ICD-10? April 16, 2015

Transcription

1 How do we get our user community and technology ready for ICD-10? April 16, 2015 Jennifer Lewis, Director, Revenue Cycle IT, Temple University Health System Anwesha Dutta, Director, Care Delivery Transformation, Healthcare Advisory DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of interest Jennifer Lewis, BA, MBA Has no real or apparent conflicts of interest to report. Anwesha Dutta, BS, MBA Has no real or apparent conflicts of interest to report 2

3 Learning objectives Describe the methodology used by a large multi-hospital health system to prepare for ICD-10: people, process, technology Establish enterprise wide IT and operational readiness workgroups to address key technical and workflow risks Discuss the IT testing roadmap including multi-entity, best-of-breed strategy aligned with payer testing and crosswalk tool implementation Modify workflows and educate impacted staff based on roles, including community physicians and staff 3

4 Agenda/table of contents Project overview Governance & roadmap IT program Stakeholder engagement Recipes for success What are we doing? How will we get there? How can we be technology ready? How can we be operationally ready? What to do and not to do? 4

5 An introduction to the benefits realized for the value of health IT Patient access improvement More accurate data Better documentation & disease management 5

6 Temple University Health System overview Temple University Health System (TUHS) is a $1.4 billion academic health system in Philadelphia, Pennsylvania dedicated to providing excellence in patient care, education and research. The Health System employs over 8,500 people and consists of Temple University Hospital (TUH-714 beds), TUH-Episcopal Campus (139 beds), TUH-Northeastern Campus, Fox Chase Cancer Center (FCCC-100 beds), Jeanes Hospital (JH-176 beds), Temple Transport Team, Temple University Physicians (TUP) and Temple Physicians, Inc. (TPI). TUHS is also affiliated with Temple University School of Medicine. 6

7 Project overview Temple Health ICD-10 activities The key ICD-10 challenges faced by this Health System centers around the fact that operationally the workflows and technology are very diverse for each entity in the health system. Due to the nature of the disparate yet inter-linked processes, the main functions that touch ICD-9 today all need different solutions i.e.: patient access, care delivery, coding, back-end revenue cycle and technology. With PwC s help Temple conducted a detailed enterprise wide assessment involving 100+ stakeholders, that looked at all functional areas end to end. Based on that Temple began the implementation with its consulting partner PwC. In addition to a Project Management Office (PMO), an ICD- 10 inter-disciplinary governance team has been established Established ICD- 10 governance 2012 Completed enterprise-wide assessment 2014 Continued implementation activities, selected education and revenue cycle system crosswalk vendor. Paused for 6 months due to CMS delay 2012 Selected PwC as the consulting vendor partner 2013 Commenced design activities by establishing 3 functional workgroups 2015 Resumed full implementation in January 7

8 ICD-10 Original Roadmap ICD-10 Go-Live CY2013 CY 2014 CY2015 Overall roadmap Stakeholder Communication & Education Operations/Revenue Cycle Clinical & HIM/Coding Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Design Establish compliance monitoring Construct Operate & Review: Implement Post Implementation monitoring Implementation planning Design stakeholder mgmt prog Evaluate Pt Access process Intermediate Training RFP CDI program impl- FCCC Communication & Intermediate Education Plan Pt Access optimization planning Advanced Training Awareness Communication & Education Intermediate Training (high & low) Pt. Reg Strategy Implementation Continued Education Review rejections & monitor feedback loop Technology Workgroup Design Vendor Mgmt Prog Physician Documentation Education Manage vendor upgrades Phase 1 Unit Test Phase 1 Integrated Testing* Process Owner Support for IT remediation Phase 2 Unit Test Phase 2 Integrated Test Dual Coding Phase 3 External Integrated Testing 8

