D'Arcy Gue

ICD-10: Why Hospitals and Physician Practices Must Partner

May 26, 2015

ICD-10 5 Minute Read

We’re now just five months away from the ICD-10 deadline. Large hospitals are relatively ready…smaller hospitals less so…and physicians are well behind the curve.

Hospitals, most of whom are highly dependent on community physicians, should be concerned. Without both groups’ readiness to produce orders and transact claims in ICD-10 by October 1, both groups will be at risk of revenue cycle crises and disruption in patient care. It’s time to work together.

The claims clearinghouse Navicure recently polled 350 physician practices about their readiness for ICD-10. Yes,  82% were optimistic about being ready by Oct. 1, but only 21% believe their practice is actually on track to meet the implementation deadline.  The biggest reason? Almost 2/3 of respondents said that last year’s deadline extension essentially stopped them in their tracks.

More significant numbers….15% of the physician practices polled said that their practice has done nothing to prepare for ICD-10. Another 18% said they are still in the planning and responsibility assignment stages. Their primary reasons are time/resource constraints (29%), waiting on software updates, a belief that implementation will not take much time, belief that the deadline will change again — and they don’t know where to start.

ICD10_LargeHospitals can, and should consider how to integrate a community physician engagement strategy into the hospitals’ ICD-10 agenda. This concept is not founded simply in altruism or camaraderie; hospitals and physicians working together at this juncture may be essential to mitigating the revenue cycle risks that both groups face post-October 1. Here are some considerations:

  • Hospitals can support physician practices’ ICD-10 education, by broadening the reach of their internal ICD-10 educational programs to support ICD-10 learning within associated physician practices.  If your hospital is already making a commitment to ICD-10 education, extending it to cover community physicians and their staff would be a relatively small investment. Such an effort would yield a more stable physician practice community, from a business continuity perspective. It would also advance physician relations with the hospital, both in general and as related to the hospital’s own ICD-10 efforts. One hospital we’ve worked with, for example, has chosen to give practice staff members access to formal online training and to coders who can help answer their ICD-10 questions. Their charter for this process anticipates at least two benefits: it will demonstrate the importance of the physician to the hospital and at the same time increase the odds that incoming documentation (like lab orders and prescriptions) will be ICD-10-compliant. Another hospital has chosen to create a formal ICD-10 help desk to provide certified coding assistance to their own coding teams, and has also decided to provide access to that help desk to the physician offices in their own community.
  • Hospitals can provide IT or billing services to the community practices. Many IT and billing shops provide services to a group of hospital employed physicians already. Expanding those services as a commercial endeavor to other physician practices is not a complicated operation, and allows the practice access to services and ICD-10 expertise as well as everyday operations that they could not afford on their own.  A shared electronic health record platform would have particular additional benefits as it would further data sharing in the community to advance population health.
  • Hospitals can “lend” an ICD-10 coordinator/project manager to work with community physician practices. While much about ICD-10 implementation requires acquisition of knowledge and capabilities that every practice will need to maintain long term, much about the transition involves one-time events.   Providing a coordinator to help guide practices through the transition, as well as sharing best practices and training materials, is a very efficient use of resources, and would do much to advance readiness in the physician practice community.
  • Hospital resources can work with physician practices in data analysis after the transition date.   It will be critical for every provider to have capable resources  ready to analyze revenue effects and denial patterns for unexpected ICD-10 impacts. A hospital-sponsored shared community resource could not only provide this assistance to the practices, but also share critical issues identified with other practice groups to prevent their having the same issues.
  • Finally, hospitals might consider using ICD-10 and Meaningful Use / MIPS as an opportunity to initiate discussion around purchasing physician practices and then quickly converting their operations to a compliant billing and electronic health records system. This is consistent with the trend in physician practice where few physicians remain in solo practice, due to the high overhead challenges of running a single provider business office.
    Interestingly, many larger hospital are adopting similar strategies with smaller hospitals too.  HIMSSAnalytics data shows that EPIC holds the #2 slot in number of installs (almost 16%) in EHRS in hospitals under 100 beds even though they don’t sell to that market.   These small hospitals are obtaining access to EPIC through direct ownership or some other formal affiliation with a larger health system.

By utilizing one or more of these strategies to enhance physician engagement, hospitals can achieve several benefits:

  • Tighter ties to community physician practices, which can lead to increased referrals and referral revenue.
  • Better relationships with the physicians themselves. There is ample evidence that hospitals with stronger physician relationships have a much easier time of implementing major initiatives like ICD-10 or Meaningful Use / MIPS.
  • A more stable physician community, more likely to remain in business and be capable of sending the hospital radiology and lab orders that are properly ICD-10 coded, thus saving considerable time and effort on the hospital’s behalf getting those corrected.
  • Direct revenue enhancement through the purchase of physician practices or selling of IT and billing services to affiliated practices

Without appropriate knowledge and expertise within physician practices, ICD-10 holds the potential to devastate a hospital’s revenue cycle integrity quickly, leading to both short- and long-term delays in reimbursement and losses in revenue.   By carefully structuring a collaborative learning and support process with associated physicians, your hospital can minimize the potentials for these issues — and perhaps even improve its physicians relationships at the same time.

For more information and assistance regarding ICD-10 implementation in  your organization, don’t hesitate to contact us. We will connect you to one of our ICD-10 professionals within 24 hours.


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