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For other articles and previous issues click here. July 15, 2002 THESE
LITTLE CODERS WENT ALL THE WAY HOME Denver Health sent their coders packing.
Well, sort of. By establishing a program that allows permanent employees to work from their homes as full-time coders, health information managers and healthcare administrators are making a choice that benefits both the facility and its employees. Additionally, such a program can boost recruiting success and significantly raise productivity. Does this sound too good to be true? It could very well be the answer to your own coding concerns, so read on and discover how one Midwestern hospital reaped the rewards of developing its own home coding program. The HIM department and coding staff at Denver Health were struggling to keep up with their workload. The search dragged on for new coders to fill several positions that had been open for more than a year. A lack of qualified applicants—combined with the growing necessity to increase the Colorado hospital’s coding staff—led Linda Schwab, RHIT, the department’s assistant director and coding manager, to believe the best solution might be to establish a home coding program to attract new employees and motivate existing coders. With the support of the organization’s CEO and CFO, the HIM department developed and launched its fledgling program with an initial recruiting meeting. “We advertised all over the Denver area,” Schwab says, “and cleared a block of time for people interested in the positions to stop in and speak with me.” Schwab’s recruitment meeting also included human resources personnel and presented potential applicants with an opportunity to ask questions, learn more about the position, or schedule an interview for a later date. Schwab credits the home coding program with the tremendous turnout but adds that she also met a number of people that afternoon who were simply interested in exploring coding as a profession. “Some stopped in just to find out about coding, and a few of those entered community college programs after that,” she recalls. However, the main focus of the meeting was the home coding program, which drew many experienced applicants from other hospitals in the area that did not offer home coding. “Within just a few months of that meeting, we filled all of our openings and grew from a staff of four to 11 full-time coders,” says Schwab. “We not only filled jobs that had been vacant for a long time, but also increased our total staff by opening up new positions.” For the most part, Schwab hired experienced coders, but also selected several who were new to the field. “My personal philosophy is to give people fresh out of school a chance,” she explains. “Some of the new coders are not working from home yet, but that is a goal they may reach farther down the road.” Denver Health’s new home coding program is resulting in quite a few benefits, including more available office space, improved staff morale, and increased productivity. “We have always been limited as to the amount of space we have for our coders, so I am not sure where we would have put the new people,” Schwab says. “Productivity has gone up for everyone who has gone to work from home. They are happy, they are not interrupted as frequently as they are in the office, and they enjoy the flexibility that working from home offers.” Expectations for home coders were outlined well ahead of time. Schwab says that they are required to attend regular office meetings and turn in productivity sheets. Their production is also monitored online. “We try to keep processes the same for the on-site and off-site coders and really make an effort to remind them that they are all part of the same team.” She adds that the department will also conduct meetings with the home-based coders to assess and perfect the program as it develops. Perhaps the most gratifying result of the project has been the increase in productivity among all of the coders employed at Denver Health. “Many of them were already high producers, which was one of the requirements for being allowed to work at home,” Schwab explains. “But everyone just seemed to blossom once they went home and could work uninterrupted at whatever time was best for them during the day.” Standards for home-based coders are slightly higher than those who work on-site, Schwab adds, because on-site coders often have added job responsibilities and are subject to frequent interruptions. A home-based coder working for Denver Health is expected to complete four inpatient charts an hour, while on-site coders are required to code 31/2 charts each hour. “The bottom line is that we consider working at home a privilege, so they understand that they need to meet higher productivity standards,” she says, adding that none of the coders so far has had a problem with the requirements. The information systems (IS) department at Denver Health played an integral role in the development and implementation of the home coding program, from setting up the initial system and DSL lines for Internet access to helping resolve workflow problems. “They have been a tremendous support, and I don’t think we could have done it without them,” Schwab acknowledges. “They go out to coders’ homes, if needed, and, if we feel the system is running too slow, they find solutions to speed it up.” For security reasons, as well as to maintain facilitywide consistency, the IS department assumed full responsibility for home-based coders’ computer and software systems. Additionally, the workstations used by home coders have been adjusted so that printing from the machines is impossible. When the program was initially launched, there were several to-be-expected “glitches,” computer problems, and communication issues, Schwab says. Once these were worked through, however, the program ran smoothly. “Now we have a much better communication system,” she says. “We use e-mail often to notify the coders who work at home of any in-house computer problems.” Surprisingly, Schwab encountered few, if any, hidden costs during the program’s planning and implementation. One that did arise, however, was the necessity for resources, such as medical dictionaries, references, and copies of The Physicians’ Desk Reference. The expense of providing these often costly resources was an aspect that the HIM department overlooked. “The resources we have always shared on-site are now needed by almost every coder we employ,” she says. “Although some resources, such as Coding Clinic are now available to everyone online, I am hoping we will be able to provide more resource materials for them in the future.” Organizations that could benefit from establishing a home-based coding program may tend to avoid this money-saving opportunity due to technical and security concerns, according to Schwab. Additionally, it is imperative to have support from the IS or information technology department because their efforts will be required during the setup and implementation phases. Where security is concerned, Schwab recommends taking any possible precautions. “It can be a scary topic,” she agrees. “We drafted a confidentiality policy that home coders are required to sign, which goes above and beyond what we require of the on-site coders.” The policy addresses issues such as the location of the home workstation, printing capabilities, filing and storage concerns, and access to the workstation. “No one except the coder is allowed to use that workstation. It may not be set up at the kitchen table where their family activities are centered,” she continues. “So far, though, we haven’t had to address any issues that are different from those we have on-site. In fact, home coders have fewer people to chat with about hospital information, and we know they are not sitting in the cafeteria discussing a patient.” Technical solutions to ensure privacy
have also been deployed, Schwab adds, noting that records are scanned
and sent electronically to home-based coders over a protected line.
They are not permitted to send patient information via e-mail and,
as mentioned earlier, are not permitted to print information from
their home workstations. The workstations’ monitor screens
are also equipped with a special screen saver that activates quickly
to prevent others in the home from seeing information on the screen
should the coder step away for a few moments. Schwab also reports that Denver Health’s home coding program eliminated the necessity for outsourcing, thereby saving the facility money. “Before this, we required a lot of contract coding, but, since we increased our staff, we haven’t needed to hire contract coders at all,” she explains. “Also, training and communication are easier to accomplish with a stable, permanent staff and result in more consistent coding.” The opportunity to train her entire staff has also afforded her more consistency and control. If, in the future, the hospital offers a new service or institutes a new policy, it will be fairly simple to make sure it is clearly understood by every coder on staff, she adds. Additionally, the facility has reduced its accounts receivable dramatically. “You can imagine that having four
coders to start, and now working with 11, we were not keeping up
very well,” she admits. “If anyone missed work, we were
dramatically behind.” At the end of the first quarter after
the program was implemented, Denver Health reported a $4.8 million
decrease in accounts receivable due to coding. “The impact
of this program was huge,” Schwab says. |
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