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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)
No documentation process in place/ planned
0%
Not currently coding/no training scheduled
0%
No system upgrade in place/scheduled, don’t know if upgraded
11%
Not tested/not planning to test
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
16
Detailed Findings
17
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
20
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)
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
21
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)
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
22
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)
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
23
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%)
24
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
For a complete list of responses, click on the embedded file
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
• Not at all confident
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
For a complete list of responses, click on the embedded file
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
• Not at all confident
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
)
No documentation process in place/ planned
34% 19% 35%
Not currently coding/no training scheduled
44% 27% 4%
No system upgrade in place/scheduled, don’t know if upgraded
8% 7% 35%
Not tested/not planning to test
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%