Moving the #ICD10 Conversation Forward [Podcast]

Posted on Dec 23rd 2014 by Kate Warnock

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We all know what you get when you do the same thing over and over, and hope to get a better result: you never do. It’s for that reason that Florida Blue decided to leverage social media not only to attract more participants to our monthly “ICD-10 Open Line Friday” teleconference but to engage more physicians and providers in getting prepared for ICD-10. At first, we did little more than tweet the agenda. With time and some research, we recognized that the potential – and need - was far greater. That’s why our social support for ICD-10 in 2014 grew to include live tweeting during the calls, posting the presentations to SlideShare, and publishing a recap of each call as a blog with the call’s recording embedded as a podcast (see below for December's content). Most importantly, we made significant connections with thought leaders on this topic. We were proud to include two of them in the December Open Line Friday panel: Joe Lavelle and Steve Sisko.   [powerpress] Both Joe and Steve (and of course, Florida Blue) curate conversations related to ICD-10 on their blogs and Twitter (Joe as @Resultant, Steve as @ShimCode and Florida Blue as @FLBlue). Following them is a smart and efficient way to become familiar with the issues related to ICD-10. Educating physicians and providers on ICD-10 is so central to Florida Blue’s mission that we’ve asked Humana, Aetna and United Health Group to join our monthly calls. Even representatives from CMS listen in! Yet central to this conversation is exactly the party we feel is most under-represented: the individual physician and small provider practice. Many in this group have expressed reluctance, confusion and angst over the hardships involved in migrating from ICD-9 to 10 – part of the reason that implementation has been delayed three times. Florida Blue is committed to disabusing erroneous information and providing reliable, cogent information so that confusion is replaced with a clear look to how every physician and practice can prioritize the work and dollars involved in adopting ICD-10. We’re excited to launch a series of tweet chats in 2015 on ICD-10’s value proposition, and will feature experts like Joe Lavelle, Steve Sisko and others. Go to for details coming soon!   The complete transcript of the podcast begins here: George Vancore Good morning everyone and on behalf of Florida Blue, our ICD-10 Open Line Friday panelists, and our special guests, Mr. Steve Sisko, Senior IT Project Manager from Cambia Health Solutions, and Mr. Joe Lavelle, Executive Healthcare IT and Management Consultant, we want to welcome you once again to our monthly ICD-10 Open Line Friday Teleconference Call.   Today's call is being recorded, and I would like to thank our panelists and invited guests who have all graciously consented. The recording and a written transcript will be posted onto the Florida Blue ICD-10 landing page at www.floridablue—all one word— by the end of this month for downloading and playback. We have been recording these sessions since December of 2013, so this is our one-year anniversary.   I also want to extend a very special welcome to our first-time attendees and a welcome back to those of you that have been on previous calls. My name is George Vancore. I'm a Senior Manager, Systems Integrator and Business Architect here at Florida Blue. I apologize up front for my voice. I came down with the flu last week and I am now in recovery mode, so please bear with me..   Before we begin, a couple of administrative items. Everyone is on mute except for our panel and special guests, and of course copies of today's material are available on our corporate website, Simply click on the Open Line Friday box to find today's material and simply follow along. If you cannot get to the material, we encourage you simply to sit back and listen to the dialogue. If you'd like to ask a question please send an email to floridablueopenlinefriday—all one word— That way we capture the question, it helps us create FAQs that we post onto our ICD-10 landing page, and of course if time permits, we will respond to questions during the call, but all questions will be answered.   And of course, today's call is also being tweeted by one of Florida Blue’s Social Media Specialists, Ms. Kate Warnock, and we can be followed using our Twitter handle @FLBlue—that’s at sign, FLBlue.   So, let's get started with the main presentation deck, and as a reminder, the presentations of today's call are available at   Today's topic is ICD-10: A Perspective View from two social media pros. We’re going to have an interesting dialogue with both Steve Sisko and Joe Lavelle on how to leverage the social media world and helping us move ICD-10 forward with a specific targeted focus on individual physicians and small physician groups. Is it really unreasonable to see where a different communications channel can be used that may help increase outreach and engagement where other traditional alternatives have fallen short? We’ll see what our experts have to say in a few minutes.   Turning to Slide 2, let me now take a moment to introduce our ICD-10 Open Line Friday panelists. We have Mr. Lee Ratliff, Clinical Business Technology Consultant at the Baptist Health South Florida. He's on his day off but he’s listening in. We have Ms. Laurie Darst, Revenue Cycle Regulatory Adviser at Mayo Clinic and sitting in Rochester, Minnesota. We have Mr. Matthew Ketterman, Director of Business Solutions out at Availity. He’s also on vacation. We have a good friend of mine, Ms. Mary Rita Hyland, Healthcare Industry Consultant, Mandates and Regulatory Compliance. Ms. Jackie Griffin, from Secure EDI; she cannot be with us this morning. We have Dr. Joe Nichols sitting on the West Coast from Health Data Consulting. Gale Scott is actually on vacation today so I’m really happy for her. So, she’s at Tampa General. We have Diana Brijbag, Office Manager at Spring Family Physicians in Weeki Wachee, Florida, and we also have Dr. Deborah Stewart Medical Director at Florida Blue. So, I want to welcome the panelists. We also have with us this morning a very good friend of mine—and I say that sincerely—Mr. Stanley Nachimson at Nachimson Associates on the call. Welcome, Stanley. Glad you could be here.   Stanley Nachimson Thanks, George. Happy anniversary by the way.   George Vancore Yes, that a boy. We give a special shout out this morning to Ms. Pam Cashes, our Provider Communications Specialist who is handling our Open Line Friday mailbox, and of course Ms. Kate Warnock, our Social Media Specialist here at Florida Blue, who again will be twittering today’s call, and as a reminder, you can follow us using our Twitter handle @FLBlue   So, turning to Slide 3, let me initially welcome Mr. Steve Sisko, Senior IT Project Manager at Healthcare Government Programs and Pharmacy at Cambia Health Solutions, and Mr. Joe Lavelle, Executive Healthcare IT and Management Consultant, for graciously accepting our offer to share their insights in how we can leverage the social media world to increase physician and provider engagement and collaboration. Welcome gentlemen. Thank you for being here.   Steve Sisko Thanks for having me.   Joe Lavelle Thank you.   