Countdown to 2014 Healthcare in Transition

By Jack Duffy

Executive Vice President

As we prepare to enter into a new year, we cannot help but reflect on the challenges 2013 brought to healthcare organizations. Many were required to reduce staff and say “good luck” to trusted colleagues. Unfortunately, the productive work these employees did every day remains for the ongoing team – adding to their ever growing work lists. In a few days the calendar will turn to 2014 and the evolution of our cherished industry will begin again.

On the top of most lists is the conversion of the code sets to ICD-10. In the short time we have left, the work of teaching the clinical teams how to document at ten times the specificity must be accomplished. Even the best prepared institutions will have gaps, and preparing for them now is critical. Towards that effort, please see the below listed recommendations.

1. Store up a lot of cash. Payment disruption estimates range up to 50% for the months following the transition. Having an emergency plan in place will prevent a payday crisis.
2. Have a full contingency plan and create a response team to fill processing gaps. The plan should include:

• What will you do when a contract coding company offers your certified coders a 50% pay increase and then wants to lease them back to you at twice the historical cost? (actually happening at the writing of this article)
• Virtually every chart becomes a series of queries. Will there be extra hands to mange this process?  Will the reporting and workflow tools be robust enough to keep the process from spinning out of control?
• Key coding professionals often select October as the month to retire. Do you have a back up plan?  Have the resources been reserved? Has data transfer and SECURITY been thoroughly tested?

We have all seen the growing use of the term “analytics” to label hundreds of different products and services. Overcoming the hype, there is a critical role for the timely use of information to manage our process going forward, rather than by reviewing past results. A key factor will be the use of analytical data management to refine every process controlled by the healthcare organization. This means that in the next few months claims must be refined to virtually eliminate factors that cause a claim to suspend or be denied.

Clinically, the decisions related to patient status, level of care, orders and treatment plans must be resolved at the point of first service.The “two-midnight” rule must be understood and communicated to ER, admitting and referring physicians. Highly trained nurses and hospitalists must be positioned to influence these decisions in real time. The time when admission could be reviewed the next day, if it was Monday thru Friday, is gone forever. 24 hour coverage will be the new standard.

The industry is passing from a period where all of us have been required to do more with less. The coming year will shift this mantra to doing less with less. The goal will be to learn how to manage in this environment, while maintaining the best possible outcomes and access to services.