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February 11, 2013

Addressing Coder Shortages From Within
By Pamela Wirth, RHIA
For The Record
Vol. 25 No. 3 P. 6

The effects of the basic economic principle of supply and demand are wreaking havoc on staffing in nearly every hospital department. With so many clinical and regulatory initiatives hanging in the balance, many hospitals that are already operating under lean staffing models are finding that resources are further taxed.

Simply put, demand for quality healthcare professionals is high and getting higher, while supply is hitting historic lows. Some industry professionals believe the challenges created by this staffing strain will be one of the greatest healthcare has faced in nearly a decade.

HIM departments are not exempt from this reality. For years they have labored under an ever-worsening shortage of qualified coders—a situation that will be compounded by numerous changes looming on the horizon. And while no one can accurately predict how extensive the deficit will be, some estimates point to nationwide coder shortages as high as 30% to 50% as soon as late this year.

One change on the horizon is the growing elderly population that will require more healthcare services and extensive medical care, increasing the demand for qualified coding professionals. Second, the industry may lose many experienced professionals to retirement over the next decade because of an aging coder workforce in which the average age is currently estimated at 54. Further exacerbating the situation is the changing landscape in which coders are operating, characterized by shorter days to bill, the ICD-10 transition, and other regulatory initiatives.

Unless the industry can attract a younger workforce, this combination of circumstances suggests that hospitals will face an uphill resource battle to maintain high levels of coding quality and compliance.

Outsourcing, a necessity at many hospitals, is one solution. Some facilities, especially those in rural areas, are not located in a region that supports a pool of qualified coders, forcing them to look outside their own walls. In locations where the population fluctuates, such as resort communities, it makes sense to leverage an outsourcing partner to manage spikes in volume. Because finding qualified coders can be a daunting task, hospitals must use good business sense to determine whether recruitment is where they want to put their energy.

At some facilities, a second alternative exists: training internal transcriptionists as coders.

Like many facets of the healthcare industry, the transcription field is evolving as technology advances. In particular, the promise of speech recognition technology has left many transcriptionists facing an uncertain future in a field that is working to redefine itself. Shrinking HIM budgets are spurring the adoption of speech recognition technology as hospitals look for ways to streamline workflows. The result is that the role of the transcriptionist is transformed to that of an editor, a position requiring less time to turn around documents and fewer staff resources.

The move from transcription to coding can be a win-win for hospitals looking to streamline costs without eliminating staff and for transcriptionists seeking job security. By expanding their skills to include coding, cross-trained transcriptionists can create a valuable resource that can be tapped to manage fluctuations in volume and planned or unplanned staff shortages.

A Solid Transition Strategy
Hospitals must examine several factors before offering a training alternative to transcriptionists. First, an analysis should be undertaken to determine the number of coders needed to fill workflow gaps as well as the types of coding functions that will most frequently need to be filled. For example, if a hospital needs inpatient coders, then training should focus on that specialization.

Once the analysis is complete, a preassessment of existing and interested transcription staff will help a facility determine who to include in the program. If more interested transcriptionists exist than available coding slots, the hospital should first include those who show the most potential to succeed. Proper testing will help determine candidates’ existing knowledge of the key coding cornerstones: anatomy and physiology, and medical terminology.

Because transcriptionists often work remotely, other considerations should center on how training will be conducted. Will the facility offer both on- and off-site training or will only one make the most business sense?

Choosing the Right Partner
Most hospitals won’t be able to dedicate existing resources to educating new coders. They are in the business of patient care, and the chances of resources being available under the weight of so many regulatory initiatives are slim at best.

Outsourcing partners with experience in this area are often the best alternative. Hospitals should seek partners with firsthand knowledge of coding and transcription with experience in conducting successful transition and training programs. It’s important to conduct research on potential partners. Check references of past clients and determine the candidate’s areas of expertise.

Questions to consider include the following:

• Does the company offer turnkey training programs?

• Is the company willing to customize training to meet the facility’s unique coding needs?

• How quickly can the company initiate a program and get training under way?

• How soon will new coding staff be up to speed and ready to work?

• Can the company offer both on-site and remote training?

• Will the company provide 100% quality monitoring on the new coders to ensure 95% accuracy?

• Does the company offer ongoing follow-up and consulting to ensure future success?

A Rare Opportunity
Hospital HIM departments are in a unique position to mitigate the impact of the worsening coder shortage. It’s rare that two closely aligned functions such as coding and transcription would face shortages in the one area and excesses in the other.

The transition to coder is feasible for many transcriptionists. Facilities must determine whether they want to expend resources and energy finding new coders or leverage the skills of good employees who are already aligned with the organization.

— Pamela Wirth, RHIA, is president of the coding, compliance, and quality division of Amphion Medical Solutions.