Monday, July 9, 2012

What’s the Risk in Using ICD-10 Risk Scoring Tools?

The “ICD-10 Playbook & Financial Risk Calculator” available on the HIMSS website is a tool to “help providers assess their ICD-10 financial risk exposure, identify ways to mitigate that risk, and augment their accounts receivable.” Here's how it's billed:

By simply answering a short survey, providers receive unique insight into the powerful impacts of ICD-10, steps they can take to address those impacts and ways to augment their accounts receivable even before they complete their conversion to ICD-10," said Juliet Santos, HIMSS senior director of business-centered systems.

Indeed, tools like this one can be useful for the awareness they raise in those who use the tool and chew on its output. For that awareness building alone, I think it’s probably a good thing for those facing the ICD-10 mandate. I’d also offer that one should be very careful relying on a simple tool as opposed to readily available checklists or qualified advisory services.

ICD-10 isn’t a game


First and foremost, be clear about the science and math behind any tool used to assign a risk score that may influence your decisions and pathway on such an important endeavor as ICD-10. Ask yourself...

- What’s the methodology for deriving the risk factor?

If it's "proprietary" and can't be shared, I'd suggest questioning its accuracy and value.

- From where were the peer indexes to which each risk factor is compared obtained? 

ICD-10 is one of those Vujà dé events: "you've never been here and neither has anyone else." Are the peer indexes derived from others who’ve used the tool? If so, what’s to say other users accurately responded to the assessment? What about people – like some I know – who just took the assessment to learn about it and randomly answered the questions? :)

Does it make sense?

Some parts/questions seem to have little relation to actual risk. For instance, how do the following questions impact risk? At least in any meaningful way.

In what state is your organization located?
- Does the tool creator have some special knowledge of states that are “more risky” than others?

Are you a nonprofit?
- How does the tax status of a healthcare facility impact its need to perfect ICD-10 compliance?

What most closely describes the function in which you work?
- Is there a higher perceived level of confidence or change to risk score if a Coding & Charge Entry Person completes the assessment vs. a Finance staff member?


Tools must be objective

Moreover, be sure to measure the "subjective questions." It’s hard to accurately assign a score to these type of questions. For instance, what’s the differentiating factor between scoring  an outcome of “very poor,” “poor,” “well,” and “very well” on the following types of questions?

- How well do your coding and charge entry teams work with your revenue cycle teams?

- How would you evaluate the workload of your coding and revenue cycle resources?

- How would you rate physician adherence to the policies and procedures in place for patient record documentation?

Consider the real value? What are the alternatives?

What’s the risk of using a risk assessment tool like this? I’m thinking that the few “mitigation suggestions” offered may actually limit or mask ones ability to consider and appreciate other information. Many “Risk Mitigation Factors” are obvious and have been available from various associations and “quasi-governmental organizations’ in one form or another for quite a while. 

So do a little research, ask some additional questions on your own and revisit this site where my next post will consist of a list of checklists and other “tools” I think are every bit as valuable as any free vendor tools.

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