March 2014

Many of us are currently experiencing March Madness – NCAA tournament, brackets, Cinderellas, etc.  Many in healthcare unfortunately may experience “October Chaos,” as the compliance deadline for the nationwide conversion to the ICD-10 family of diagnostic and procedural codes is set for October 1, 2014.  Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services, at the Healthcare Information and Management Systems Society convention recently said that there will be no more delays to the implementation of this system.  Unfortunately, some are predicting “Chaos” for the October 1st deadline/nationwide conversion rollout.

To mitigate this “chaos,” providers need to make sure they are appropriately preparing now.  While many phases/parts of the healthcare playing field have been delayed and continue to be delayed, the October 1, 2014 deadline for the ICD-10 rollout seems real. What should providers do?

1) Invest now in physician/staff training on documentation;
2) Engage in best practices discussions with other similarly situation providers;
3) Mitigate your risks and assess possible financial impact of coding errors;
4) Work with your team (physicians, payors, provider groups, vendors, consultants, and secondary data users) to ensure everyone is prepared.

Unfortunately, this process, preparation and implementation will be expensive for the physicians/providers. Fiercehealth IT reported on criticism of the rollout by the American Medical Association, which published a report concluding that ICD-10 implementation costs will be more expensive for physician providers than previously thought. My conversations with providers has unfortunately supported this proposition that costs financially and in resources are high. The study provided an update of 2008 research and predicted small practice costs will range anywhere from $56,639 to more than $226,000, and for medium-sized practices it expects costs will be between $213,364 and $824,735 for implementation.

Perhaps, as troubling as the information in this costs study is, a recent study by the Medical Group Management Association found that less than 10 percent of responding physician practices were ready for the transition to ICD-10.

In short, the deadline is coming; physician practices and providers need to act immediately.

I do note that just as I was writing this blog post, I saw that attached to the proposed SGR Fix Bill was a proposed delay in the implementation of ICD-10 until October 1, 2015.  I guess in this healthcare environment, one can never say “never.” We can hope for the delay to make sure everything is ready, but prudence dictates taking steps now to prepare.


Much of my practice focuses on physicians’ and physician groups’ business and contracting needs, including employment contracts specifying physician duties and responsibilities. We are going to look at some key provisions within your employment contract, specifically those on physician duties and responsibilities.

Physician duties and responsibilities are identified within your employment contract in provisions that may seem innocuous and unimportant.  In reality they are vital.  The provisions set forth in great detail the physician duties and responsibilities to the employer, whether that employer is a physician group, hospital or other entity.

Read carefully to determine expectations: Do you have an hourly expectation? Do you have a certain number of days provision? How often are you expected to participate in Call coverage? Is Call equally divided among the number of physicians, or do you as a newer physician carry a heavier burden? You should know this information before entering the contract. Make sure that you are comfortable with your defined duties and responsibilities as a physician.

You also need to examine what, if anything, you can do outside of your employment arrangement. Many contracts have provisions that set forth physician duties and responsibilities in this regard.  Often they specify that you are not to provide any medically inclusive services. For instance, if you are thinking about teaching, or providing locum tenens coverage, you need to make sure that you are able to do so under your contract.

A contract may provide that if you serve as an expert witness, or assume teaching responsibilities, or provide locum tenens coverage, any compensation for those services will go to your employer rather than to you. If you want to make sure that this does not occur,  be sure that the contract language provides that the stipend or compensation will actually be coming to you.

Physician Contracting 101: Physician’s Duties and Responsibilities, by Paul Drey – YouTube.