George Vancore No problem there. So, if you turn to Slide 4 of the main presentation deck, we’ll take a quick run through the agenda. Today we’ll once again do a refresh on our Open Line Friday Objectives, then turn our attention to a couple of healthcare industry updates. We will then turn the discussion over to our panelists and special guests.   So, turning to Slide 5, let me begin by—and as most of you would recall—we have four primary objectives for our Open Line Friday. We want to promote the 3Cs, remember? Collaboration, communication and coordination, not only between us; physicians, providers, payers healthcare electronic trading partners; expand your understanding of the current state, give you regulatory decisions and industry perspectives; raise your awareness and understanding of the unique opportunities and challenges that ICD-10 brings to the healthcare industry, and of course to try to help provide you with tools and techniques, best practices, helpful hints from your peers that you can use, or begin, to either continue or begin your ICD-10 journey.   Okay, let’s continue onto Slide number 6. Right now just a couple of quick hitters. What I like to do, because it talks a little bit about testing, I want to turn this over to Stanley Nachimson from Nachimson Associates for an update on what’s happening with Medicare testing.   So Stanley, we have the three, right? We have the functional acknowledgement testing that’s going to go on from now through October 1st, 2015 with Medicare. We have the special functional acknowledgment testing weeks that are articulated there. We had one back in November; we have another week in March and we have one in June, and of course this thing called end-to-end testing. So, what are you hearing, Stanley? What are you seeing out there in terms of this testing? Stanley.   Stanley Nachimson Well, George, what we’re seeing is at least the beginning of the industry moving into more end-to-end testing. Acknowledgment testing has taken place already with Medicare and continues to do so, but that’s really just, you know, can I send a transaction with an ICD-10 coding. It doesn’t really give the provider, or the health plan for that matter, any good information as to how the claim or other transaction will be processed. This end-to-end testing which will take place—actually, Medicare’s got three sessions scheduled. The first one this month—the first one next month and then they’ve got another one coming up in April. That will really begin to show providers what happens when they send transactions, claims with ICD-10 codes in there and how they’ll be processed. It’ll really start to give people some very good information. That’s sort of the positive. We do have a number of health plans—yours among them, George: Florida Blue. You manage some others that are already doing some testing and we expect to see a lot more testing, this end-to-end testing, taking place in January, February and March. So, we’ll begin to get some information as to what the real impact of ICD-10 is and I think that is critically important. For hospitals, I think you’ll see them begin to understand what DRG shifts, if any, may be occurring because of ICD-10, and for physicians I think you’ll get to see if there really are any changes in the processing of ICD-10 claims and if their—both and if their software systems are ready and if they’re coding accurately. So, we’re beginning to see that, and on the flip side, we’re also beginning to see with WEDI and a few other groups talking about publicizing testing results; not only for individuals health plans but for the country as a whole, and that knowledge, that communication—to go back to your 3Cs, that communication I think will be critical.   George Vancore I totally agree with that. I think the work that WEDI is doing and collaborating and coming through a common understanding and a common ground around testing and what we’re learning. You know, in our testing we found some compliance violations between two different clearing houses. You know, they implied something different, and then we even had a third interpretation. So, I don’t want to have that happen in production, not have that happen. The reason we test is to test those things out, so. So thank you, Stanley. For those of you that are on the call, if you are engaged and you got selected to be a member of the Medicare end-to-end testing capability, please let us know. We would like to see if we can get some learnings directly from you. Now I know that Mayo Clinic Jacksonville and the folks here, they have been—they were selected and they are going through it, so we’ll get some feedback from them and provide that feedback to this team at a later date.   Let’s turn quickly to Slide 7. Now, I’m going to turn this over to Laurie Darst. Now Laurie, there’s a lot of things that are happening around the industry. You know, we talked about the NUCC change, the CMS 1500, and by the way this health plan as we migrate into the new professional paper claim form that’s been ICD-10 enabled, we’re at about a 87, 88% conversion rate which is really good. Of course the partial code freeze has been going on since 2011. What else are you seeing out there, Laurie? Is there something that you want to share with the team in terms of the regulatory update, Laurie?   Laurie Darst Yes, I think that probably the thing that’s foremost on most people’s minds is the lack of a delay, an announcement of the delay in the recent spending bill, and that’s really despite a lot of efforts to ask for an additional two-year extension. The fact that there is no wording about ICD-10 in the current spending bill doesn’t provide definitive insight into what’s going to come. About the only thing that can be inferred is that there is no strong evidence to support a further delay, but then again there’s no strong evidence that there should be no further delay. The recent December 10th statement from the House Energy and Commerce Committee Chairman Upton and the House Rules Committee Chairman Sessons provide little insight via the phrase, “We will continue to”—I’m sorry. “We will continue our close communication to CMS to ensure that the deadline can successfully be met by stakeholders,” but the press release also mentions having a hearing on these issues in 2015. That doesn’t really seem to close the door once and for all for any future delay.   Back in June, key members of the Senate Finance Committee, House Ways and Means and the House Energy and Commerce Committee sent a letter to the CMS administrator urging CMS to take appropriate steps towards ICD-10 readiness for both CMS and the industry, and to provide ongoing information on progress in areas such as provider outreach and education and on testing with providers. This certainly shows a high level of interest in ICD-10, however, if the information provided indicates the industry is still not making sufficient progress, there is no hard guarantee that further delay might not occur. In other words, we may continue to live with some level of uncertainty well into 2015.   The best thing the industry can do is to continue to make progress and to show success in testing, removing the fear of payment disruptions. It would also be helpful to show the compliance effort may not be as difficult as some may think.   