ICD-10 training and education planning-Not for the faint of heart
by Annie Boynton, BS, RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I, CPhT
By now, you are probably aware of the April 9 HHS proposed rule CMS-0040-P, which proposed to delay ICD-10 to October 1, 2014. While we know the implementation date will likely change to the proposed 2014 deadline, we must keep moving forward. Organizations are spending hundreds of millions of dollars on the transition, and the additional time will be valuable by allowing providers to better handle the change process associated with ICD-10, especially planning for education and training.
The industry will have an additional fiscal year over which to spread training costs if HHS finalizes the delay. Now is the time to think strategically and plan accordingly for ICD-10 training and education. Managers must not underestimate the size and scope of ICD-10 educational needs and must begin educational planning early. Without careful, thoughtful strategic planning, ICD-10 training could easily be one of the larger expenditures in any overall ICD-10 implementation budget.
Managers and directors must think strategically to maximize training value and minimize training costs. Centralizing training, spreading costs over multiple fiscal years, and train-the-trainer programs can all help save precious resources and money as the industry moves forward along the ICD-10 implementation path.
Centralizing training refers to adopting project management principles, such as creating a formal governance structure complete with an education and training committee, and is a solid start. This allows a straightforward, bi-directional approach for decision making and information dissemination. An ICD-10 education and training committee can assist the project with the development of:
- Training and education plan (e.g., what is the training and education vision?)
- Training needs assessment (e.g., who needs training?)
- Budgetary estimates (e.g., how much will it cost?)
- Training delivery timeline (e.g., when will we deliver training?)
- Resource selection (e.g., who will provide training?)
- Outcomes measurements/assessments (e.g., was the training successful?)
Create a training plan
Managers should set the guiding vision for training in the training plan. The training plan should address the overall objective of training—in essence, what will be accomplished during training. The plan should address what methods trainers will use to accomplish the objectives and whether the organization should use an internal resource or/and external resource. The training plan will identify target audiences—those who are the intended recipients of training activities.
The training plan should also discuss instructional design methods or what styles of education will be used.
When creating training, trainers must remember that not everyone learns in the same manner (e.g., visual, aural, and kinesthetic learners).
Adult learners tend to have different educational needs than children, so trainers must plan when to deliver the education, which become especially important in light of the proposed delay.
Finally, the training plan should explain the outcomes measurement. This is usually some form of a test, quiz, or mechanism of follow through that shows whether training accomplished the objectives and also highlights any individuals who may need additional or supplemental training.
Implement a training plan
The scope of ICD-10 education is vast. The education and planning committee with guidance form project governance and can help to narrow the scope. This is another reason to consider including some type of formal project management concepts within the overall implementation plan, as well as the training and education planning activities. Leaders should consider including the following topics in an ICD-10 training plan:
- Implementation overview
- General equivalence mapping (GEM)
- HIPAA version 5010 and EHR meaningful use
- General regulatory overview
- Compliance application/decision
- Clinical documentation improvement (CDI)
- Support application training
- Any application/tool purchased specifically for ICD-10 implementation
- Existing application training
- Business process specific training (e.g., ABN form, payer policy changes, etc.)
- General code set overview
- Detailed code set instruction
- Supporting knowledge
- Anatomy and physiology
- Surgical procedural methodology (for ICD-10-PCS)
All of these topics could add value for role/user based training planning and require careful planning to make the most of precious training dollars. For example, organizations should consider whether to introduce documentation improvement now to spread out costs over multiple budget years.
Management should also consider whether to introduce ICD-10 coding concepts now and save in-depth code set training until closer to the implementation deadline. This again spreads costs out over multiple budget years to get the most out of training dollars.
Understand job roles
Because of the wide variety of topics and needs for ICD-10 education, any training and education committee needs a solid grasp of the job roles that will require training.
ICD-10 training and education forces the healthcare industry to realize the value of staff members and invest in their training like never before. To that end, ICD-10 education will be needed by far more than just physicians or coders. Additional staff members who may require training include:
- Revenue cycle staff
- Administrative staff
- Customer service staff
And let’s not forget the patients! At some point a patient may ask questions or express concerns about ICD-10. A prudent training committee will prepare basic education, such as a one-page flyer, to quickly educate patients regarding ICD-10 implementation and potential for reimbursement delays.
