OneHealthPort Washington State ICD-10 Readiness Survey Research Conducted February – March 2015 By...

OneHealthPortWashington State

ICD-10 Readiness Survey

Research Conducted February – March 2015By Hardwick Research

2

Background & Methodology

3

Project Goals

The primary objectives of this research are to: Assess readiness of medical providers in Washington

State for the ICD-10 implementation on October 1, 2015 in terms of…

Specificity of documentation required by ICD-10 standards Practicing ICD-10 coding System/application upgrades to enable entry of ICD-10

codes Testing the system to verify it can produce ICD-10

claims/superbills Partnering to test the claims submission/reception process

with payer or clearinghouse Practices overall confidence level that they will be able to

send ICD-10 complaint claims and get back appropriate remittances

Evaluate interest in various support and training programs related to the ICD-10 transition

Gather demographic information for grouping the data generated from the survey

Methodology

Hardwick Research conducted an online survey to gather feedback from medical practices in Washington State regarding their preparedness for the ICD-10 changes coming October 1, 2015

In order to participate in the survey participants must:

Be an administrator within OneHealthPort’s network Be a critical care hospital or a clinic/clinical service

provider with under 100 practitioners providing medical care to patients

The survey was conducted from 2/18/15 through 3/5/15

1,397 completed surveys were gathered The survey contained 22 questions needing a response

• Six questions were open ended• To see the questionnaire, click on the embedded link

4

Questionnaire

5

Research Caveats

OneHealthPort… Hosted and administered the survey

Sent initial invitation and two reminder emails to 14,784 clients who indicated they are the “administrator” for their OneHealthPort account (and met the screening requirements)

• Respondents were asked to forward the survey invitation to the correct person if they were not familiar with their practice’s ICD-10 readiness status

• In exchange for completing the survey, if desired, respondents were entered into a drawing to win one of five $100 Amazon gift cards

OneHealthPort provided Hardwick Research with the raw data for cleaning, analysis, and reporting

Survey respondents are self-selected and as such, may not be balanced to represent the actual make-up of practice types and locations (urban vs. rural) in Washington State

• A breakdown of the types of organizations included in this survey can be found on slide 36. Respondents from Mental Health (24%) and Massage (17%) practices make up the top two largest groups

6

Report Annotations

Throughout the report, percentages may not total 100% due to rounding or questions allowing multiple responses

Statistical testing referred to in the report was conducted at the 95% confidence level

For comparison purposes, zip codes were grouped into two categories – “urban” and “rural.” Generally, urban includes Bellingham, Everett, Seattle/Eastside, Tacoma, Olympia, Vancouver and Spokane regions, while the remainder was grouped into rural. For a complete list of how each zip code was treated click on the embedded file

The organization type “facility” is used throughout the report to represent facilities such as skilled nursing, imaging, dialysis, surgicenter, urgent care, etc.

Please refer to the Detailed Findings section for further explanation of the information found in the Summary of Results. Included are specific percentages and embedded Word and Excel files with further details

WA Zip Codes by Region

7

Summary of Results

Status: Documentation and Coding In preparation for the ICD-10 transition slated for

October 1, 2015, Washington State providers surveyed report the following status in regards to documentation and coding

8

Cur-rently coding15%

No, but certified/ trained

28%

No train-ing

sched-uled38%

Not appli-cable19%

Prepared to Code

Process in place22%

Process planned,

not in place34%

No process planned

or in place29%

No process needed

16%

Documentation Process

Status: Upgrade and Testing

9

Yes51%

No, but sched-uled15%

No12%

Don't know21%

System Upgrades

Yes, by my orga-nization

6%

Yes, by the system vendor

27%

No, but we have a plan in place to

test the system

19%

No, we are not planning on testing

16%

Don't know32%

System Testing

In preparation for the ICD-10 transition slated for October 1, 2015, Washington State providers surveyed report the following status in regards to system upgrades and testing

