“Tomorrow’s victory is today’s practice.”
- Chris Bradford, The Way of the Warrior
We are raised with the mantra that ‘practice makes perfect’ and later you learn that ‘perfect practice makes perfect’. The people who make things look easy are not always the most gifted but usually the most prepared. Malcolm Gladwell in his book Outliers even quantifies that it takes 10,000 hours of practice to become an expert at something. You will almost never find someone who is at the top of their game who has not spent years of preparation and practice.
The medical coding world is no different, especially as we get ready for the massive change that is the ICD-10 in October. ICD-9 has been around since 1979 and still we have a huge shortage of experienced coders and only a small elite can be considered consultant status. When a client asks for outside assistance, they expect proven resources who can ramp up quickly and meet or exceed their own internal productivity and accuracy standards and metrics. Imagine being dropped into a brand new employer and being expected to already understand all of their systems, guidelines, processes and documentation while ramping up immediately and outputting quality work. Even the best can fold under that pressure.
Now imagine ICD-10, which compared to ICD-9 is like moving from English to Spanish or at least finding out your English was more limited than you thought. To learn a language many will go to school for multiple years and still only know a few key words and phrases. All language programs say your best success comes from real world practice or immersion in cultures who are native to the dialect. With ICD-10, the only true native speakers live in other countries using variations much different than in the United States. Coders across America that work for good employers have been doing years of training and education getting ready for this massive shift to ICD-10. The constant delays have whipsawed these efforts and many have struggled staying ready while speaking ICD-9 in their everyday lives.
While training and education is critical for success nothing is more important than real world practice. Most progressive organizations by now have started a dual coding effort. Some are utilizing test charts in a learning lab and many are dual coding live charts in ICD-9 and ICD-10. The best prepared coders will have months of dual coding as many real world charts for the provider they work for with constant feedback and education from expert Auditor/Educators. This builds confidence and is even a great retention strategy as the best coders want to be the best ICD-10 coders too and will often leave a job to get a better readiness experience.
ICD-10 will compound the current industry coder shortage due to its impact on productivity. I speak with many ICD-10 coding experts who predict a productivity decreases of 30% - 70% which will have devastating effects on today’s limited resources. The better prepared your staff is the less of an impact there will be as well as a quicker recovery back to as close to pre ICD-10 as you can get. With that said, almost every provider will need to utilize outside coding resources before, during and after this Epic event. It is critical to verify that these resources have received strong ICD-10 training and education and enter your organization as prepared as possible. This becomes an investment in risk mitigation and those that act quickly will win.
This brings up a hot topic that is currently being debated in the community. Some consider contract staff to be like robots who come in and already know everything. While contractors are often the elite in the coding world they too are human. Nobody has been reimbursed yet in the United States for an ICD-10 coded chart so we are all in this together. If you decide you need additional contract resources you should bring them in early, lock them up for at least one year and involve them in all of your readiness activities. Some hospitals I am speaking with are deciding not to include the contract staff in their Dual Coding exercises as they are reluctant to make that investment. I believe this is short sighted because the most trained and educated coders will struggle without the same dual coding experience on your actual charts. If you plan on keeping this additional staff beyond ICD-10 Go Live, you are cheating yourself by not offering them the same readiness as your own staff.
The best prepared always win and this will be extremely true in the ICD-10 transition. Embrace your outside resources and invest in them and you will be in the top 10% of ICD-10 transition success stories. Don’t turn Dual coding into Duel Coding!