From a WEDI perspective—and I’ll just mention this just as a final piece—we’re proceeding with the assumption there will be no more delay and the focus is on testing and transition related items. However, again, the SDR bill coming up would be another opportunity to include a delay if, you know—so we’ll be monitoring that closely.   George Vancore We’ll be—yes, very, very much so. Very much so. Well, thank you Laurie, and once again, congratulations on your selection as Chair-elect at the WEDI Board of Directors. That’s a significant industry accomplishment and well recognized across the industry of your knowledge and understanding of all things regulatory. So, thank you for being here, Laurie. We do appreciate it.   Let’s turn quickly to Slide 8 and just a quick note on Florida Blue’s status. We have previously reported this out but I wanted to make sure that—we are continuing our physician and provider end-to-end testing. We have over 657 physicians, provider, hospital organizations currently inside one of our three phases of our testing, and we have now posted testing results out on our ICD-10 landing page. But of special note, we are posting specifically who we have tested with, including names of physicians, named provider organizations, clearing houses and any electronic trading partner. If they’re not included on the list it’s because we haven’t successfully tested with them, so I get calls on that all the time. We’re also including some of our testing results—something that Stanley Nachimson had reported out earlier in terms of the WEDI effort—and some of our learnings to date. So, as we move forward and if you want to get engaged in our interim testing, please—with Florida Blue of course—please simply visit and look up the Testing with Us.   So, let me now turn this over to Ms Kate Warnock, Florida Blue’s social media expert. Kate is the reason why both Steve Sisko and Joe Lavelle are with us this morning, and she felt so strongly about the use of social media for ICD-10 and she’s actually been part of our team and has been tweeting—I’m using the right terms—over the last year I guess it’s been. It seems like a long time. But she’s also going to tell us how—why she felt so strongly about bringing both Steve on and Joe on for this call. So, Kate Warnock, Florida Blue’s social media expert, what are your thoughts and why are Kate—why are Joe and Steve here?   Kate Warnock Well, thanks for the opportunity to talk and to really provide the lead-in for our two social media experts, George. Like you said, we’ve been tweeting for about a year and the original request from the Provider Communications Team here at Florida Blue was we think that we need to try something different, and George, you have mentioned many times that it’s critical for us to be able to extend our educational opportunities, all the resources that we have accumulated over the years around ICD-10 with our core constituents, which include our health practitioners and everyone that’s important to adopting ICD-10, and when we realized that we just weren’t penetrating deeply enough into our provider network, our Provider Communications Team suggested maybe we can leverage social media, and I was more than happy to start exploring this audience on this topic. As soon as I plugged in the hashtag on Twitter, ICD-10, the conversation simply flowed and it became very obvious that there are some folks who are extremely learned on this topic, and two of them are on our call today.   So, we have, as you mentioned before, Joe Lavelle and Steve Sisko. Joe tweets under the handle @Resultant and Steve as @ShimCode, and they have been engaged with us on Twitter over these past 12 months, you know, sharing our content, responding back and I really felt that they could provide an additional insight into how we can use social media to take this conversation to the next level, and so I think that that’s what we’re going to hear from them today.   George Vancore Very good. Thank you, Kate. So Steve and Joe, before I ask our—my initial question to kind of get a sense of where our collective pain is right now, let me give you a little bit of background and set point here.   For those of us that are on this panel and others from across the healthcare industry, when we get confronted with regulatory compliance mandates, one of the most significant challenges that we all face centers on physician and provider engagement, we have covered entities. So, we all recognize that physician and provider priorities are well established around treating patients, healthy outcomes, and obviously getting paid for the services rendered. We can definitely—we all definitely appreciate that position. However, what we have seen in the past with implementations like HIPAA, high tech, 5010 and the NPI, we found it significantly easier to engage and collaborate with the—I’ll use the term institutional and large provider organizations in their respective implementations. Well, with these past implementations most of the work centered on technology, and what we refer to as a technical silver bullet construct. For individual physicians and small physician practices and attaining their compliance; they waited for their trading partner to attain compliance and by definition they were now compliant. That approach worked well for any of the past regulatory mandate that had a technical silver bullet. Unfortunately, under the ICD-10 construct, there is no technical silver bullet. As much as we need the ICD-10 readiness of the technical environment and infrastructure in place, the real challenge sits within the clinical setting, and Dr. Nichols and Dr. Stewart speak about this all the time. Where our collective reach and influence is limited—which is the way it should be. I mean, we don’t tell a doc how to practice medicine, at least I don’t. Anyway, so we have a dilemma. We, like other health plans and payers, have significant due diligence records where we show that we have reached out to countless medical associations and societies, attended and presented the ICD-10 challenge at physician and provider-focused seminars, we’ve hosted numerous face-to-face sessions, written and had published articles of ICD-10 interest in trade journals, physician newsletters, updated physician and provider contracts to reflect ICD-10, hosted free webinars, free workshops, only to find that the physician and provider engagement remains stagnant at best, and that’s not a negative, that’s just a fact.   So, here we are, closing in on our nine-month countdown. I’ll put aside the political environment where the lines have obviously been drawn between the ‘let’s implement ICD-10’ and the ‘let’s indefinitely postpone ICD-10’ camps that we are all too familiar with, but we’ll just do that for now. So, with that said, most of us are struggling, and really in essence we’re at our wits’ end with all of this. So, given your experience, your expertise, the social media channels that Kate was talking about earlier, the dialogues that we have seen, the linking and the tweeting back and forth that you have had across the healthcare spectrum, what can we do differently or more of that can—I’ll use this term—measurably increase the engagement of individual physicians, small practice in ICD-10, keeping in mind the old saying: if you continue to do what we have always done, we will continue to get what we have always got. But this time, it’s different. We cannot continue along this path and be successful. So, Steve and Joe, who wants to take a first crack at what your advice would be and guidance going along using the social media channel? Steve? Joe?   