Status: End to End Testing

10

In preparation for the ICD-10 transition slated for October 1, 2015, Washington State providers surveyed report the following status in regards to working with a partner (payer or clearinghouse) to test the claims submission/reception process

Yes, my organization has/does

9%

Yes, my system vendor

has/does19%

No, but test-ing is

scheduled10%

No, we can't find a payer/clearinghouse to

test with us3%

No29%

Don't know12%

Partnership for Testing

Very confident26%

Somewhat confident50%

Not very con-fident16%

Not at all confident8%

Status: Overall Confidence

11

In preparation for the ICD-10 transition slated for October 1, 2015, Washington State providers surveyed report the following status in regards to overall confidence that the provider will be able to send ICD-10 complainant claims and get back remittance advice information

Overall Confidence

Interest in Training is High

12

Activities/TrainingsWould take if offered

Not needed

Skills building for ICD-10 code selection

70% 30%

ICD-10 coding of sample scenarios 72% 28%

Training on chart documentation by providers

69% 31%

Guidance on assessing vendor readiness

45% 55%

When asked which of the following activities would help their practice be more prepared, survey respondents note three of particular interest

Generally, the less confident the more likely a respondent is to be interested in training that would help their practice be more prepared fro ICD-10

Preparedness Varies by Practice

13

All practices are in various stages of preparation for the ICD-10 transition. The percentages of those lacking a documentation process, coding, upgraded systems or testing are reported below

Status

All Type

s(n=139

7)

Ment

Hlth(N=33

3)

Massage(N=24

2)

SpecPhys(N=16

8)

Chiro

(N=152)

Prim

Care(N=13

0)

OccMed(N=10

3)

E.A.Med(N=65

)

No documentation process in place/ planned

29% 38% 17% 19% 34% 34% 22% 46%

Not currently coding/no training scheduled

38% 42% 26% 27% 48% 44% 42% 40%

No system upgrade in place/scheduled, don’t know if upgraded

12% 12% 15% 7% 14% 8% 6% 15%

Not tested/not planning to test

16% 22% 14% 10% 14% 15% 9% 23%

14

Critical Access Hospital Preparedness

Status

CriticalAccess

Hospital(n=9)


0%


0%


11%


0%

15

Rural Practices Prepared

Urban practices appear to be further behind than rural in preparations

Rural practices are significantly more likely to have a documentation process planned but not in place (40%) compared to urban practices (32%)

• Although about 20% of both urban and rural practices have a documentation process in place

• Urban practices are significantly more likely to have no process planned or in place (31%) vs. 24% of rural practices

Rural and urban practices show no significant differences regarding coding training/certification

Urban practices are significantly more likely to indicate they have not upgraded their systems/applications (10%) than rural practices (13%)

Urban practices are significantly less likely to have a plan in place to test their system (17%) than their rural counterparts (23%)

Interestingly, rural practices see more patients per week on average (139) than urban practices (119)

Survey Respondent Demographics 92% of survey respondents submit claims

electronically

The majority (76%) feel confident that they will be ready to submit ICD-10 compliant claims by the October 1, 2015 deadline

62% of survey respondents have an office with only one practitioner

The average number of patients seen each week is 125, with the median at 30 per week

The majority of respondents surveyed (72%) are from urban practices.

Rural practices see significantly more patients per week than urban practices

Mental Health (24%), massage (17%), specialty physician (12%), chiropractor (11%) and primary care physician (9%) practices make up the majority of organizations surveyed

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Detailed Findings

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Documentation: 50+% moving ahead In preparation for the ICD-10 transition slated for

October 1, 2015, many Washington State providers surveyed have a process for documentation planned or in place

18

Process in place

Process planned but not in place

No process planned or in

place

No process needed

• 100+ practitioners• Have their

own in-house system• Confident

will be ready

• Use an external clearing house or billing service• Rural• Specialty physician,

chiropractor and occupational medicine• Somewhat confident

• <20 practitioners• Urban• Massage, specialty

physician, chiropractor

• Paper claims• Massage

, mental health

22% 34% 29% 16%

22% Have Documentation Process Just under a quarter of the 1,397 providers surveyed

