Lessons learned from ICD-9 implementation

When healthcare transitioned to ICD-9 on Oct. 1, 1984, there was still great confusion 18 months later on how to submit the codes. There was great deal of frustration both on the provider side as well as the health plan side. There was also a huge lack of training to prepare the doctors for the transition to ICD-9. As a result, for almost a year, there were large drops in revenue.

I am seeing things now, for ICD-10, that I witnessed back then for ICD-9. A great deal of people have not even started their processes. I think the last figures I saw showed less than a third of the medical population has begun processes to implement ICD-10, which includes the 5010 Readiness Evaluation, the training processes, understanding their vendors’ readiness, etc.

I had a conversation with a client from a health system with 27 hospitals and about 10,000 doctors. He said that the most frustrating part of the transition to ICD-10 for him are the responses from their vendor community. As you can imagine, there are a tremendous number of systems within a large integrated delivery system that touch ICD-10.

Their primary vendors seem to be prepared. But a lot of the secondary vendors - in the lab area, the radiology area, a lot of the ancillary systems - still are not advertising or articulating where they are in the process. Until these vendors respond, these systems are going to have to be more of a retrospective coding function versus prospective coding. Some of these systems won't be able to assign a code, because they don’t know how they are going to operate as it relates to the total process. So that’s a very frustrating factor for a lot of CIOs.

I used this particular client as a bellwether, because they were one of the first to adopt ICD-9 back in the 1980s, and they did it very well. It makes me think we are going to have the similar problems now with ICD-10.

The other issue that has not been dealt with is the training issue. What is it going to take to train healthcare providers for this new complex system? That’s going to be a tremendous undertaking. One of the things that people can do if they have a claims editing tool in place within their organization (on the inpatient side and the ambulatory side), is run their claims through in a profile mode (e.g., don’t stop the claims if there is an error) to be able to see where the coding errors are, and use the opportunities to train providers.

Overall, the lack of preparation is similar to what it was in Y2K as well as ICD-9. We are going to see some reimbursement reduction as this transitions, as we did in ICD-9. What the extent will be, I don’t know, but I am going to assume it's going to hit some pocketbooks very hard.

The number one priority of course is to finish the 5010 evaluation. It’s a requirement, and critically important. Then, you must assess your ICD-10 processes – it is the most important piece. It is not a lengthy process, but it is one where money invested is going to pay dividends. Also, be prepared for the unexpected. As with any transition to a new system that affects reimbursement, I think healthcare organizations need to be financially ready for a hit to the revenue cycle initially, and have a lot of backup plans. They should anticipate the reimbursement lag during the transition, and have enough reserves ready to make it whole. Within that is testing, testing, and testing - you can't do enough testing in this process.

OSHA Updates Tire Servicing Materials Charts

The revised materials address OSHA's Materials Handling and Storage standard that protects workers who service single-piece and multi-piece rim wheels.


OSHA Compliance has revised its tire servicing materials to address current hazards in the industry and help workers safely perform maintenance on large vehicle tires.

The revised materials address OSHA's Materials Handling and Storage standard that protects workers who service single-piece and multi-piece rim wheels. Following recent talks with representatives from tire, rubber, and wheel manufacturers, OSHA determined a need for new materials with updates from sources such as the Tire Industry Association.

The updated information, available in a portable manual or as three poster-sized charts, is designed to be easier to access and use. OSHA's revised "Multi-piece Rim Matching Chart" provides an updated list of current and obsolete components, and the old "Demounting and Mounting Procedures for Truck/Bus Tires" chart is now expanded into two charts that deal individually with tubeless and tube-type tires.

"These updated materials will provide readily accessible information on how to prevent worker injuries and deaths from tire-servicing incidents," said Dr. David Michaels, assistant secretary of labor for OSHA. "The new format and easy access will simplify compliance with the standard by helping employers provide their workers with vital servicing information."

The revised tire charts are available for download on OSHA's Publications page.

Warrant in Hand, OSHA Cites Pet Food Manufacturer for Failing to Protect Workers from Dust and Noise Hazards

For those employers who've thought about denying OSHA entry at the door of their facility…don't do it. OSHA cited All-Feed Processing & Packaging's facility in Galva, Ill., for 23 health and safety violations with fines exceeding $750,000.

All-Feed Processing & Packaging was cited for alleged willful violations of OSHA’s air contaminant, respiratory protection and hearing conservation standards. Some violations were cited under OSHA's "general duty" clause, including failing to provide appropriate fire and explosion protection in locations where concentrations of combustible dust existed. Proposed fines total $758,450.