Steve Sisko Well, this is Steve. I’ll jump in there, Joe. Thanks for having me and just wanted to clarify I don’t really consider myself a social media expert by any stretch. I guess I just got in early in this ICD-10 niche and then stuck with it because of my job and stuff. So, you know, there’s so much awareness, understanding, the tools, the best practices, learning procedures and opportunities down at a specific specialty level. I think in the pre—before we started we were talking there and Stanley and Joe were talking and I think the question about which providers are going to be impacted by ICD-10 I think lends itself to leveraging social media. You know, there’s a lot of channels in social media for specific specialties or specific diseases and I believe there’s a lot of opportunity to share those understandings and tools and procedures with those specific specialties and groups via social media. And, you know, I’ve seen all the major associations, the HEMA and, you know, certainly the AMA and MGMA, AAFP and CMS, they all have a lot of good information out there. Do people know where it is, that it’s available? Do they have connections? You know, you mentioned the 3Cs, communicate, collaborate and coordination, I mean that’s pretty much what Twitter and social media is all about.   Joe Lavelle Yes, Steve, I’ll jump…   George Vancore Yes, go ahead, Joe.   Joe Lavelle I’ll jump in. So, I’ll say that I think Steve is a social media expert. I learned a lot from him over the last five years, and another point Steve made is although we do social media, we have day jobs. My day job for the last four years has been helping multiple clients as a health IT consultant do ICD-10. So, we’re in the bowels, or I’m in the bowels of different organizations for the last four years, from the assessment to the implementation planning to the actual implementation and testing work. So, that’s where our perspective’s come and that’s why I think on social media when we tweet about ICD-10, you know, we’re able to engage in conversations. You know, I go to social media to get smart and I think that in a large part small practices can do the same but first we’re going to have to teach small practices to do social media.   That said, George, the question you asked is how do we get people engaged and how do we get them started, and I think that’s the biggest problem. That these small practices and small hospitals, and maybe even some bigger hospitals, haven’t really taken this seriously and gotten engaged, and if I were to decode and I look at things simply as a consultant and try to zero in on root cause, I think the root cause is if you read what’s coming out from the people that they take their direction from, the American Medical Association and MGMA, they’ve been very clear on Twitter and other places about what their objections are or what their concerns are with ICD-10, and I’m not seeing any response to each one of those concerns, and I think that’s something we can do, Steve, myself, others that are—Brad Justus, others that are ‘big names’ in the ICD-10 conversation, whether it’s Twitter or other places, we can start to take those objections one by one. Some of them are really valid, you know. As we were entering the first of last year, there were many vendors who still hadn’t released an ICD-10-ready product. Well, you know, maybe if we’d shed more light on that, it would have put pressure on those vendors to get that product out. And, by the way, several vendors still don’t—or many vendors still don’t have their product out.   So, I think that that’s one way we can help, is to start working on the challenges that are keeping AMA and MGMA from telling their constituents, “Hey, you’ve got to jump on. Here’s the way we’re going to do it.” So, if we can one by one come up with solutions to the objections, we can do that through Tweet chats; we can do that through a series of blog posts from some of the renowned ICD-10 experts. I think we could really make a dent and make a difference. I think we need to do that quick because if we aren’t in that position, I think that whatever power drove AMA and MGMA to get the delay tied to SGR is going to keep that same delay and on March 31st we’ll have same outcome.   George Vancore Yes, unfortunately you’re right. You know, Joe and Steve, to Joe’s point, I want to talk a little bit about the mixed signals that I get—and all due respect to the AMA. Now just yesterday, they sent out a—what they call at the AMA Store, ICD-10 specialty coding, and there’s a summit, and they’re doing it around the nation. It’s reasonably priced. It’s all about ICD-10, ICD-10 coding, ICD-10 PCS, ICD-10 CM. They’re even talking about HCPCS and CPT codes and it’s all certified, you know, through CME approved certifications, and I step back and I go to their website and I see this great material out there. I said, “Wow, this is really good stuff.” I wish the physicians would just go out there and take a look at what they’re writing, what they’re saying about ICD-10. There’s even value propositions out there. There’s early adopters out there, on their website, and then I hear the political—and I don’t want to get into that arena but…   Steve Sisko Flaming water skis. That’s a good red herring.   George Vancore Yes, flaming water skis, you know, to that point, and it’s like, you know what? I sit back and I look at that and I say—I listen to Dr. Wa’s comments to the Board of Delegates and it’s like, you know, with all due respect, you know, this is pretty serious stuff and to Dr. Nichol’s point that was raised a couple of months ago where he said, you know, those codes exist in 9; they’re not new. These are not new codes, and by the way these codes are put in by physicians originally. So, I see that point but I get that mixed signal and that’s where my rub is.   But, I want to get specifically to another point you raised and that is to take a negative—let’s use the ICD-10 to—let’s leapfrog ICD-10 and go to ICD-11 dialogue. Now, for most of us that are at least here, we darned well know that ICD-11—by the way, it’s not generally available. It’s generally available for beta and it’s been moved out from May of 2015 implementation to May of 2017. That was just a recent announcement. So, the World Health Organization who owns the ICD-10 construct, they now moved ICD-11 out to 2017. Now, that’s based upon them getting a willing country that’s currently running ICD-10 to implement ICD-11, and there’s a lot of value to doing that but that’s for another conversation. If you take 2017 and say, “Okay. Okay, okay, it’s available 2017. Now we’ve got to make the American—the version for use in the United States.” That takes another two years on the average. This is coming from the World Health Organization. Then after that—so we’re now in 2017. Now after that, it could take—well, 2017 with the beta version. We now make an American version which is 2019, and now it could take 24 to 48 months to implement. Now we’re out to 2021, 2022. Now, here’s the rhetorical question or comment. Can we continue to limp along on ICD-11—that has been frozen—I mean ICD-9; that has been frozen by the way since 2011—between now and 2021, 2022, and the answer to the question is no, you can’t do that. So, I think your point is, is that if we take that construct, that misinformation that’s sitting out there and play that out through the channels that you’re talking about, we can cut that off at—I’ll use the term at the knees. Is that your point that you’re raising, Joe? Is that where you’re at?   