(22%) have a process in place to verify that their providers’ clinical documentation practices are consistent with the level of specificity required by ICD-10

Those with a documentation process place are significantly more likely to be…

• From a practice with 100+ providers

• Very or somewhat confident they will be able to send ICD-10 complaint claims by October 1st

• A practice with an in-house claim processing system than those who use a clearing house system to indicate they have a process in place

Those with a documentation process in place are significantly less likely to be from a massage or chiropractor

There is no statistically significant difference between those located in an urban or rural setting 19

Q1. Do you have a process in place to verify that you providers’ clinical documentation practices are consistent with the level of specificity required by ICD-10? (N=1,397)

34% Have Documentation Planned Those who have a documentation process planned

but not yet in place are significantly more likely to be…

From a specialty physician, chiropractor, occupational medicine, or primary care than an mental health, massage, or East Asian medicine practice

Located in a rural vs. urban area Submitting claims through a clearinghouse, billing

service or in-house rather than on paper Somewhat confident they will be able to send ICD-10

complaint claims by October 1st

The size of the practice does not indicate likelihood to have a documentation process planned but not in place

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29% Without Documentation Process This leaves 29% with “no documentation process

planned or in place” to ensure the level of specificity required by ICD-10

Those with no documentation process planned or in place are significantly more likely to be…

• From a practice with <20 providers compared to those with 100+ providers

• A massage, specialty physician, occupational medicine and especially East Asian medicine practices rather than mental health, chiropractor, or a primary care practice

• Urban rather than rural locations

• How providers process their claims does not make a practice more or less likely to have no documentation process/plan in place

The less confident they are that they will be able to send ICD-10 compliant claims by October 1, 2015 the more likely they are to not have a documentation process in place or planned

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16% Documentation Not Applicable Of those surveyed, 16% state that the referring

providers supply diagnoses so a documentation process is not needed

Those indicating this need for increased documentation specificity not apply to them are significantly more likely to…

• Be from a massage practice than any other type of practice

• Be from an mental health practice than a specialty physician, chiropractor or primary care practice

• Submit claims by mail rather than electronically, through a billing service or in house system

In regards to the respondents’ practice size and location (urban vs. rural) there is no statistically significant difference between whether or not the need for increased documentation specificity applies to them

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Additional Documentation Insight Of those who chose to provide additional information

regarding the status of their practices documentation process, 22% said their software/billing systems will handle it

For a complete list of responses, click on the embedded file

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Q2. If desired, feel free to share any additional comments regarding the status of your practices’ process, including when/if you plan to have this process in place. (N=236)

Comments on Process Status Percent

Software/billing systems will handle it 22%

Process will be in place by Oct. 1 17%

Will be taking training/Will study 16%

Uninformed of process/Not sure what to do

15%

Sole provider/Handle it myself 11%

Not applicable to me 7%

Referrers do most of the coding/limited use

5%

Significantly more likely to be those who are very confident vs. all others

Currently coding15%

No, but certified/

trained28%

No train-ing

scheduled38%

Not ap-plicable

19%

Coding: Many Underway

43% respondents indicate their billing staff (either providers or coders) are currently practicing ICD-10 coding (15%) or are already trained/certified (28%)

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Q3. Is your billing staff (either providers or coders), currently practicing ICD-10 coding? (N=1,397)

Significantly more likely to be: • Specialty physician vs.

all others except East Asian medicine

• Chiropractor, primary care physician, occupational medicine or East Asian medicine vs. mental health or massage

• Using a billing service or in house system vs. all others

Significantly more likely to be: • From a practice of 100+

practitioners• Mental health vs. all

others except specialty physicians

• Massage, specialty physicians, primary care physicians vs. chiropractor

• Very/somewhat confident they are ready

Significantly more likely to be:• From a

practice of less than 20

• Mental health, chiropractor, primary care, occupational medicine, East Asian medicine vs. massage, specialty physicians

