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ICD-10 – Is Everyone Ready? – ICD-10 Tuesdays

Posted on March 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
One of the biggest challenges to revenue a practice will face in 2014 is the move to ICD-10 on October 1, 2014. One of the biggest challenges with ICD-10 is that it impacts the entire healthcare ecosystem. This means that revenue flow could be impacted if any one part of the healthcare billing continuum isn’t ready.

The first key step every organization can take to prepare for the switch to ICD-10 is to do an audit of which systems, people, and processes will be impacted by the change. Second, you should evaluate the ICD-10 readiness of each system, people and process. Finally, you should make a plan for how you’ll ensure that each piece of the puzzle is ready for ICD-10.

Here’s a quick look at some of the places you’ll want to look when doing an audit of your ICD-10 readiness:
EHR Software
This is an obvious one. We all know that the EHR vendor needs to be ready for ICD-10. However, as John posted previously, Is Your EHR Ready for ICD-10, Not Just Say They’re Ready? it’s really easy for an EHR vendor to say they’ll be ready for ICD-10. At the core of being ready for ICD-10 is just being able to use a new code. Every EHR vendor will be able to enter the new code. Instead of asking if they are ready for ICD-10, you should ask your EHR vendor what interface they’ve created for you to be able to find the ICD-10 codes. You’ll want to get in and test this new interface for finding codes well before the ICD-10 deadline so they can make any changes to the software.

Providers
Every doctor I know understands they they’re going to have to be ready for ICD-10. They’ve heard about the expanded set of codes and how finding the right code is likely going to take extra time. What many doctors haven’t realized yet is that with increased coding specificity, the doctor’s documentation is going to have to change as well. Coding 101 is that the coding has to match the documentation. This will require every doctor to change the way they document their visit even if it’s only a small change.

Billing Software
This is another obvious one and many of the lessons mentioned above about EHR software apply to billing software. However, you’ll definitely want to make sure that your billing software is ready for ICD-10. Can you imagine the impact to your organization if they’re not ready? You might not think this is possible, but I’ve heard some billing software already announce that they’re not planning to revise their software for ICD-10.

Billers and Coders
This is the group that seems most prepared for ICD-10. Most people realize that the coders or billers in their organization need to be ready for ICD-10. Unfortunately for many organizations, that’s where they think all the ICD-10 preparation needs to happen. As this list shows, they are so wrong. However, if you haven’t invested in getting your billers and coders ready for ICD-10, then you better start doing so now. In some cases you may have an older coder that chooses to retire instead of learning ICD-10. Make sure you learn if this is the case now instead of October 1st.

Billing Company
It’s really hard to imagine a billing company not being ready for ICD-10. It’s a basic fundamental of them being a business. If they can’t do ICD-10 they’ll be out of business. However, it makes sense for you to check with them to see what they’ve done to prepare for ICD-10. You’re their customer and it never hurts to hold them accountable. If they don’t thank you up front, they’ll thank you on October 1st when they’re ready for the change.

Labs and Radiology
You’d think that these wouldn’t be that big of an issue since we’re just talking about a new code that gets sent to the lab or radiology. However, if they’re not expecting ICD-10 codes, your patients could run into issues. Plus, many of you have interfaces which send this information automatically. You’ll want to make sure that these interfaces can handle the new codes as well.

Payors
This is probably the most important one and also one of the most challenging. It is the most important, because if they’re not ready for ICD-10 that could mean that you stop getting paid. In many organizations, a hit to their cash flow could have serious ramifications. My guess is that some of you don’t think that this could ever really happen. I assure you that it could happen. Certainly they’ll eventually fix whatever issues they have and they’ll get rolling with ICD-10. Although, will it take them a week, a month, a couple months, to fix whatever issues they may be experiencing? Can you handle not getting paid for a week, month, or multiple months? The challenge is that there’s no simple way for you to know if the payors are indeed ready for ICD-10. The best advice I can offer is a famous statement, “The squeaky wheel gets greased.” Don’t be afraid to make some noise to make sure they’re ready.

Hospitals and HIE
Many vendors are starting to build interfaces with their hospital or an outside HIE (Health Information Exchange). If you have one of these interfaces, you’ll want to make sure that it can support the new ICD-10 codes. Don’t forget to check and test both sides of the interface for their ICD-10 readiness.

