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Agencies brace for productivity declines, increased documentation and coding detail

The results are in: home health agencies nationwide believe the scheduled implementation of ICD-10 — more than payment cuts, Medicare audits or face-to-face changes — will have the biggest impact on home health operations and financials in 2015.

The implementation of ICD-10 on Oct. 1, 2015, will have the greatest regulatory impact for the home health industry, according to 32% of 274 respondents to a question within DecisionHealth’s 2015 Trends Survey.

Other changes agencies ranked as having the top impact include payment cuts (31%), face-to-face changes (13%) and proposed con­ditions of participation (8%).
Part of the reason agencies are concerned about ICD-10 is that estimates circulating in the health care industry suggest ICD-10 could cause providers a decrease in productivity of 30% to 50%.

ICD-10’s impact is also particularly significant when you consider that about 56% of trends survey respondents believe they will see revenue decline in 2015.

In anticipation of the transition to the new code set and greater documentation specificity required, 74% of agencies surveyed said they plan to spend more on ICD- 10 training this year.

Agencies prepare for ICD-10 transition

Agencies need to start immediately preparing for the switch to ICD-10 by planning out what needs to be done.

Agencies should begin dual coding, assess productiv­ity and educate intake, coding and performance improve­ment staff by late spring or early summer. By July through September, agencies should continue dual coding, increase coding productivity and establish competency for ICD-10.

The increased level of specificity regarding, for in­stance, the more specific site location of pressure ulcers in the coding set will allow for more accurate coding and payment than currently available in ICD-9. Home health agency FIRST At Home, in Atlantis, Fla., has been training coders and clinicians for ICD-10 for more than a year.

Janet Kondziela, its director of nursing, earned her HCS-D certification this summer in preparation for ICD-10. The agency’s coders and clinicians also have been meet­ing for the past year at quarterly quality assurance meet­ings to review the need for more detailed documentation on areas such as precise pressure ulcer location and cardiac issues for treating patients coming out of open-heart surgery.

Part of this training involves reminding clinicians, particularly at intake, that they’ll need to consistently ask for and make certain they receive doctors’ notes coming from referrals, Kondziela says.

Kondziela’s agency isn’t alone in gearing up and getting ready for ICD-10 to take place.

Northern Rose Home Health, in Libertyville, Ill., sent its primary coder to an ICD-10 training seminar and purchased an ICD-10 training book. The agency reviewed the book, chapter by chapter, at least every other week during weekly hour-long in-service training sessions with coders and clinicians. The agency has mostly used scenarios and practice questions to quiz staff, Administrator, RN, BSN, Kate Semmerling says.

Going forward, Semmerling plans to keep herself and others at the agency on their toes by dual coding every fifth or sixth chart in ICD-9 and ICD-10.

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