9 ICD-10 Revised Roadmap You are here ICD-10 Go-Live Overall roadmap Stakeholder Comm. & Education Operations/ Rev Cycle CY2014 PAUSE CY 2015 CY2016 Q2 Q3-Q4 Q1 Q2 Q3 Q4 Q1 Q2 Design P a u s e Construct Communication & education plan refresh Awareness communication & leaders education Back office coding work queue design WBT: Coders, CDI & providers launch #1 Implement Establish compliance monitoring Community MD awareness WBT: Hospital Biller Back office coding recruitment & training WBT: Basic Users WBT: Coders, CDI & providers launch #2 WBT: Professional Biller Back office coding work queue implementation Operate & Review: post implementation monitoring Continued education Review rejections & monitor feedback loop Clinical & HIM/Coding FCCC Revenue Cycle Standardization Project Dual Coding Physician documentation education Process owner support for IT remediation Technology Workgroup Manage vendor upgrades Integrated test for TUH/JH Crosswalk Implementation Integrated testing for all entities Early adoption: amb clinical users Phase 3 external payer testing High impact activities IT Systems Freeze 9

10 Manage vendors Governance Govern the program and manage risk TUH-TUH-E/NACC JEANES HOSPITAL FOX CHASE CANCER CENTER TUP / TPI TUHS Steering Committee CFOs/CEOs from each entity Executive Sponsors, CHRO, Human Resources PMO and Oversight Committee reps TECHNOLOGY Scope: Planning, management and dependency management of all clinical, patient access, revenue cycle, ancillary systems and decision support Oversight Committee Operational leaders, IT leaders and Functional Leads CLINICAL & HIM CODING WORKFLOW Scope: Develop and implement transition plans for: Clinical orders & documentation (paper and electronic), coding, HIM and impact on HIT tools ICD-10 Project Management Office OPERATIONS / REVENUE CYCLE Scope: Develop and implement transition plans for: Patient Access (including referrals), Patient Accounting and impact on HIT tools Manage and control the risk and quality Manage education, training and communications 10

11 Project risks Multiple entities initiatives Roadmap Governance Technology Vendor dependencies Stakeholders & organizational readiness High risk processes for revenue cycle Vendor delays Moving timelines of in-flight projects Regulatory dependencies Varies timelines for application readiness Nonstandardized EMR & rev cycle systems Clinical User adoption of new tools Community physicians Lost Momentum Due to CMS delay Resource bandwidth & Skill sets 2 major crosswalks 11

12 What does our ICD-10 IT world look like? Best of breed environment across Temple Health s 7 entities 200 applications In-scope for ICD-10: 58 applications 49% 12% Impact level 39% High Medium Low 12 12

13 IT timeline Crosswalk Customizations Completed Go-Live TUH JH FCCC TUP/TPI April May June Integrated Testing Phase 1 Clinical Systems Upgrade CY 2014 CY 2015 July December Q4 January February March April May June July August September Text October TUH/EH/NACC w/lab JH w/o Lab ICD-10 Project Restart and FCCC Revenue Cycle Standardization Project Assessment All applications including Lab Pause Period All Applications Crosswalk and new Inpatient Crosswalk and Lab Early adoption of ICD-10 in ambulatory EHR Payor testing Early testing CMS Other payors Expected FCCC Standardization Production freeze starts 13

14 ICD-10 IT inter-dependencies with other major projects Ambulatory EHR: Clinical documentation tools & education ICD-10 impacted applications, regulatory & departmental initiatives Integrated Testing Integrated Testing Inpatient EHR: Training curriculum inclusion & clinical documentation tools ICD-10 COMPLIANCE FCCC Rev Cycle standardization: Back office coding workqueue Integrated Testing Integrated Testing Oncology module: Training curriculum inclusion & clinical documentation tools Enterprise lab implementation 14

15 Key testing takeaways what worked Defining roles & responsibilities before the official start Uploading Testing results & documentation to SharePoint Brief daily testing status conference calls Pilot testing week to familiarize testing leads with process Master Defect Management Log used for all entities + + = Defining Roles Clear Documentation Engage Resources 15

16 Polling questions 1. Have you tested with CMS yet? 2. Do you have an external outreach program for community physicians? 3. Do you have multiple cross-walks in your organization? 4. Do you have any special programs/functions/tools to address "missing codes or insufficient codes" at the time of registration? 16