Joe Lavelle Absolutely. There are—everything we need to know to get ICD-10 is out in the public space. We need to engage. I think we need a (inaudible) for ICD-10. That’s a whole different thing—but we’re not even going to have that opportunity unless we address the objections of MGMA and AMA and get their lobbyist to untie—or whatever the right, proper terminology is—the delay from SGR or any other legislation. If they are to get behind ICD-10, we’re going to go. Until they don’t—until they get behind it, there’s going to be a fight and worse than that, providers are going to stand still because of this uncertainty of whether it’s going to go or not, so it’s going to be a self-fulfilling prophecy. They’re not going to be ready in March/April because they’re not going to have done anything.   Steve Sisko No, I don’t buy the—I don’t buy the ICD-10—11 argument. I think, you know, do they really want to wait until 11 or is it just, you know, an excuse to just put it off. When 11 comes are we then going to wait for 12? I mean, at some point we have to go on this. I mean, one of the things I see is, you know—and I come from the payer side, so relatively speaking there’s a much smaller bevy of payers that we have to get onboard compared to the providers, but then it’s not all the—the specialties aren’t impacted the same, you know, so this idea of the AMA just being nay-sayers, are they—you know, out of their how many? What, 380,000 members? I don’t know. Some bevy of—some stable of members, how many orthopedists and OBs and cardiologists versus practices that may not be as impacted by ICD-10? You know, I just don’t buy the numbers.   Stanley Nachmison Yes, this is Stanley, and I think you have to kind of separate the political debate, which is, much like many political campaigns, is full of half-truths, lies, misinformation, from the actual truth. And not only do we have to kind of dispel a number of these myths, and there have been a number of—I see website and other discussions dispelling myths, but we really have to, again, crank up the, ‘All right, doc. Here’s really what you have to do. Here are—here’s people that have done it. Here’s what you have to do.’ The tweeting and the re-tweeting and the posting, I mean, one of the values I think of social media is not just the initial blog post or the initial tweet but the fact that it gets picked up in so many other places, so that you’ve got lots of newsletters being able report that, “Oh, here’s what—look what Steve Sisko just posted,” or, “Look what Joe just mentioned,” or, “Look what the AMA just said.” “Look what Florida Blue just said,” and spreading that information. So we’ve got to, I think, separate out this political discussion. I don’t think you’re going to get the AMA, Congress—House of Delegates I believe is the correct term.   Steve Sisko You know, and Stanley and Dr. Joe, I’d like to thank you for all of your thought leadership because you’re the guys that I’m getting a lot of this stuff that I’m sharing from. I know, you know, you two aren’t real prolific on social media, but in fact, you know, you’re really the thought leaders in this area from both sides, payer and providers. So I’d like to thank you for providing all this fodder for me over the last three, four years.   Joe Lavelle I second that, Steve.   George Vancore Yes, there you go. Hey, I know Laurie Darst wants to ask a question. Laurie from Mayo Clinic, you have something you want to add here?   Laurie Darst This is just Laurie as an industry participant, not necessarily from Mayo Clinic, because we’re kind of—we’re moving forward so this isn’t an issue for us. But, you know, one, I just want to say I think Joe and Steve are spot-on on this. You know, in the absence—and so this is more of a comment. I think in the absence of addressing this, the provider community is only going to get the concerns that are being raised by the provider associations, and I think it is absolutely critical for everyone to, you know, take a look at what some of the challenges and concerns are being discussed and say, “Okay, is this really a concern?” and address it if it’s not, and get that message out there so there is other information out there for providers to see. But on the same point, if there truly is some concerns that are valid out there, we need to address them also. So I think there’s an opportunity to dispel the myths if there are myths, and, you know, address some of the challenges that are reality that don’t seem to be being addressed. So, I think the—what Steve proposed here is really the key.   Steve Sisko You know, and that’s what Joe had said about a tweet chat. I don’t know how many people know what that is but the idea of addressing specific concerns is a good one. You know, Open Line Friday and some of the other programs that are out there that are promoting ICD-10 information and best practices might do well to sponsor like a tweet chat where then a specific concern could be discussed in that chat and then having different, you know, thought leaders and people that specialize maybe more in that area. You know, like for instance, you know, clinical documentation improvement, I really don’t have a clue about that stuff. I mean, I’m a payer side guy. We’re getting more into that because of the risk adjustment and the chart, the importance of that for risk adjustment factors, but that might be one approach to address these concerns. I think, you know, the AMA has five or six. Joe and I were talking about them, so maybe there’s some opportunity there going forward to share that information and to repeat it and get it out there so it is spread around the picked up by different media outlets and shared with others, and you know, hopefully it’ll get disseminated to the people that actually need it.   Stanley Nachimson This is Stanley. I think that we need to move from the theoretical to the practical. I think what Laurie says, you know, address the concerns, the AMA might raise or others might raise a theoretical concern, but again, if we get someone, whether it’s a health plan or a provider to say, “I’ve done this. Here’s what the real results are. It’s been tested. Health plans are working fine. There will not be major payment disruptions,” et cetera, et cetera, I think that’s how you counter these “theoretical arguments”.   Joe Lavelle Exactly. Exactly.   