"Even after a powerful dust explosion and fire at this facility in 2009, along with a number of citations previously issued for similar conditions, All-Feed Processing & Packaging fails to comply with safety and health requirements," said OSHA Assistant Secretary Dr. David Michaels. "By showing a blatant disregard for worker safety and health, this employer continues to expose workers to deadly hazards."

OSHA issued nine per-instance willful citations for allegedly failing to mandate the use of respirators for six workers exposed to dust in excess of the permissible exposure limits; and failing to protect three dust collection units, which collect combustible dust such as starch, potato base, cellulose fiber and pea protein, from fire and explosion hazards.

The agency also issued four, single-instance willful citations for allegedly requiring employees to work in areas where they were exposed to total dust in excess of permissible limits, together with failing to implement adequate engineering controls when employees were so exposed; failing to administer a continuing and effective hearing conservation program for employees exposed to excessive noise; failing to ensure the safe use, wiring and installation of equipment in hazardous locations; and allowing the use of liquid propane-powered industrial trucks in atmospheres where combustible dust may be ignited. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health. Proposed fines for the 13 willful violations total $700,700.

Three repeat safety violations were cited for allegedly failing to ensure that operators of powered industrial trucks had completed training and were evaluated on their skills, have the load rating affixed to lifting devices and post danger signs to warn exposed employees of potential dangers posed by work spaces involving hazardous conditions. One repeat health violation was cited for allegedly failing to post safety instruction signs indicating the presence of combustible dust. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last 5 years. The company was cited for similar hazards in 2009. Proposed fines for the four repeat violations total $50,050.

One serious safety violation, with a proposed fine of $3,850, was cited for allegedly failing to have a written certification indicating that all hazards in the permit-required confined space had been eliminated. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazardous condition about which the employer knew or should have known.

All-Feed Processing & Packaging also was cited for five other-than-serious violations, with proposed fines of $3,850, for allegedly failing to record work-related injuries and illness as required on the OSHA 300 log. An other-than-serious violation is one that has a direct relationship to job safety and health, but probably would not cause death or serious physical harm.

The company was placed in OSHA's Severe Violator Enforcement Program, which focuses enforcement resources on employers with a history of safety violations that endanger workers by demonstrating indifference to their responsibilities under the law. The program includes mandatory OSHA follow-up inspections, and inspections of other work sites of the same employer where similar hazards and deficiencies may be present. All-Feed Processing & Packaging was placed in the program due to its previous violations as well as the per-instance violations cited during both the current and a January 2011 inspection.

"Employers have a responsibility to provide appropriate safety equipment and training to protect workers from respiratory hazards, and to ensure that workplaces are safe and healthful," said Michaels.

All-Feed Processing & Packaging has 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.

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OSHA NEP Strives to Protect Workers from Chemical Releases

According to OSHA Administrator Dr. David Michaels, "Far too many workers are injured and killed in preventable incidents at chemical facilities around the country." OSHA set out to address this concern by announcing a National Emphasis Program (NEP) on Nov. 30 to protect workers at these facilities from releases of highly hazardous chemicals.

"This program will enable OSHA inspectors to cover chemical facilities nationwide to ensure that all required measures are taken to protect workers," Michaels said.

The new NEP, which replaces OSHA's 2009 pilot Chemical Facility National Emphasis Program, establishes policies and procedures for inspecting workplaces that are covered by the agency’s process safety management (PSM) standard.

The NEP's inspection process includes detailed questions designed to gather facts related to PSM requirements and verification that employers’ written and implemented PSM programs are consistent. The intent of the NEP is to conduct focused inspections at facilities randomly selected from a list of worksites likely to have highly hazardous chemicals in quantities covered by the standard.

In July 2009, OSHA Compliance Training implemented a multi-year pilot NEP for PSM-covered facilities in an effort to reduce releases of highly hazardous chemicals. According to Michaels, this pilot NEP uncovered many of the same safety-related problems in the chemical industry as found in the refinery industry. OSHA therefore decided to expand the enforcement program to a national level. In this way, the agency can "increase awareness of these dangers so that employers will more effectively prevent the release of highly hazardous chemicals," Michaels explained.

The new NEP can be downloaded as a PDF at http://ping.fm/SR5AD. For additional information, see OSHA’s Safety and Health Topics Web page on Process Safety Management.