17 Key messages and content Stakeholder engagement Awareness Executive Steering Committee & Oversight Committee ICD-10 Remediation workgroups Leadership meetings s and memos from leaders Departmental staff meetings SharePoint PMO / Workgroup leads presentations at various venues/meetings Stakeholder and change management based # of FTEs: 1,837 Intermediate Low: More in-depth role based for non users of actual codes High: More in-depth role based For power users of actual codes and reporting including support of clinical specialties # of FTEs: Low- 2,011 High- 366 Advanced Facility Level End Users Employee meetings Newsletters Intranet site Targeted training modules: Awareness Intermediate (Low and High) Advanced In depth role based training for power users of codes sufficient for certification of professional coding societies # of FTEs: 72 17

18 Communication timeline You are here Q1 15 Q2 Q3 ICD-10 Go-Live Q4 Feb: April: July: ICD-10 project relaunch blast Awareness, intermediate, and advanced education updates May: ICD-10 column in Temple Health entity specific mediums Presentation at entity leadership meetings June: ICD-10 follow up to leadership presentation ICD-10 presentation: new resident orientation Aug: Community MD outreach via physician liaisons Cafeteria tent cards Sept: Employee web page updates Distribution of TUHS pocket guides Final reminders and announcements for Go-Live Ongoing announcements and updates on ICD-10 transition Post implementation issues management 18

19 Web-based education timeline FEB 15 MAR APRIL Learner mapping Curricular assignments Import file prep & system launch Testing You are here MAY Hospital biller (IP) Coders, CDI JUNE Providers, Nurse Managers, Case managers (Launch #1) JULY/AUG/ SEPT IT,Pt. Access, PFS, Dept Mgrs/Directors, Data analysts Coders & CDI Providers, Nurse Managers, Case managers (Launch #2) Professional biller (OP) training 19

20 Stakeholder engagement: community physicians Inbound referrals from community MDs Issues: Community MDs contribute approximately 31% of TUH/JH referrals At TUH and JH outpatient registration, on an average week day there are 205 cases with insffuicient ICD-9 documentation. Source: Data and sampling analysis performed with siemns Invsion data Solution: Patient Registration Coding Office/Work Queue This function will enable the post-service assignment of ICD code by HIM coding staff when a code is not provided on an order form presented at Patient Registration. This will aid in the reduction of patient delays in obtaining services since code clarification will occur at the back-end. Existing tools and processes are being adapted and scaled across Temple e.g.: use of Rev Cycle system exception report, crosswalk at the point of registration etc. At the same time, potential impact on pre-service medical necessity checking opportunities are being evaluated. 20

21 Stakeholder engagement: community physicians outpatient registration workflow Order presented to Outpatient Registration PATIENT ICD-10 code entered in to Reg System or calculated using crosswalk YES Does order have a code? NO Call Center queue is populated, daily report run REGISTRATION STAFF Estimates 205 per day BACK-END CODING OFFICE Coders access queue, remediate problem accounts Reports Generated: (1) Order not scanned (2) Open problems-aged (3) Service hitting queue (4) PHY offices hit queue 21

22 Stakeholder engagement: community physicians Awareness education Issues: Low engagement of community physicians and minimal awareness about ICD-10 impact. Solution: communication strategy through physician liaisions emphasizing the value of better experience and service for patients: Materials have been designed (i.e. Postcards/pocket guides and external website), and approved by Oversight Committee Marketing and physician liasions have been engaged to support the execution. Starting in April, physician liasions will reach out to community physician practices with the materials to begin the awarenss education. Standardized order forms will be distributed. 22

23 Key takeaways Dos 01 Test early, in multiple rounds even if all systems are not ready 02 Implement early adoption - people, process & technology 03 Focus on high volume areas that can cause workflow issues Engage & educate with discipline & focus 04 Don ts Train too early Broaden the scope of in-flight projects Wait until September 15 to hold your executives accountable! Forget the residents & community physicians 02 Projects 01 Training 03 Executives 04 Stakeholders 23

24 Benefits realized for the value of health IT Patient access improvement More accurate data Better documentation & disease management 24

25 Questions Jennifer Lewis, MBA Director, Information Systems & Technology Revenue Cycle Systems TASB (Temple Administrative Service Building) 2450 Hunting Park Ave, Philadelphia PA Office: (215) ; Mobile: (267) Anwesha Dutta, MBA PwC Director, Care Delivery Transformation, Healthcare Advisory Philadelphia, PA Mobile: PricewaterhouseCoopers LLP 2001 Market Street, Philadelphia, PA 25