Mary Rita Hyland This is Mary. I just want to bring another perspective as well to the table. It’s the fact that we have all suffered through many of these initiatives over the years that have been delayed, and you know, disbanded and reconstructed, and, you know, I think that history is one of the major elements that impacts us today. We all have the fear that it’s not going to come into fruition. That all of our work is not going to matter. It’s not going to mean a thing, and we’ve seen the shift in our congressional leadership. People are now demonstrating their voice through their elections. I think, you know, the more that we get into the fact that there are many initiatives across the country that have separated themselves from the government initiatives and have been very successful, that we’re bringing this back to the people. We’re bringing this back to the patients and the individuals, the physicians and other clinicians that are dealing with healthcare, is that we can affect change ourselves, and we do not need to be derailed by whether it be legislation or other initiatives. We can continue our efforts and be very successful and also assist in elevating our healthcare to that next level. I think the fact that we’ve seen our healthcare initiatives take a drop in our poll across the world as well has brought home the fact that we really need to redirect ourselves and the way we’re approaching this.   George Vancore Yes, I totally agree with you, Mary.   You know, I want to go back to something that we were talking about earlier, the MGMA. I had several conversations with Robert Tenant over the years and one of the things that we did, back in—I think, Stanley, you might have been in the room at the time; we were doing a WEDI down in South Florida, and I happened to have an opportunity to read out our work in terms of what we’ve done for revenue neutrality. Now I think the complexity of ICD-10 makes revenue neutrality an unattainable goal, except what we found in the professional side of our claims processing, we modeled three years of claims data. We did what we call premier picks. We took the 9 code and kind of translated it and made assumptions about laterality, et cetera, but when we created a 10 code, and then ran it through. What we found on the professional side, three years of modeled claims data, we found zero—zero change in reimbursement. No change. If anything got dinged, it might have been that of medical necessity, but we kind of pushed that aside for the sake of the model, but we found zero.   Now, I can’t say the same thing—so that takes that off the table, so to speak, from this health planner’s perspective. But I had the opportunity to speak to Sid Hebert from Humana, Shirley Reynolds from UnitedHealth, and Brian Parkany from Aetna on these calls, and I asked them the same question and they came to the same conclusions: that, yes, we’re fine on the professional side. That’s not where the issue is. The issue is something Stanley mentioned earlier, the DRG shifts. Now, are DRG shifting? Yes, they are. Are we modeling those shifting? Yes, we are. We’re using, you know, the OptumInsight version 32 of the DRGs. But the word—the jury is still out on that one, so I cannot say that we’ll be financially neutral in the DRG world because I don’t know that yet. But are we trying to get there? Are we working with Humana, Medicare, CMS, 3M? Yes, we are. We’re heavily engaged in that and we go through that going forward, and that’s what the first quarter is going to bring to us, because most of our institutional providers will be in a position to do that kind of testing. So, that kind of brings up that whole issue again. You’ve got this misinformation, ICD-11; you’ve got the revenue neutrality issue, that we can kind of—you used the term tweet chat, you know, but then the whole rub on costs. What is it going cost me to implement? I mean you get numbers anywhere from $350 to a physician to $150,000 for a practice. So, there’s a little bit of a rub there and the readiness and the costs associated with implementation and getting ready for ICD-10. So, you know, I do appreciate this whole dialogue.   Dr. Nichols, I want you to put your practicing hat on for a second. Do you have time to get into this social media stuff and interact with that? Where do you get your information from? So, Dr. Nichols, you’re a physician. What’s your comment about this?   Dr. Joe Nichols No, I think the use of social media is highly variable. I know that for a number of folks that are of my age, we’ve been slow to get there, and mainly because I think it’s a matter of time and my biggest challenge was looking at all the stuff that’s out there as there is too much and I don’t know what’s reliable. I don’t know how to pick out the stuff that really means something from the stuff that doesn’t. So, just trying to weed through all of that to get to the stuff that really matters is so difficult and time is so short, I don’t get involved in it that much from my standpoint, but I think it’s highly variable. I think what we’re seeing is a lot of the younger physicians certainly are adapting that because that’s what they grew up with, but for a lot of the healthcare industry or the older physicians in particular; they’re not.   Steve Sisko Yes, that’s a pretty accurate assessment of it all, you know, and like as far as the time components and reliability, that’s sort of the service I think I provide in terms of curation and the time as far as using tools and being able to automate some things, you know, some people have commented, “Wow, you must spend a ton of time in front of those monitors.” You know, in fact I do spend a lot of time in front of monitors but I also use tools to find things and some things are automatically posted and scheduled. I hate to admit that because some purists would claim that’s cheating, but in fact, you know, I have a life and four kids, and a wife, and you know, you can’t spend too much time on this.   George Vancore Kate Warnock, you’re the social media expert here at Florida Blue.   Kate Warnock Yes, sir.   George Vancore What have you been hearing on this dialogue?   Kate Warnock I think there’s a real—I’m really excited by this conversation. We have, you know—we have a lot of social media experts. In addition to the two live on the call, we have Brad Justus, we have Mandy—my gosh, I’m blanking on her name. Mandy Bishop, thank you.   Steve Sisko Bishop.   Kate Warnock I think that these are people who are—they really help to curate the conversations, so where Dr. Nichols was saying that it’s really hard to spend the time to kind of go through all the conversation and weed out what’s valuable from what’s not, I think once you identify people that you respect because they take a critical view of all that’s being published and they help to curate that content, it really does help kind of give you that laser focus. It helps to, you know, help you not waste your time. It’s really going to give you the information that is going to help you make your own educated opinion on what do I need to do? How do I move forward? What are the right resources to point people that I respect to as well?   So, I really think that as people really adopt social media, it turns into a time saver instead of a time suck once you really identify those key individuals, those key resources, and I really think that’s why our charge is in 2015, you know, is to help really refine that conversation so that we as a payer are always presenting what we feel is the best possible information on this topic.   