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Staffing Solutions that take you Beyond ICD-10
AAHIM Annual MeetingApril 24, 2015
Kayce Dover, MSHI, RHIAChloe Phillips, MHA, RHIA
How many feel like you’ve been on the ICD-10 roller coaster ride?
Benefits of ICD-10
• Improve clinical decision making and outcomes research
• Patient Safety• Population Health• Accuracy of Claims
What’s the big deal?• Complex changes
– Biggest change in health care since implementation of DRGs in early 80’s
– Not a simple update of ICD-9• Impacts everyone
– Clinical, Technical and Administrative staff• Resource intensive & costly without proper
planning
ICD-10: How will it impact your staffing?
AGENDA
• ICD-10 potential impact HIM staffing• Training, Productivity, Resources
• Staffing solutions before, during & after transition • A different approach to staffing: Baptist Health
System• Questions/Answers
Getting Staff ReadyEstimate of hours for ICD-10 education & training
50-480
Getting Staff ReadyAdditional training & practice prior to 10/1/2015
70%
Getting Staff ReadyHours a week for training
3-5
2014 AHIMA/eHealth Initiative•Planned to continue with dual coding47%•Improve document integrity62%•Train more staff on ICD-1059%•Conduct more testing39%
AAPC, AHIMA and CMS all say that when it comes to in-depth training, timing is
everything!
3-5 hours a week for training creates staffing challenges now.
What will the overall impact be on coding productivity?
Not a Simple ChangeThe sheer increase in the # of codes will have an impact on productivity
155,000 codes
Diagnosis Code Comparison
Procedure Code Comparison
Physician QueriesIncrease in queries
30%
increase in time spent on documentation
4%
Projected decrease in productivity
•Humber River Regional Hospital in Ontario, Canada50%•AHIMA ICD-10 Field Testing Project53%•HIMSS/WEDI ICD-10 National Pilot Program50%
Manage ExpectationsMonth learning curve
6-10
Setting New Productivity StandardsEstimate of productivity loss that may never be recouped
10-30%
How can you minimize potential negative impact?
9-1-1
2014 eHI & AHIMA Survey
•Hire more coders•2014 eHI & AHIMA Survey31%•Using Computer Assisted Coding or similar tools29%•Contract with outsourced coding companies28%
PLANNING IS CRITICAL
Education & Training
New Systems Training
New Coder Onboarding
Coding Partners
Avoid Backlogs
Retention
Are you Ready?
Staffing Solutions• Enhance recruiting efforts
– Internally– Recruitment partner
• Establish coding partnerships– Outsource– Onsite/Remote– Off-shore
• Outsourcing – Training, Auditing, etc.
• