ICD10 and the 80/20 Rules

Whether you're a multi-hospital system or small physician practice, chances are, you've got good docs and bad docs.

ICD10, as you've probably been told 50,000,000 times now, is going to affect everything and everyone.  But what most people don't tell you is that it doesn't effect everyone and everything equally.

We know that ICD10 has big changes for Orthopaedics and GI and OB, but for opthalmology?  Maybe not so much.  So if you're going to try and figure out which specialties need the most training, you need to look at 3 things:

First: Financial impact.  Different specialites have different potential impacts on facility reimbursement.  You obviously want to spend the most time and effort training and tracking on these groups.  

Second: Volume.  Sure, GI may have some large shifts, but if that's a tiny sub-set of your business, why would you waste that time and effort to affect 3% of your overall business?

Third: Documentation from doctors.  We know that some doctors document better than others.  OB has large changes, but they also might have the best doctors at your facility in terms of EHR use and documentation quality.  If that's the case, maybe you can focus your efforts elsewhere.

The gist of all this?  The old 80/20 rule, that is, 80% of your impact will be the result of 20% of your specialties/providers.

You can't boil the ocean and you can't hit everyone equally with ICD10, so apply the 80/20 rule and really find your risk area and focus most of your effor there.

To understand our 80/20 impact, we brought in an outside firm to do a claims analysis and documentation review.  We could thus see potential DRG shifts, volume of cases and see where documentation gaps existed.  A little statistical analysis later, and we could pinpoint who/what we needed to focus on.  In some cases, it was a whole specialty.  In others, it may be 4 providers in a specialty.

Doing this type of work helps both narrow the focus and avoid the concern that some leaders have about this conversion being too big.  If you can do an analysis and show that you only have this 20% to really dive into and put all your resources on, it allievates fear.

This doesn't mean that everyone doesn't get some training or analysis, just that the heavy duty efforts go to the 20%.

There isn't much time left before 10/1, so you have to be smart and specific.