Steve Sisko Yes, and you know, and even though Dr. Joe may not be active on Twitter, going back to what I said before, I share and I get a lot of his information and insight, so it’s really maybe an informal teamwork. So, even though certain people aren’t on Twitter active, they’re in other venues that are providing and generating this information, so that’s useful.   George Vancore You know, Stanley, you and I have debated over the years about the 3Cs: collaboration, communication and coordination. You are very, very active and you’re very much an ally in getting the word out. What is your flavor of this social media stuff? Because I don’t see you out there. You’re like me, you know. I don’t really participate in it.   Stanley Nachimson George, George, please don’t ever say I’m like you.   George Vancore Well, that’s true. That’s true. Very good.   Stanley Nachimson No, but I’ve actually just started engaging in it, starting to send a few tweets here and there and started to be a little bit more active on the LinkedIn site. I’m certainly not up to the level of Steve and Joe, but I mean, there certainly is value in doing that and I’m just learning, you know, how best to use that.   As far as getting to the individual physician, I don’t really see that social media is the way to do that; it’s certainly one of many avenues. But we do really need to find, you know, where does—where do the individual docs and the doctor practices get their key information. It may be from places like the AMA. It may be from health plans. I would also say that their vendors—and I believe it was either Joe or Steve said something about vendors not being ready. I think their vendors are another key point, and this has been an ongoing problem and almost circular in the industry, where the vendor—where physicians will depend on their vendors to keep them up to date or to inform them of new initiatives, yet many vendors say, “Well, we really can’t move forward until we get the customer demand for moving forward.” So, we’ve got a little bit of a chicken and egg issue, a circular issue there.   In terms of ICD-10, I think it really has to be a multi-faceted approach.   Kate Warnock Stanley. Stanley, this is Kate Warnock. I really—I completely agree with that position and I think that we also view social media as just one way to extend our reach. The other way that I think is really critical is to take people like Dr. Stewart and have her write articles for industry media where our providers might also be getting their news. So if they can’t depend as much on their vendor partners, they’re likely reading things like Healthcare Finance news or Fierce Payer or, you know, other things that—other news resources that if we have Dr. Stewart crafting articles for those outlets, they’re likely to see that and they’re likely to—they’ll see her byline, know that she works for Florida Blue and be likely to come back to us for more information. So, that’s another strategy that we’re trying to enact moving into 2015.   Stanley Nachimson Absolutely, and, you know the physician-to-physician communication is critical. Dr. Nichols, Dr. Stewart both bring a lot of credibility to physicians because they’ve gone through the training; they’ve gone through the practice. They understand some of the pressures on physicians.   You know, we talk about certainly electronic communication but somehow the—I’d also like to advocate for more sort of face-to-face communications, whether that’s vendor fairs or, you know, health plan meetings, and I know Florida Blue has been doing a lot of that within the state and I think we need to continue to see groups going out to docs and giving them the opportunity to come in for a few hours to talk about ICD-10 and really how to do it.   Joe Lavelle That’s a great point, Stanley. This is Joe. In Alabama, we’re putting together seminars. The HEMS, the Alabama HEMS is based on all the things we’ve learned at the larger providers and at the plans and they’ll be two-hour seminars. We’ll have them in different parts of the state, basically to take the CMS guidance, we’ve created a spreadsheet that’s a—for lack of a better term, a work plan and provided two-hour session on how to approach the project, how to get started and how to get going.   George Vancore You know, and of course, you’re going to tweet all that information, right?   Joe Lavelle Absolutely.   George Vancore See? See? This is called collaboration at this point.   Joe Lavelle And share the blogs…   Steve Sisko Say George? One of the things that we found out when we were first reaching out for the small provider practice work with CMS to providers is that when we tried to go out and reach directly out to providers, it really didn’t work well.   George Vancore Right.   Dr. Joe Nichols And I think we stepped back to look at it and thought, ‘well, how do we normally reach providers?’ and it really comes down to they need CME and they need breakfast, lunch or dinner, and they need it in a site where they trust. So, so many more physicians now are really relying on their own organizations, and most of them are now part of another organization, to get them the information that matters. So, if we want to reach these folks, we need to think about reaching them through the organizations that they’re aligned with or trust, and we need to provide it in a way where they see some benefit of that information and in an area where they trust. It kind of goes back to that sort of chain of trust that we originally had in HIPAA and privacy and security laws. I think we really need to go look what is the chain of trust for physicians?   Dr. Deborah Stewart And Dr. Nichols, this is Deb Stewart. You know, I agree. One of the areas that we haven’t talked that much about but I’ve mentioned a few times is specialty societies and, you know, just the other day I had to pay my specialty dues and it struck me how much it is, and so that I think, you know, we as practicing physicians need to demand from our specialty societies the information that is critical to our practice, and you know, making sure that each specialty society takes into account what are the nuances with ICD-10 that’s specific to that specialty, just to your point, with the OB docs, just calming their nerves about all these codes that they’re going to be faced with when you simply laid it out that it has to do with attaching the trimester to the diagnosis, when it’s really not that complex.   So, you know, where do physicians get their information?   I think, you know, specialty societies is certainly one avenue, and to your point, as there’s more consolidation in the medical industry and physician practices are being bought up, then hospitals and other large organizations are going to be part of that communication chain. So I think, you know, as been mentioned, this really has to be a multi-pronged approach, and you know, I think figuring out how to simply the message, as you said, you know, is going to be key to engage our physicians and decrease their anxiety and angst about all of this.   George Vancore I’ll agree with that.   