Other ICD-10 Readiness Advice
When assessing the readiness of the various entities listed above (and you will likely have others), it’s important that you ask the right questions to make sure you get the right answers. Much like when you’re evaluating between EHR vendors, you want to avoid asking Yes/No questions. For example, if you ask your EHR vendor, “Are you ready for ICD-10?” then you will quickly get a response of Yes. If instead you ask, “What have you done to get ready for ICD-10?” you will get a much more informative answer that helps you understand their true ICD-10 readiness.

Also, when doing your assessment of their readiness, don’t forget to also verify that they can handle ICD-9 for those situations where an organization still hasn’t moved to ICD-10. Yes, it’s crazy that some government organizations aren’t moving to ICD-10. However, it’s the stark reality, so make sure that when needed to you can still support ICD-9 as well.

In all of this, there’s a challenging balance between doing your training too early or too late. If you train your doctors on ICD-10 too early, then they’re likely to forget it by the time October 1st rolls around. However, if you wait until the ICD-10 deadline approaches, the resources for ICD-10 won’t be available. Can you imagine what it will be like to try and hire an ICD-10 coder or ICD-10 trainer in September?

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

Unintended ICD-10 Consequences: Inadequate Clinical Documentation Can Negatively Impact Physician Profiles – ICD-10 Tuesdays

Posted on March 11, 2014 I Written By

The following is a guest blog post by Minnette Terlep from Amphion Medical Solutions.
Minnette Terlep
Often lost in the overarching conversation surrounding the potential negatives of ICD-10 is the very real impact it could have on the selection of physicians and hospitals by health plans, MCOs and shared-risk organizations for participation in provider networks. To succeed, these organizations seek out providers with a strong track record of care that is both high quality and cost-efficient—which is where ICD-10 can hurt or help.

Physicians do not assign codes. They are, however, responsible for documenting at a level of specificity that allows the assignment of codes—the burden of which is exponentially higher under ICD-10. The coder can only assign codes matching the level of specificity supported by the documentation. If the assigned codes reflect a level of severity that is artificially low because of inadequate documentation, it can raise red flags for organizations who profile physicians.

That is because these organizations look not only at severity of illness and mortality rates, but also cost efficiency in providing care. If a physician appears to be over-utilizing resources based on the final assigned codes, it is very likely he or she will be considered a risk and excluded from the network.

For example, if a physician simply documents “pneumonia” as the principal diagnosis and the patient receives standard care for this simple pneumonia, the case will generally and appropriately assign to the lower weighted MS-DRG for community acquired pneumonia.  But what if the patient is actually diagnosed with a type of gram negative pneumonia that is fully supported by a positive culture? If the physician fails to document this more resource-intensive type of pneumonia so the significantly higher weighted MS-DRG can be assigned, then the patient’s days in the ICU and on the medical floor for continued care would not appear to be justified.

The difference in cost between the two scenarios is thousands of dollars, which is problematic on its own. However, it also presents ongoing challenges for the physician in the second scenario: Getting improperly tagged as a resource over-utilizer because, based on the codes and MS-DRG assignment, excessive care was provided. This could easily result in exclusion from a plan or participation in shared-risk initiatives.

We’ve been inundated with information on how clinical documentation must be significantly improved in advance of ICD-10 because of the impact under-coding can have on reimbursements and core measures performance. However, as illustrated in the pneumonia scenario, the potential impact on individual physicians runs deeper. When the highly detailed nature of ICD-10 is coupled with the growing emphasis on standardized care and quality over quantity, it spells potential financial and reputational ruin for physicians whose profile raises concerns about mortality rates and ability to provide cost effective care.

It may also impact the hospitals with which the physician is affiliated. Both can quickly find themselves locked out of networks and excluded from potentially lucrative shared-risk models. Exacerbating the potential impact is the growing (albeit slowly) emphasis patients place on identifying physicians and hospitals with high quality and outcomes rankings, both of which can be tainted by the specter of over-utilization.

While protecting a physician’s profile from the over-utilization category isn’t generally at the center of documentation improvement strategies in advance of ICD-10, there are ample reasons why it should be. So much of what we see and hear about the greater specificity required under ICD-10 is geared toward the impact DRG assignments will have on reimbursement, but in reality it can have far greater long-term financial and reputational repercussions.

Thus, identifying and correcting gaps and areas of weakness in clinical documentation will be beneficial not only for ensuring appropriate reimbursement levels and outcomes metrics reflecting true performance, but also to prevent unjust exclusion from provider networks.

