Doctors & Documentation: How to get physicians on board with ICD-10 initiatives

By Carle Natale for Healthcare IT News

ICD-10 implementation is a problem that affects how physicians will practice medicine. But just how to you persuade them that they need to get involved in the training and planning now?

The first thing you do is put a physician on the ICD-10 steering committee. That physician is going to be your champion who gets his or her peers to understand and support the changes needed.

That’s nice but not enough. There’s a little more to do. Paul Weygandt, senior vice president of Clinical Services and Education at J.A. Thomas & Associates, talked Tuesday about why physicians are resisting becoming part of the ICD-10 project management process.

“Most physicians view ICD-10 as another governmental burden imposed upon their practice – much like HIPAA, ” said Weygandt. “It presents a significant cost to the practice. Which leaves many physicians to ask ‘What’s in it for me?'”

Make the logical argument

This is that the United States is behind the rest of the world.

Appeal to their professionalism

ICD-9 codes are inadequate. It’s is not suited for modern medicine.

This is detailed a bit more in Billy Richburg’s ICD10Monitor column on persuading physicians to participate in ICD-10 implementation. He lists the following factors:

• It provides more specific data than ICD-9
• It better reflects current medical practice (ICD-9 was developed 40-odd years ago)
• Its structure accommodates the addition of new codes, so it is less likely to become obsolete
• Conversely, ICD-9 is running out of capacity and cannot accommodate changes in the state of healthcare
• It has expanded data capture capabilities
• It has enhanced quality measurement functionality
• Its greater specificity has the potential to reduce coding errors
• It permits better analysis of disease patterns, both endemic and epidemic
• It supports enhanced tracking of, and response to, public health outbreaks
• Once coding is completed, ICD-10 makes claim submission more efficient
• It has the potential to help identify fraud and abuse of payment systems

This tact is pretty effective according to Weygandt. “If we can make an argument that the current terminology in ICD-9 is inadequate for the clinical practice of medicine and excellent patient care then we can get some endorsement from the physicians to transition to ICD-10.”

Create consistent coding

Richburg makes the point that patients see a great many healthcare professionals. Often for the same diagnosis or condition. If all those contacts are coded differently, there’s not much reconciliation to see who’s right.

But ICD-10’s granularity will give physicians more choices in codes and more opportunity to differ from how a hospital may code it. Technology will help payers spot inconsistencies and reject claims based upon perceived medical coding errors.

Staying within standards of care

Standards of care is an important defense for doctors in medical malpractice  suits. According to Richburg:

“Poor documentation impacts a physician’s ability to defend oneself when his or her care is questioned, and this is not limited to legal proceedings. Every hospital has some sort of quality assurance committee, typically operating under the auspices of the medical staff, and the findings of those committees can be every bit as damaging to one’s career as the typical lawsuit.”

Documentation will keep the doors open

Richburg makes the point that ignoring documentation issues simply is bad business. It’s going to hurt the healthcare organization’s ability to do business.

But that may not be enough for some medical practices.

Weygandt says some small practices probably will have to change their business models. “They simply cannot afford the additional burden of transitioning their information systems to IcD-10.”

There is talk about medical coders retiring before they have to deal with ICD-10. Will physicians make the same decisions?