• Submitting electronically vs. by mail, billing service or in house system

Significantly more likely to be: • Massage vs.

all others

Comments Show Many Not Trained Of comments provided regarding staff’s current ICD-

10 coding practice, many relate to not being ready yet

For a complete list of responses, click on the embedded file 25

Q4. If desired, feel free to share any additional comments regarding your staff’s current ICD-10 coding practice, including when/if training is scheduled. (N=173)

Comments on Coding Practice Percent

Plan on training/training scheduled 23%

Unsure how or where to get training/need info

21%

Have completed training on coding 14%

Already practicing ICD-10 coding 8%

Ready for new ICD-10 requirements 8%

Sole proprietor/Do my own coding 8%

Software/biller will handle/provide instruction

8%

Not applicable/don’t handle/not a big deal

6%

Not ready/still need to practice 6%

Significantly more likely to be chiropractor vs. mental health, massage, specialty physiciansSignificantly more likely to be massage or primary care vs. specialty physicians or occupational med.Significantly more likely to be specialty physicians or chiropractor vs. mental health, massage or primary care

Q4 Responses

Most use Systems supplied by vendors Nearly all survey respondents (92%) process claims

electronically, only 6% create paper and submit them by mail

26

Q5. Which of the following claim processing approaches best describes your practice? (Pick the best fit – what you do most often.) (N=1,397)

Use clear-inghouse

Use in-house system

Use a billing service

Create paper claims

Don't create claims, use superbills

Other-10%

0%

10%

20%

30%

40%

50%

60%

70%

50%

26%

17%

6%1% 0%

Significantly more likely to be:• Mental

health, massage and East Asian medicine vs. other practice types

Significantly more likely to be:• practice 20+• Specialty

physician, chiropractor, primary care, occupational med

• Rural

Significantly more likely to be:• Mental health,

occupational med vs. specialty physician, chiropractor

• Urban

Significantly more likely to be:• Massage,

chiropractor• Rural

System Upgrades Underway

Half have upgraded to systems/applications for ICD-10, while 15% have upgrades scheduled

27

Q6. Has the system and/or application your practice uses (or your vendor uses) to create claims/superbills been upgraded so ICD-10 codes can be entered as of Oct. 1, 2015? (n=1,397)

Yes51%

No, but sched-uled15%

No12%

Don't know21%

Significantly more likely to be: • Specialty

physicians vs. mental health, massage, chiropractor, or East Asian medicine

• Submitting claims through a clearinghouse

• Confident

Significantly more likely to be:• Mental health,

massage, chiropractor, East Asian medicine

• Urban• Create super bills or

paper claims• Not all confident

Significantly more likely to be specialty physicians, chiropractor, primary care physician, occupational med

Significantly more likely to be: • <20

practitioners• Mental health,

massage, East Asian medicine

• Not at all confident

System Preparations

41% of those who chose to add a comment indicate they are prepared


28

Q7. If desired, feel free to share any additional comments regarding your system’s ICD-10 upgrade, including when/if it’s scheduled. (n=102)

Comments on Systems Upgrade Status

Percent

Systems/application/vendor is prepared 41%

Use Office Ally 21%

System upgrade scheduled 10%

Unsure if system/application/vendor is ready

8%

Need more info/training 7%

Unaware/don’t know if it is ready 6%

Q7 Responses

Respondents not Actively Testing 33% have had their system tested either internally

or by the vendor, however, 32%, a nearly equal number, don’t know the status of their system testing

29

Q8. Has your system been tested to verity that it can produce ICD-10 claims/superbills? (N=1,397)