Physicians and hospitals taking the time to analyze profiles to ensure they accurately reflect utilization rates, and to identify and correct documentation-related problem areas that may leave managed care and shared-risk organizations with the wrong impression, will find doors to participation will remain open—and benefit the bottom line.

Minnette Terlep, BS, RHIT, is vice president of business development and chief compliance officer for Amphion Medical Solutions. She can be reached at Minnette.Terlep@amphionmedical.com.

Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.

Making the Case for Dual Coding

Posted on December 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA, Healthcare Scene sat down with Kim Carr, Director of Clinical Documentation at HRS. In the following video, I ask Kim Carr to make the case for dual coding. I even assert that many look at dual coding as dual work, but Kim Carr offers a number of important reasons that organizations should be doing dual coding ICD-9 and ICD-10 today.

While dual coding is great for your ICD-10 preparations, it turns out that your organization can benefit from dual coding even under ICD-9. Kim Carr talks about a specific example of benefits you can gain for your organization even before ICD-10 becomes a requirement.

Certainly some organizations struggle with how to do dual coding while still maintaining their day-to-day coding production. This is where an organization may want to look to an outside company to help them through the process.

Considering New Years is just around the corner, maybe dual coding would be a great New Years resolution for your organization.

Check out all of our ICD-10 Tuesdays posts for other related content.

Is Your EHR Ready for ICD-10, Not Just Say They’re Ready? – ICD-10 Tuesdays

Posted on December 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’m attending the mHealth Summit in Washington DC. One of the interviews I’ve had at the event was with Dan Cane, CEO of Modernizing Medicine. You might remember my previous post talking about Modernizing Medicine’s unique interface (and it’s still unique). However, Dan demoed their ICD-10 interface which was like none other I’ve seen.

What I found unique about the Modernizing Medicine ICD-10 interface was that the ICD-10 codes were identified algorithmically as opposed to doing a search. In fact, it begs the question: are there other EHR vendors that algorithmically choose an ICD-10 code as opposed to providing some interface where the user has to search and identify the code? I don’t know of any other EHR software that do this.

Certainly there are plenty of ICD-10 interfaces that let you search for the ICD-9 code and then let you find the ICD-10 code. While it’s an extra step, this can be one way to filter down the vast ICD-10 codes. I’ve also seen other interfaces that after doing a search group the various ICD-10 codes and allow you to drill in to find the right code. However, it’s very different for the EMR to use the data you’ve entered into a note to determine the ICD-10 code for you.

The problem that most EHR vendors have is that they don’t have the EHR data recorded in a way that they could create an algorithm to identify a specific ICD-10 code. Is this even possible to do with a template or macro based EHR documentation system? The only possibility is to take something like Watson together with NLP technology to try and identify the ICD-10 code. The results of such a thing would vary greatly by doctor. Watson can’t magically know right or left (or choose something more esoetric) if you don’t document it.

Why does this matter? If it takes you can extra 1-2 minutes per patient finding the ICD-10 code, that’s going to be a major issue. The moral of the story is that even though your EHR vendor might say they’re “ready” for ICD-10. Are they really ready? Just because a program can do something doesn’t mean it does it well.

Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.

Will ICD-10 Be Delayed….Again? – ICD-10 Tuesdays

Posted on December 3, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We all know that October 1, 2014 is the date when ICD-10 will go live in the US (if you didn’t know that shame on you, but you know now). There have been plenty of rumblings that ICD-10 is going to be delayed…again. In fact, I even hypothesized that the Healthcare.gov debacle could prompt HHS to delay ICD-10 again.

While I think that there are plenty of reasons why they could choose to delay ICD-10, I now think that there’s no way HHS is going to delay ICD-10 (meaningful use may be another story). There’s so much momentum behind ICD-10 and with the previous delays, I think HHS will go forward with ICD-10 regardless of whatever reasons people come up with for delay.

Is your organization ready for ICD-10? What do you think about the possibilities of a delay? I’m interested to know your views in the comments, but for those too shy to comment I’ve embedded a poll below where you can rate delay or not on a scale from 1 to 5.

In a more complex question to answer, I’m also interested to know if readers think their IT and EHR vendors will be ready for ICD-10. Vote in the poll below.

Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.