OSHA Pounds Meat Manufacturer for Exposing Workers to Fall Hazards

Sigma Processed Meats Inc. has been cited for 16 serious and three repeat violations worth $204,800 in proposed penalties.

OSHA Training has cited Sigma Processed Meats Inc. for 16 serious and three repeat violations following an inspection that found workers were exposed to fall and other hazards at the company's processing plant in Seminole, Okla. Proposed penalties total $204,800.

OSHA's Oklahoma City Area Office began its investigation June 1 at the company's plant after receiving a complaint. Serious violations include failing to provide guardrails as fall protection for employees working on elevated walking/working surfaces, provide an adequate emergency action plan, provide personal protective equipment such as goggles or face shields, train employees on the use of hazardous chemicals, and address hazards created by deficiencies in the company's process safety management system for anhydrous ammonia. Anhydrous ammonia is used for the refrigeration system.

The repeat violations include failing to develop and implement a lockout/tagout program for isolation of energy sources as well as to provide training for employees on the use of lockout/tagout devices.

"Failure to effectively implement OSHA's safety and health regulations to protect workers from potential hazards could lead to serious injury or death. OSHA will not tolerate such negligence," said David Bates, OSHA's area director in Oklahoma City.

Sigma Processed Meats employs about 160 workers at the Seminole plant, which produces cold cut meats, cheese, creams, and frozen foods.

 

21st Century Skills are so last century!

The new mantra, the next big thing, among educators who need a serious sounding phrase to rattle around in reports is ‘21^st Century Skills’. I hear it often, almost always in some overlong, text-heavy, Powerpoint presentation at an educational conference, where collaboration, creativity and communication skills are in short supply. Thank god for wifi!

But does this idee fixe bear scrutiny? In a nice piece of work by Stepahnie Otttenheijm, she asked (radical eh?) some youngsters what 21^st C skills they thought they’d need. Not one of the usual suspects came up. They were less vague, much bolder and far more realistic. Rather than these usual suspects and abstract nouns, they wanted to know how to create and maintain a strong digital identity, be nice, recognise what’s learnt outside school, learn how to search use my Facebook privacy settings. My suspicion is that they know far more about this than we adults.

Collaboration & sharing

Young people communicate and collaborate every few minutes – it’s an obsession. They text, MSN, BBM, Myspace, Facebook, Facebook message, Facebook chat and Skype. Note the absence of email and Twitter. Then there’s Spotify, Soundcloud, Flickr, YouTube and Bitorrent to share, tag, upload and download experiences, comments, photographs, video and media. They also collaborate closely in parties when playing games. Never have the young shared so much, so often in so many different ways. Then along comes someone who wants to teach them this so called 21^st C skill, usually in a classroom, where all of this is banned. I’m always amused at this conceit, that we adults, especially in education, think we even have the skills we claim we want to teach. There is no area of human endeavour that is less collaborative than education. Teaching and lecturing are largely lone wolf activities in classrooms. Schools, colleges and Universities share little. Educational professionals are deeply suspicious of anything produced outside of their classroom or their institution. The culture of NIH (Not Invented Here) is endemic.

Communication

Again, we live in the age of abundant communication. There’s been a renaissance in writing among young people, who have become masters at smart, concise dialogue. The mobile has taken communication to new levels of sophistication. They know what channel to use, in terms of whether it’s archived or not, synchronous or asynchronous. Texts and Facebook comments are archived, some messages are not (voice and; BBM). You call people, synchronously, when you want them to make a decision. Text is asynchronous, therefore slower, more relaxed. They can also handle multiple, open channels at the same time. What do we educators have to offer on this front? Whiteboards?  Some groupwork round a table? Not one single teacher in the school my sons attend has an email address available for parents. I’ve just attended two major European conference where only a handful of the participants used Twitter. What do we know - really?

Problem solving

Problem solving is a complex skill and there are serious techniques that you can learn to problem solve such as breakdown, root-cause analysis etc. I’m not at all convinced that many subject-focussed teachers and lecturers know what these generic techniques are. Problem solving for a maths teacher may be factoring equations of finding a proof but they’re the last people I’d call on to solve anything else in life. Do teachers actually know what generic problem solving is or is it seen as some skill that is acquired through osmosis when a group of kids get together to make a movie?

