Presentation on theme: "Acknowledgments Nicole Stanzer – District Health Information Manager"— Presentation transcript:
0 Coding Workforce – New Strategy required Prepared by Wendy Loomes eMR Program Director, Clinical Informatics Information Management and Technology,Northern Sydney and Central Coast Local Health DistrictsSeptember, 2011
1 Acknowledgments Nicole Stanzer – District Health Information Manager Belinda Saad – District Coder EducatorLizz Kopecny – former Area Quality Coding ManagerAll the Coders and Managers of Health Information Services in the former NSCCAHS
2 What were our issues ?The biggest – employing coders full stop ( and HIS staff generally)Drawing from a limited pool of experienced or qualified managers and codersA decreasing clinical coder workforce due to natural attrition and the low profile of clinical coding in the job marketHoop jumping with NSW Health to have coder roles deemed “front line” and advertised externally – seek and HIMMA websiteInsufficient coding FTEs to meet NSW Health coding deadlines, looming ABF requirements, maintain a data quality program and provide leave coverageNo funded trainee positionsHeavy reliance on expensive contract coders
3 Existing StrategiesIntroduction of Area Coding Educators (2) and Area Coding ManagerThrough additional hospital funding increased our recurrent coding workforce by 7.0 FTE across the districtsNegotiated with NSW Health for coder roles to be considered front lineAs of the 1st of July coders have been instructed to use the R69 code when records are unavailable for coding and when information is missing.Permanent add for coders on HIMAA website and automatic adds to seek.comEstablishment of a NSLHD Casual Coding pool – 3 staff that work weekends – 3 more staff being interviewedEstablishment of the Clinical Coder Traineeship ProgramContract coders still in useOvertime always available
4 Existing Strategies continued As sites meet NSW Health target coders moved to assist other sitesRecords coded by staff and contract coders at alternate sitesRemoval of any non coding related tasks from coders-Regrade of Administration level 4 Coding staff to Administration level 5 using appropriate toolSignificant work undertaken with Workforce Metropolitan Careers StaffParticipated in a school job fair at Gosford advertising coding as a professionInclusion of Clinical Coding on the NSW Health HealthWise DVD which aims to promote jobs in the health industry to potential recruits
5 Coder Traineeship Program New Block MethodTraditionalMaterial delivered as modules3 funded trainee Coders come to IM&T at Macquarie Hospital every 2 weeks for a 4 hour session with coding educatorTrainee coders have an experienced coder onsite “buddy”Development of a large amount of teaching materials for the in- house trainee programOff week is a review week4 Coders continue to complete specialities under the mentorship of facility HIS managersCoding educator checks records of speciality and acts as mentorCoders have access to in house modulesThese coders will be complete by end of September 2011
6 Sustainability issues Coding workforce challenges to ensure that there is a sufficient and skilled workforce to meet the current and future external and internal reporting requirementsCoded data is routinely audited to ensure accuracy and optimal funding outcomes for the LHDs.Reduce significantly our reliance on contract coding staff - costAn increasing rate of separations now and into the future due to population increases, demographic changes and new models of careActivity Based fundingOngoing skills development and changing work practices, e.g. development of the electronic medical record, document imaging
7 Clinical Coding Workforce Model The coding workforce model aims to place the local health district in a position where it is able to retain and attract skilled clinical coders that will support a cohesive and well structured coding workforce. This will in turn enable the LHD to meet its coding reporting targets and support Activity Based Funding (ABF).
8 The Coder Workforce Project In January 2011 a Clinical Coding Workforce Project was established by IM&T and Workforce Services to review the current clinical coder workforce.Report was produced for both of the Local Health Districts and released to Chief Executives in May 2011.Team: Clinical Informatics Manager- sponsor, Former Area Health Information Manager, Manager, Workforce Redesign, Former Area Coding Quality Manager, former Area Coding Educator, Beaches HIS Manager, Gosford Deputy HIS Manager, Clinical Coder, Gosford, Clinical Coder, RNS
9 What the project reviewed Current LHD Clinical Coding WorkforceOrganisational context of each LHDExisting coder workforce education and qualificationsCurrent award ratesOrganisational context for both Local Health DistrictCurrent coder workforce profile and FTECoding management and Organisational structureCurrent trainee coder workforceContractorsBudgets – overtime/contractors
10 What the project reviewed Challenges affecting coder productivity and QualityNSW Health Coding deadlinesCoder educationCoder staff turnover issuesCareer progression opportunitiesStaff leaveTrainee or newly appointed coders- throughputPoor documentationAuditing requirementsCoder working environmentFlexible working hours
11 Recommendations CCLHD Increase the number of coding FTEs by 1.81 to meet the demand for quantity and qualityRecruit 2.0 FTE Auditor roles to support an ongoing auditing programImplement a new coding structure – Coding Manager, Coding Trainee, Senior Clinical coderImprove the salaries for coders – Administration 6 increase after 12 months of senior coding experienceImprove working conditions –working from home, flexible hours, reduce noisy environmentsEnhance continuing education opportunities for existing coders – funding two clinical coding staff per annum to undertake Intermediate or Advanced HIMAA Clinical Coding Courses
12 Recommendations CCLHD Promote the trainee program through the establishment of an additional trainee positions – 2 dedicated trainee positions be created. Recruited from the business and enrolled in a funded certificate beginner course with HIMAA or OTEN.* Two dedicated trainee positions are advertised for candidates interested in becoming clinical coders.* Appointed as Coding Trainees at Administration Officer Grade 3 for a 12 month period and are funded by CCLHD to undertake the Introduction to Clinical Coding education at HIMAA or OTEN.* During their traineeship they will be mentored by the coding team and coding manager* On successful completion of the HIMAA or OTEN course, the candidates will be regraded as Coders at an Administration Officer Grade 4 within their current positions (ie without having to sit another interview).* Recruitment to vacant positions would remain based upon the principles of Equal Employment Opportunity.
13 Recommendations NSLHD Increase the number of coding FTEs by 3.55 to meet the demand for quantity and qualityIncrease in Assembly Staff FTERecruit 2 FTE Coder Co-ordinatorsRecruit 3.47 FTE Auditor roles to support an ongoing auditing programImplement a new coding structure – Coding Manager, Coding Trainee, Senior Clinical coderFund coding pool – reduce reliance on contractorsImprove the salaries for coders – Administration 6 increase after 12 months of senior coding experience
14 Recommendations NSLHD Improve working conditions –working from home, flexible hours, reduce noisy environments- document imaging coming for RNS and RydeEnhance continuing education opportunities for existing coders – funding two clinical coding staff per annum to undertake Intermediate or Advanced HIMAA Clinical Coding CoursesPromote the trainee program through the establishment of an additional trainee positions – 3 dedicated trainee positions be created. Recruited from the business and enrolled in a funded certificate beginner course with HIMAA or OTEN.
15 Agreement in principle by Chief Executives Positive response from Hospital ExecutiveTo recruit additional coding FTE’s immediatelyReview and an enact other recommendations through transition process