Should ICD-10 Go Through Rigorous Outside Testing? Definitely. – ICD-10 Tuesdays

Posted on November 26, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Sometimes it’s fun to critique my health IT editor colleagues in this space, but this time, I can do nothing but agree with a column written by FierceHealthIT editor Dan Bowman.

In his column, he notes that physician practices and hospitals have been quite worried about the transition from ICD-9 to ICD-10, something which is inevitable given the complexity of the switchover. And with the switch set to go into effect Oct. 1, 2014, the time available to prepare is flying by.

So, he says, it’s definitely a Good Thing that CMS may be amenable to do external ICD-10 testing, despite previously asserting that it wouldn’t do so. Now, bear in mind that CMS hasn’t promised to do external testing — it’s just said that it would consider the  idea — but that’s encouraging news.

After the mind-blowing failure of HealthCare.gov, CMS hardly needs another disastrous failure of systems or operations in one of its key responsibility areas. What’s more, if ICD-10 coding doesn’t work right, we’re talking about tying up millions (or even billions) of dollars in reimbursement to providers. That could prove to be a disaster which makes the HealthCare.gov debacle look like a minor blip.

Given that a failure of testing was instrumental in the HealthCare.gov debacle, I can’t imagine why CMS wouldn’t have become super-cautious in its wake. The last thing CMS needs is mass confusion, delayed payments, undercoding, upcoding, fraud….need I go on?

As things stand, CMS’s IT operation is already in turmoil, with the agency’s CIO having resigned and other heads still likely to roll. And Congress, for once understandably, isn’t going to have a lot of patience with anything resembling another IT failure.

CMS, don’t tell the public you don’t have the resources to do more extensive ICD-10 testing. Find them. Your future as an agency may depend on it.

Meanwhile, readers, if you want to keep up with ICD-10 twists and turns, don’t miss John Lynn’s ICD-10 Tuesdays. He’ll have plenty of insights to offer as the big day approaches.

Outfitting for the ICD-10 Voyage – Breakaway Thinking

Posted on November 19, 2013 I Written By

The following is a guest blog post by Laura Speek from The Breakaway Group (A Xerox Company) and Honora Roberts from Xerox. Check out all of the blog posts in the Breakaway Thinking series.
ICD-10 Boat
These are challenging times for healthcare providers in every imaginable vessel – and the whitewater ride is not over yet. Just around the bend looms the transition to ICD-10, scheduled for October 1, 2014. Most providers know the wisest course is to start preparing now, yet few have dared to navigate these uncharted waters.

For many, a major problem is not knowing where to start. Others may be suffering from protracted procrastination. And still others may be well on the road to ruin via the path of good intentions.

An effective way to put some wind in your ICD-10 sails is to get real about the serious costs of noncompliance. After October 1, 2014, claims must be submitted using ICD-10 coding to be eligible for reimbursement. In other words, if you don’t bill with ICD-10 codes, you simply won’t get paid. And that’s the cold, hard truth.

The transition to ICD-10 will affect every facet of healthcare, but it begins with understanding the basic differences between ICD-9 and ICD-10. First and foremost, ICD-10 is not just a simple expansion of ICD-9. There is no reliable one-to-one mapping system. Some ICD-9 codes equate to multiple ICD-10 codes, while some do not correspond to any.

ICD-10 codes include much greater specificity; care providers must document etiology, laterality, exact anatomical site, and other information. Patient encounter documentation must include proper detail to enable coders to locate the correct ICD-10 diagnosis and procedure codes. Physicians and mid-level providers should begin to assess their documentation today to identify where ICD-10 coding requirements are already being met and where improvement is needed.

Because clinical documentation is at the core of every patient encounter, it must be complete, precise, and accurately reflect the scope of care and services provided. Assuring depth and consistency of documentation represents a challenge for many organizations.

ICD-10 encompasses a huge increase in accessible codes. The ICD-10-CM diagnostic code set, used in all healthcare settings, increases from roughly 13,000 to 68,000 codes. The ICD-10-PCS procedural code set, used within inpatient settings only, expands from roughly 3,000 to 87,000 codes. It should be noted that ambulatory settings will continue to use CPT (Current Procedural Terminology) procedural codes.