Creativity

Beware of big, abstract nouns. This one has become a cipher for almost everything and nothing. I have no problem with art and drama departments talking about creativity but why does creativity have to be injected into all education. Creative people tend to struggle somewhat at school where academic subjects and exams brand them as failures. When it comes to creativity, my own view is that the music, drama and other creative skills my own offspring have gained, have mostly been acquired outside of school.

Critical thinking

I have some sympathy with this one, as critical thinking is sometimes well taught in good schools and universities, but it needs high quality teaching and the whole curriculum and system of assessment needs to adjust to this need. However, as Arun has shown, there is evidence that in our Universities, this is not happening. Arun (2011), in a study they tracked a nationally representative sample of more than 2,000 students who entered 24 four-year colleges, showed that Universities were failing badly on the three skills they studied; critical thinking, complex reasoning and communications. This research, along with similar evidence, is laid out in their book Academically Adrift.

Digital literacy

Across the Arab world young people have collaborated on Blogs, Twitter, Facebook and Youtube to bring down entire regimes. Not one of them has been on a digital literacy course. And, in any case, who are these older teachers who know enough about digital literacy to teach these young people? And how do they teach it – through collaborative, communication on media using social media – NO. By and large this stuff is shunned in schools. We learn digital literacy by doing, largely outside of academe. To be frank, it’s not something they know much about.

Conclusion

Beneath all this, is there just a rather old, top-down, command and control idea – that we know what’s best for them? Isn’t it just the old master-pupil model dressed up in new clothes? In this case, I suspect they know better. There’s a brazen conceit here, that educators know with certainty that these are the chosen skills for the next 100 years. Are we simply fetishising the skills of the current management class? Was there a sudden break between these skills in the last compared to this century? No. What’s changed is the need to understand the wider range of possible communication channels. This comes through mass adoption and practice, not formal school and university. It is an illusion that these skills were ever, or even can be, taught at school. Teachers have enough on their plate without being given this burden. I’ve seen no evidence that teachers have the disposition, or training, to teach these skills. In fact, in universities, I’d argue that smart, highly analytic, research-driven academics tend, in my experience, often to have low skills in these areas. , formal environment is not the answer. Pushing rounded, sophisticated, informal skills into a square, subject-defined environment is not the answer. Surely it’s our schools and universities, not young people, who need to be dragged into the 21^st century.

This article was originally posted at  http://ping.fm/LT8mr

Ways To Make Money From Your Job Through Learning

Evert business has to struggle hard to extract the best performance out of employees. While some companies use the mix of various managerial tools, there are others who believe in the process of earning from learning. As a matter of fact, learning is one of the simplest ways to improve the performance of human resource of an organization. For those organizations, which seek to find cost effective ways of imparting learning process, e-Learning is the best tool at hand.

However, learning is sometimes frustrating and uninteresting. But when learning is inherent in a job, the task of the management becomes easier. There are various things that one must incorporate in order to accelerate the process of learning. Firstly, if employees know that have to learn, things will get pretty difficult for the management because employees have a tendency to repel new changes. As such, learning should be inherent in the business, so that the employees know that they are gaining something out of the process.

E-learning is straightforward and uncomplicated. Organizations that have incorporated e-learning in daily routine have witnessed improved performance overall at all levels. Management might have several issues with a new system, just like the employees, but the top management needs to find the return on investment. Needless to mention, just like employees, management, too has to involve a lot of efforts and time, which often can be of real worry.

There are many companies in the world, which have been hugely benefitted from the earning from learning process. On the onset, it can be said that the process works largely for employees. However, there are many companies, which use the technique for improving their output. It is like a source of motivation for the employees, unlike monetary motivation, that seeks to bring the best from them without giving extra pressure on the job.

Earning is the prime concern for both employees and the organization, but doing the same job constantly for years reduces the pleasure of doing it. When the effectiveness of the mind improves, there is an increased desire to do things better and faster, which in turn can be of immense benefit to the business itself. Instead of hiring new staff and training them for new jobs, improving the abilities of present staff is a much better concept because the management can control them better. Learning and earning are essential components of every business that wishes to grow and develop on a constant basis.

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emPower  is a leading provider of comprehensive Healthcare Compliance Solutions through Learning Management System (LMS). Its mission is to provide innovative security solutions to enable compliance with applicable laws and regulations and maximize business performance. empower provides range of courses to manage compliance required by regulatory bodies such as OSHA, HIPAA, Joint commission and Red Flag Rule etc. Apart from this emPower also offers custom demos and tutorials for your website, business process management and software implementation.



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