1. Jane Dimond Vicki Nicolaou SLHD 2nd September 2011
Coding Counts
Jane Dimond
Vicki Nicolaou
SLHD
2nd September 2011

2. BACKGROUND 2007/8 Casemix pressure reignited
SSWAHS – Identified and supported need for increased Clinical Coding workforce

3. INITIATIVES Clinical Coder Trainee Program – Three to-date
Standardised SSWAHS Coding Auditing Program
SSWAHS Documentation Guidelines published on the intranet
Clinician Buy-In

4. CLINICAL CODER TRAINEE PROGRAM
Three programs run to-date
PROGRAM 1
Advertised internally – no experience necessary
PROGRAM 2
Advertised internally only – working towards qualifications
PROGRAM 3
Advertised internally and externally – working towards qualifications
Program 1 – offered 1 year secondment, grade 3 & to pay for the course & books – great deal of interest – 10 staff commenced – all finished training.
Program 2 – only received 6 applicants – 2 staff commenced – both employed within the LHD
Program 3 – great deal of interest – interviewed 15 for two positions – commence soon

5. PROS AND CONS +VE Increased workforce
Familiarisation to our practical coding
Networking (trainers and trainees)
Trainees able to fill vacant positions
-VE
Loss of investment – trainees moved on
Cost / Time - course / trainer’s time / non-productive time
The right fit – What makes a good coder???
Different learning styles – formal program didn’t fit
Individual vs Group training
No Area Trainer
Other Cons – where space, desks, computers

6. CODING AUDITING PROGRAM
Standardised program across all SSWAHS Facilities
Designed to fit all facilities
Weekly / Monthly / Quarterly / Bi-Annual
Types of Audits
Individual Clinical Coder Audit
Random 5% of one months discharges
Error DRGs
Adjacent DRGs
Outliers
Coder Education
Clinicians presenting to coders
Coders watching procedures
Internet Access for self teaching

7. PROS AND CONS +VE Benchmarking across facilities
Identification of training needs
Identification of documentation issues
Development of Documentation guidelines (specialty cheat sheets in some facilities)
Correction of errors – hopefully for gains in funding
Coders Self Checking - mandatory highlighting of patient’s LOS against ALOS/DRG
-VE
Time restraints
Staffing restraints
Internet access

8. DOCUMENTATION GUIDELINES
Published documentation per specialty on the intranet
Endorsed by SSWAHS Executive
Memo to GMs from CEO
Copies in JMOs offices on wards,
Laminated copy for bedside
Sent to Clinical Training Schools / Facility
The Good Clinical Dcoumentation Guide was our reference tool
Laminated re-useable copy was on each bedside for doctors to refer to however this is a problem for outlier patients and resources to produce – volunteers used at Concord for laminating.

9. PROS AND CONS +VE Standardised information across SSWAHS
Education by Specialty
Accessibility via intranet
-VE
“Not one shoe fits all”
“Cheat Sheets” or tick a diagnosis/procedure – not always documented in the record as well as the cheat sheet – therefore can’t code = waste of time

10. CLINICIAN BUY-IN Revved up education in past few years
Heads of Department meetings
Ward Rounds
JMO Orientation
Specialty meetings (Adopt a HIM or Adopt a Clinician)
Individual Clinician
Patient Flow
Casemix reports

11. PROS AND CONS +VE Education for Clinicians at all levels
Education by Specialty
Lifts the HIM’s and Coder’s profile
-VE
Jaded Senior Clinicians
Availability of HIM to educate
Time consuming
Lack of Casemix HIM specialists
Coders – under the spotlight

12. MOVING FORWARD Surgical Targets Introduction of Local Health Districts
Workforce issues
Education
Maintaining HIM profile
Driving Efficiency and Change