Dr. Joe Nichols Yes, the other thing I want just to follow up, I think she hit it right on the head. The specialty focus of this is becoming more and more important. Early on, at a high level, I’d done a lot of presentations in Oregon for the Oregon Medical Association for other groups there, and it was for everyone because it was learning it. This year, all the stuff I’m doing down there is specialty specific, and so the orthopedists who have heard this say, “Look, talk to us about the orthopaedic stuff.” The OBs want to know about the O—they really don’t care about the rest of this stuff. So, I think particularly as we move forward, we’re going to see much more of a focus on the specialty specific side of things because the impact and the changes are so totally different depending on what specialty you’re in, and you really don’t care about the other areas; you’re really focused on your area.   George Vancore And Dr. Joe, that is so highlighted in ‘Road to 10’. You go back to and you look at that and it’s specialty specific, and I applaud that. I just think that’s wonderful. That’s a key takeaway for me today.   Now listen, as we wind down on our last couple of minutes, and before we turn it over for some comments from Dr. Deborah Stewart, I want to ask Joe and Steve for some parting comments here. So Steve, I’ll let you go first. What would be your key parting comment that you would make to the team?   Steve Sisko Well, I think, you know, we’re in the 11th hour here, and as Dr. Joe just said and other people had brought up, the idea of focusing on, you know, what matters to you, you know, the specialties, the societies, even within a specialty certain types of common conditions, how are they impacted by ICD-10, I think people need to focus and drill down to what matters to them and get away from the flaming water skis and the general nay-sayers, you know. There is so much information out there, and you know, to weed through it, there are all the specialty organizations and all the way up the CMS and AMA have information out there, so there’s really no excuse, you know? Two or three years ago, you know, you would have been the people, the vanguard incurring the pain and creating this, but now it’s out there so go get it.   George Vancore Well, thanks Steve. We appreciate that. Joe Lavelle, what would be your parting comment for the team?   Joe Lavelle I couldn’t agree more with Steve. The information’s out there. If there’s anything that big organizations or organizations that are leaders could do, it’s get what they’ve learned, type it up. It doesn’t have to be in perfect format. Share it. Have a webinar about it. If you’re struggling with how to do that, you know, tweet me, tweet Steve, tweet Brad or other ICD-10 thought leaders and we’ll help you either create a tweet chat or a webinar. The information, getting it into hands, to people’s hands that haven’t had the luxury or the time to figure ICD-10 out, once they have the information and they do the analysis on their practice or their small hospital, their tensions are going to go way down.   George Vancore Yes. Yes, I totally agree with that. Okay folks, so as we focus in on our allotted time, I’d like to now take the opportunity to turn this over to one of Florida Blue’s finest, and I use that term very seriously. It’s Dr. Deborah Stewart, Medical Director here at Florida Blue. She’s been listening for some key takeaways. So Dr. Stewart, with your clinical ears, what are some of the key takeaways from today’s call?   Dr. Deborah Stewart Thank you, George, and I also want to thank our new contributors as well; it’s been very enlightening.   So, what I heard today is I think what we’ve heard before, is that the hospitals, payers, intermediaries, clearing houses are well on their way with ICD-10. It’s either almost done or being done, but the problem still is that our smaller practices, our physicians in particular, are not as engaged, maybe even ignoring ICD-10, and that some of the leadership, the trade organizations representing medicine, you know, are not helping and they are continuing to raise objections; some of them, you know, are very valid but yet not trying to help build the bridge and contribute to getting the change that we really need to have. So, I think, you know, what I’ve heard is that as physicians we need to use whatever channels we’re most comfortable with to get the information, and that those of us providing the information need to really try to simplify the message, personalize it as much as possible to the audience that you’re talking to, be it the specialty, the size of practice, and that we need to look at all of the myths and falsehoods out there and try to address those, and maybe one of the ways to do that is to bring out our early adopters, bring out the stories and successes, like for instance Diana in the small office in Florida here, the Springs Family Medical Center, what she’s been able to do and what it’s meant for her practice. We need to get more of those stories, get the word out through whichever communication channel we can and use multiple channels I think, and be resolute that, you know, ICD-10 is the right thing, it’s at the right time and it will benefit individual patients by improving medical records, the communications that go across various settings, and last, it will improve information from a population health perspective which will be good for society in general.   So, I think, you know, to your question, George, you know, can we really stay with ICD-9? I think the answer is absolutely no, and if we continue to wait it’s just putting us more and more behind. So, I think that’s really the message today is that we have to figure out—continue to nuance our message to meet the needs of practicing physicians.   George Vancore Thank you. Thank you for that, Dr. Stewart. It’s very much appreciated.   CONCLUSION   George Vancore So, just a couple of closing items. Just please remember that today’s call has been—is being recorded and it will be transcribed and both the transcription and recording will be available at the Florida Blue ICD-10 landing page at later this month.   Our next session is scheduled for February—January 16th, Friday—I’m sorry—Friday, January 16th at 9:30 AM. So, please use the same dial in and passcode. During that session we’re going to talk to a number of physician practices regarding the costs associated with the work that they incurred in preparation for ICD-10. So, we look forward to that dialogue.   And in closing, and on behalf of Florida Blue, our ICD-10 Friday panelists: Lee, Laurie, Mary, Jackie, Dr. Joe Nichols, Gale, Dr. Deborah Stewart, Matt and Diana, and of course our ad hoc and much welcomed attendee Stanley, our social media team Pam and Kate, and our very special guests Mr. Steve Sisko and Mr. Joe Lavelle for being with us this morning, and a special shout out to Brad Justus and Mandy Bishop who have both been tweeting during the call this morning. We do appreciate your engagement here.   So, in closing, be safe; go out and enjoy your families and friends during this holiday season, and please have a very blessed, happy and healthy New Year. We’ll see you all next year. Thanks guys.

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Kate Warnock

Kate Warnock is a member of the Florida Blue social media team and has loved being at the forefront of the social wave @FLBlue. A marketer with ten years’ experience, Kate is also a wife and mom to two children. When not at work, you’ll find Kate listening to NPR, reading The New Yorker and Cooking Light, and arriving two minutes late to yoga class.

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