Yes, by my organi-zation

6%

Yes, by the system vendor

27%

No, but we have a plan in place to test the system

19%

No, we are not planning

on testing16%

Don't know32%

Significantly more likely to be:• Submitting

paper claims by mail

• Very confident

Significantly more likely to be:• Mental health or

East Asian Medicine

• Urban• Create superbills• Not at all

confident

Significantly more likely to be:• Specialty practitioner

vs. mental health, massage, chiropractor, primary care physicians

• Using a clearinghouse, billing service, in house system

• Very confident

Significantly more likely to be:• Massage

practitioner• Paper claim,

clearing house, or billing service


Significantly more likely to be:• Specialty physician,

chiropractor, primary care, occupational medicine

• Rural

Many Report Testing Under Control 74% of commenters have tested, know how testing

will be taken care of, or use Office Ally and won’t need to test

24% don’t know about testing, are not ready to test or need info on testing


30

Q9. If desired, feel free to share any additional comments regarding your system testing, including when/if it’s scheduled. (N=92)

Comments on Systems Testing Status

Percent

Software/vendor is handling it 34%

Use Office Ally 20%

Testing is scheduled 13%

Don’t know if tested/unsure how to test/need info

12%

No testing – can’t/won’t test/not ready 12%

Testing has been done 7%

Significantly more likely to be:• Mental

health or massage

• Urban

Q9 Responses

Yes, my organization has/does

9%

Yes, my system vendor

has/does19%

No, but test-ing is

scheduled10%

No, we can't find a payer/clearinghouse to

test with us3%

No29%

Don't know12%

Many Lack Partner to Test With

31

Q10. Have you worked with (or do you have an agreement to work with) at least one payer or clearinghouse to test sending them ICD-10 claims and receiving feedback from them on their processing of those ICD-10 claims, including remittance information?. (N=1,304)

Significantly more likely to be:• 20-99

practitioners vs. <20

• Very confident

Significantly more likely to be:• Very confident • Specialty

physicians, primary care or occupational medicine

Significantly more likely to be rural

Significantly more likely to be:• <20

providers• East Asian

medicine vs. massage


Significantly more likely to be from a practice of <20 or 100+

Additional Partner Testing Insight Of those who chose to provide additional information

regarding trading partner testing, the following comments were shared:

For a complete list of responses, click on the embedded link

32

Q11. If desired, feel free to share any additional comments regarding finding a payer/clearinghouse to test the exchange process, including when/if the test will occur. (N=77)

Comments on Testing Partner Status

Percent

Don’t know if tested/unsure how to test/need info

27%

Software/vendor is handling it 26%

Use Office Ally 18%

Testing is scheduled 14%

No testing – can’t/won’t test/not ready 10%

Don’t know/NA 9%

Significantly more likely to be urban vs. rural

Q11 Responses

Very con-fident26%

Somewhat con-fident50%

Not very con-fident16%

Not at all confident8%

Confidence in their Readiness

A majority of respondents (76%) have some level of confident that they will be ready to send compliant claims by the October 1st deadline

33

Q12. What is your confidence level that your practice will be able to send ICD-10 compliant claims and get back remittance advice information beginning Oct. 1, 2015? (N=1,304)

Significantly more likely to have practice size of 40-99 physicians vs. <40

Significantly more likely to be mental health vs. all but East Asian medicine

Confidence Increase With Training Over half of commenters feel that training and

education would increase their confidence level that their organization will be ready to create and submit ICD-10 claims

Click on the embedded icon for a complete list of responses

34

Q13. What will increase your confidence level that your organization will be able to create and submit ICD-10 claims? (N=1,304)

What Will Increase Confidence Percent

More training/education 57%

Nothing will increase my confidence level

22%

More time to get ready 14%Significantly more likely to be chiropractors

Significantly more likely to be:• Mental health or

Specialty physician practice

• Very confident

Q13 Responses

Interest in Training is High

With the exception of guidance to assess vendors’ readiness, the majority of respondents would find training helpful

For all trainings, those who say they would take the training if offered are significantly more likely to be not very confident

For all trainings except “guidance on assessing vendor readiness,” those who those say the training is not needed are significantly more likely to create paper claims and be very confident

35

Q14. Which, if any, of the following activities/trainings would help your practice be more prepared for ICD-10? (N=1,397)