Many in the industry have suggested supplementing staff for ICD-10 implementation. This additional staff will be important after the go-live date, but may also be of value as training activity ramps up. Supplementing staff may help with productivity while training is ongoing during the next two years. Supplemental staff may also allow organizations to better absorb attrition, reduce stress, and avoid mistakes before and after the go-live.
Much has been said in the industry regarding documentation improvement. We know that it will be vital for ICD-10 and a critical part of any training and education plan. Implementing a clinical documentation improvement plan will require strategic thinking.
Starting a CDI program sooner rather than later provides value in both an ICD-9 world and an ICD-10 world. Managers may have an easier time justifying a new program to a chief financial officer (CFO) when they can demonstrate a potential for revenue benefit to starting CDI programs early.
Consider conducting a documentation gap analysis to quickly ascertain where physicians’ documentation does not reach the needed level of specificity. Providers, facilities, and even payers who may be creating CDI training for their provider networks can perform documentation gap analyses.
By targeting the highest utilization or highest revenue generating codes/DRGs and analyzing the documentation in ICD-9 and ICD-10, organizations can begin work on this core revenue generating areas, which should provide benefits in ICD-9 and ICD-10.
Perform routine documentation audits to ensure physicians collaboration. While organizations can spend a lot of time performing this review initially, it can be just as expensive (if not more) to bring in a consultant.
CDI programs can also engage nursing and non-provider staff to help with documentation. While coders cannot use non-provider documentation, it can help coders and auditors form more sophisticated physician queries.
Cost of training
Each coder will need approximately 50 hours of overall training at a cost of $100 an hour, according to an October 2011 Healthcare Information and Management Systems Society (HIMSS) virtual briefing. That means organizations will spend $5,000 per coder. That is a lot of money, and the more coders an organization has to train, the more fiscally daunting the challenge.
Training trainers is a great cost savings mechanism that can be employed by fiscally challenged organizations. The difficulty lies in selecting the right individual to act as an organizational trainer. However, the right person in any position will be able to accomplish great things.
Ideally trainers will be the organization’s most experienced coders. This is not a job for a recent graduate of coding school. Any candidate should be:
- Comfortable with public speaking
- Comfortable with change
- Highly organized
- Detail oriented
- Willing to branch out from day to day chart coding
Once an organization identifies the best candidate, it should fully immerse him or her in all manner of ICD-10 training: anatomy, pathophysiology, and code set specific training. Industry organizations like AAPC and AHIMA have excellent programs in place to train trainers.
A word of caution: Because the industry expects a shortage of skilled ICD-10 coders in 2014, organizations should be certain to protect themselves throughout the ICD-10 go live. Consider creating or modifying human resources education policies or creating retention agreements to keep trained ICD-10 coders.
For example, an organization that pays $5,000 to train an employee may consider requiring a one-year service commitment in return. Or consider offering an incentive or retention agreement to keep skilled ICD-10 coders beyond the October 1, 2014 proposed implementation. Organizational size and budget will be a constraint here, but organizations need some mechanism in place in advance of the go-live to prevent attrition losses with recently trained employees.
The proposed ICD-10 implementation delay offers the gift of additional time to prepare for ICD-10. Training and education programs will surely benefit from the added time. The additional time will allow organizations to think more strategically about how they implement training.
Start early to spread out costs of multiple budget years and use cost saving concepts like training trainers to make ICD-10 education and training plans successful. Organizations need to begin planning early and not underestimate the size and scope of the organizational ICD-10 education need.
Editor’s note: Boynton has served in the health information management field for over 10 years in provider, payer and educational capacities. Currently, she is the Director of 5010/ICD-10 Communication, Adoption and Training at UnitedHealth Group. Annie is a member of the AAPC’s (www.aapc.com) National Advisory Board representing the Northeast region, and was a developing member of the AAPC’s ICD-10 Implementation Training Curriculum. Annie holds several certifications as well as degrees in health information technology and health care management and is pursuing graduate work in Health Law.
Email your questions to Senior Managing Editor Andrea Kraynak, CPC, at email@example.com.