The Ballad of ICD-10: A Sit Down with Akhila Skiftenes

Ballad of ICD-10 with Akhila Skiftenes

At Next Wave Connect, we are always looking for new and innovative points of view when it comes to healthcare topics that garner our attention. ICD-10 is no exception especially with the previous years of delay. Many want to know whether or not the scheduled October 1st deadline will actually occur. When we had the pleasure of sitting down with one of our ACEs Akhila Skiftenes from Aspen Advisors we addressed some common concerns. 


Who is Akhila Skiftenes?

Akhila is an advisory council expert at NWC and a skilled consultant with experience in research planning, financial analysis, IT strategy and system selections, as well as ICD-10 and meaningful use project management.  Among her many projects, Akhila has completed GAAP analysis for ICD-10 readiness with a focus on training needs, practice improvement technology needs through many organizations. 


To Delay or Not to Delay?

Although there hasn't been any indication of another delay, that doesn't mean that it won't happen.  How likely is it that we will have another delay?

“There is a subset of physicians and physician groups that are lobbying Congress for an additional two year delay.  Meanwhile, AHIMA is lobbying on the other side and saying that ICD-10 is a necessity and that the U.S. is behind the rest of the world in adopting it.  They are lobbying pretty hard to make sure that there isn't a delay.”
“There definitely is a possibility for a delay, depending on who yells the loudest and who makes the strongest case.  I can't say how strong of a possibility that is, but I wouldn't be surprised to see another one or two year delay.”

What is the fallout of a delay?

“Though I do know that there are many organizations who hope that there are no further delays because they have already spent a lot of time and effort and really a lot of money remediating their systems and they've been ready to go-live since October.  Really that’s the tangible fallout of any further delays-wasted resources.”

How does the United States compare to other countries?

“There’s a lot of criticism pointed at the U.S for the delayed adoption of ICD-10.  However, you have to understand that most of the world runs on a single payer system.  It’s basically only the U.S. who uses ICD-9 codes as part of the billing process.  That makes the transition extremely complicated.  “ 
“We can't just change the way physician’s code, we have to change all of the documentation systems, the billing systems, the insurance company systems, deferred party billing systems and we have to test and manage any impact on revenue as well as training all of those people on the new ICD-10. “ 
“I think a lot of people think that we’re the latest in adopting because there’s a lot of bureaucratic red tape or that we just haven’t decided to do it.  But it’s really a lot more complicated than that.  While maybe it’s not an excuse we do have to get on the ball to catch up with the rest of the world, there are a lot of reasons why it’s more complicated for the U.S.

What does ICD-10 really allow us to do as a country and as healthcare providers?

“The biggest impact is on our ability to analyze public health data.  ICD-10 is a much more robust coding system.  It captures the conditions, the severity of the condition, at times even the cause of the condition.  Whereas ICD-9 really only captures the basic condition and maybe some of the severity.
"For example, if Mr. X comes in with a concussion, the ICD-10 code will capture that there was a concussion, the grade of the concussion, which identifies whether or not he lost consciousness, for how long, and that the concussion was due to maybe a falling object, a sports injury, a car accident, etc."

How do we see benefits from ICD-10?

"Now let’s say that ten years down the road Mr. X develops a migraine headache and starts getting repeated migraine headaches.  There’s now the possibility of a population of other people who had similar injuries around the same time who are the same age.  If we have these ICD-10 codes in place we could see whether or not concussions might be a cause of migraines later in life.
"Similarly we could look and see what the longer term impact playing amateur contact sports is and having repeated concussions or similar types of injuries and we could make that kind of information available to the public.  That would allow for informed choices about activities or maybe changing the games so that they don’t cause some of these injuries." 

What are some of the challenges of ICD-10?

“Really the challenges are around getting providers and coders to be consistent and accurate with how they document and code.  All this analysis is pretty much useless if there isn’t consistent capture in data and if it isn't fairly accurate.  That’s where training and follow-up and some of the regulations come into play.”

Is it worthwhile, especially with the implementation of Computer Assisted Coding?

“I think that it’s going to take years and maybe decades for us to really realize the benefits of ICD-10.  Ultimately, I do think it’s worth it.  We are deep in the midst of an age of big data.  Healthcare is really far behind other industries, like banking and manufacturing.  Those industries have used their data to develop a deep understanding of consumer behavior and they've been able to improve their efficiency overall. 
"Honestly, I think we need ICD-10 to help us achieve those kinds of results in public health management, so I personally think that the effort is going to be worth it. 
"The problem, of course, is that you're investing a lot of money and time now for an unknown payoff in the future.  I think that organizations are really focused on the pain right now.  I with my imaginary crystal ball say that it is going to be worth it but we have to take that leap of faith and put in the money and time now.”

Computer Assisted Coding: More than just an expensive piece of software?

“Computer assisted coding has been a mixed bag.  I'm a consultant with Aspen Advisors.  We've managed the selection, planning and implementation of computer assisted coding at a lot of different hospitals.  When we’ve worked with our clients, they’ve really taken the time and optimized their processes and I think they are achieving a lot of the promised benefits, like faster coding, more accurate and inclusive coding, maybe even some increased revenue because they’re capturing the severity of conditions a little bit better. 
"But for every hospital who has successfully implemented computer assisted coding, there are several who have implemented it more blindly.  I would say one of the pitfalls is like letting the vendors run the implementation because they don’t really fully understand every individual environment and so those hospitals have not achieved the intended benefits.  They’re committed to very, sometimes very large annual contracts.
"My thought is that if you don't have the resources and commitment to really optimize the CAC process, you might end up wasting a lot of money.  But if you do it right it can be a powerful tool and it can help to avoid having to hire a ton of coders who achieve your ICD-10 milestones and being able to go live with it.”

The inevitably feared revenue reduction…Could we really avoid revenue reduction with the appropriate amount of training and preparation?

“In the immediate future there will be cash flow issues for the first several months, and maybe up to a year.  I think everybody is expecting billings time frames to increase.  Coders are going to have to query for more information.  Denials are going to increase due to missing information.  Even payers are going to have issues on their end.  It may delay payment as a result. 
"Again, if I pull out my imaginary crystal ball, I think that those organizations that prepare their cash position ahead of time and can survive that first six to 12 months, they will probably be fine in the longer term.  I think ultimately everything will get back to some state of normal. 
"This is a really big change.  I do think that there are organizations who are going to struggle to get through it.  If I'm being really honest, even in the perfect world I think we're going to have some organizations who really have a hard time with this change. 

A lover of Ballads: If you could sing any song on American Idol what would it be?

“Ooo, that’s a good question.  Well, I’m a lover of ballads.  I would say, probably I would sing something like Open Arms by Journey or One Sweet Day by Mariah Carey or Boyz II Men. 
"In closing, whether Akhila chose Journey or Mariah Carey I’m sure her delivery would be as superb as her insight on ICD-10.  Either way healthcare is on the path to progress and the implementation of ICD-10 in the United States is a giant leap in the right direction.  The ability to have cleaner and better quality data will undoubtedly progress the health of our population as a whole-and who doesn't want that?" 

Connect with Akhila and other ICD-10 Experts in the ICD-10 Community on Next Wave Connect.