Activities/TrainingsWould take if offered

Not needed

Skills building for ICD-10 code selection

70% 30%

ICD-10 coding of sample scenarios 72% 28%

Training on chart documentation by providers

69% 31%

Guidance on assessing vendor readiness

45% 55%

Training Preferred Option

When asked what else would help their practice be prepared for ICD-10, those who chose to respond indicate “training” would be helpful

Click on the embedded icon for a complete list of responses

36

Q15. What would help your practice be prepared for ICD-10? (Please be as specific as possible.) (N=186)

Helpful for Preparation Percent

Training 32%

Code list/conversion/for my specialty

15%

Uncertain everyone/vendors will be ready

10%

More info on ICD-10 9%

If could test/practice 8%

Ready to go 6%

Extend/delay deadline/more time 6%

Don’t know/NA 8%

Significantly more likely to be East Asian medicine

Q15 Responses

Many Types of Organizations

37

Q16. Which best describes your organization? (Choose only one.) (N=1,395)

Men

tal H

ealth

Mas

sage

Pra

ctiti

oner

Special

ty P

hysic

ian

Chiro

prac

tor

Primar

y Car

e Phy

sicia

n

Occup

atio

nal M

edicin

e

East A

sian

Med

icin

e

Dentis

t

Mul

tispe

cial

ty P

hysic

ian

Facili

ty

Critical

Acc

ess H

ospi

tal

Ancill

ary Ser

vice

s

Other

0%

5%

10%

15%

20%

25%

30%

24%

17%

12% 11%9%

7%5% 4%

2% 1% 1% 1%

6%

Most Practices are Small

The average number of practitioners in the respondents’ workplace is 4.1

62% of responding practices only have one practitioner

Those who create superbills or paper claims and those from mental health, massage or East Asian medicine are significantly more likely than others to come from a one practitioner office

Occupational medicine average 7.0 practitioners which is significantly higher than other practice types

38

Q17. How many practitioners do you have? (N=1,394)

Average 125 Patients Seen Weekly The average number of patients seen per week at

respondents’ practices is 124.7 The median is much lower at 30.0, indicating that some

respondents’ practices were quite large

Urban practices are significantly more likely to be seeing 11-40 patients per week

Rural practices are significantly more likely to see 41-80 and 121-200 patients per week

Those using an in-house system to create claims are significantly more likely than all others to see >80 patients per week

Respondents creating superbills are significantly more likely than all others to see 0-10 patients per week

39

Q18. What is the average number of patients receiving medical care from you each week? (n=1,303)

Number of Patients Seen (Continued)

Mental health, massage, East Asian medicine are significantly more likely to be treating 0-40 patients a week

Specialty physicians, chiropractors, primary care, and occupational medicine are significantly more likely to treat 41+ patients a week

40

Q18. What is the average number of patients receiving medical care from you each week? (N=1,303)

Majority are Urban

Nearly three quarters of the practices are in urban locations

41

Q19. What is the ZIP code of your primary clinical location? (N=1,394)

Urban72%

Rural28%

Significantly more likely to:• Use superbills

or billing services

• Be an mental health or East Asian medicine practice

Significantly more likely to:• Use paper

claims, electronic claims or in house systems

• Not be East Asian medicine

Addendum

42

Preparedness and Confidence

43

The following table summarizes the results for the following types of practices: Primary Care Physicians, Specialty Care Physicians, and Multispecialty Physicians

Status

PrimCare(N=130

)

SpecPhys(N=16

8)

Multi

Spec(N=23

)


34% 19% 35%


44% 27% 4%


8% 7% 35%


15% 10% 26%

Confidence Will Be Ready

PrimCare(N=130

)

SpecPhys(N=16

8)

Multi

Spec(N=23)

Very 21% 26% 18%

Somewhat 52% 50% 45%

Not very 14% 17% 32%

Not at all 13% 6% 5%

OneHealthPort Washington State ICD-10 Readiness Survey Research Conducted February – March 2015 By...

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