Given this massive growth in coding scope, the importance of detailed clinical documentation becomes even more pronounced. Physicians and other healthcare providers typically are not trained to develop proper documentation skills in medical school or residency; nurse practitioners (NPs) and physician assistants (PAs) generally do not receive such training during graduate school or clinical rotations. Hospitals and healthcare systems need to compensate for this training deficiency by instituting educational programs and tools that align healthcare providers with proper documentation practices to clear the decks for successful transition to ICD-10.

ICD-10 requires physicians, NPs, and PAs to thoroughly document each and every patient encounter to a much greater level of specificity than is needed in ICD-9. Nonspecific or incomplete documentation within ICD-10 will cause delays, claim denials, cash-flow interruptions, and inaccurate quality reporting. Definition and terminology changes inherent in ICD-10, particularly for surgical procedures, will also require focused education and training.

At the end of the day, providers aren’t coders. They are far less concerned with ICD-10 codes than they are with improving quality of care. This is where ICD-10 can be viewed as a welcoming beacon on a rocky shore. It gives healthcare providers an incentive to establish a clinical documentation improvement (CDI) program. In fact, implementing and sustaining an effective CDI initiative should be a top priority for all healthcare organizations preparing for ICD-10. For those with no CDI program in place, the time to begin is now. Consider improved clinical documentation as essential equipment for maneuvering through the twists, turns, and churns that accompany the voyage to ICD-10.

Honora Roberts - Xerox
Honora Roberts is Vice President of Healthcare Provider Services at Xerox.

Laura Speek  - The Breakaway Group
Laura Speek is a Learning and Development Specialist at The Breakaway Group (a Xerox company).

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Timeline for Healthcare Organizations to Train for ICD-10 – ICD-10 Tuesdays

Posted on November 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Right as the AHIMA exhibit hall was closing (literally they turned out the lights on us), I pulled out my video camera and got the following interview with Garry Huff, MD, CEO and President of Huff DRG Review Services. In the video, Dr. Huff addresses the challenge of training doctors on ICD-10. As a doctor, he offers a unique perspective on what works and what doesn’t work when training doctors on ICD-10. Plus, he looks at the timeline organizations should plan for training doctors on ICD-10.

I really love Dr. Huff’s approach to teaching doctors ICD-10. They realize that doctors have limited time and attention span. They have doctors from a specific specialty training that specialty. They do a gap analysis on the training needs so they can focus that training on what each specific provider needs to learn.

Dr. Huff also suggested that a doctor can be trained on ICD-10 with this type of specialty and provider specific training in 30 minutes to an hour. Is this enough time to train doctors on ICD-10?

ICD-10 Tuesdays

Posted on November 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As promised, today is the start of a series of blog posts I’m calling ICD-10 Tuesdays. Every Tuesday I’m planning to publish a series of blog posts looking at the challenges and opportunities associated with the implementation of ICD-10 in the US.

I’ll do this for as long as I have interesting ICD-10 content to publish. I won’t be surprised if the series lasts until close to the ICD-10 implementation date, October 1, 2014. I’ll also be soliciting some outside experts to participate in the series as well.

This blog has always been a learning experience for me and this series will be a continuation of that trend. Hopefully you’ll add to the conversation in the comments of each post. The more perspectives given, the more we all learn. Plus, don’t be shy about suggesting other ICD-10 topics I should cover on our contact us page.

Since my love is technology, most of the posts in the ICD-10 series will touch on the technology aspects of ICD-10 in some way. Plus, I’ll likely highlight some interesting companies and people in the ICD-10 space. I’m already scheduling a Google Plus hangout talking about the ICD-10 workforce that will no doubt be part of the series. In fact, we’ll probably have a number of ICD-10 related videos in the series.

Now that you have the ICD-10 Tuesdays plan, I’ll start the series by saying that many in healthcare aren’t ready for the change. Although, even scarier is the large contingent of healthcare organizations that think they’re ready for ICD-10 and they are not. Hopefully as we dig into each aspect of ICD-10 and how it will impact the entire healthcare cycle, organizations will be made aware of places where they can work on their ICD-10 readiness.

Another topic I’m sure we’ll cover much more in the future is physician readiness for ICD-10. I’ve heard organizations say that they didn’t need to train their physicians for ICD-10. Those organizations are in for a rude awakening. In fact, I’m not too worried about the coders being ready for ICD-10. They know that they have to be able to work with ICD-10 if they want to have a job as a coder. So, they’ll be ready. The same can’t be said for doctors.

There’s a little ICD-10 flavor to get ICD-10 Tuesdays started. Much more to come.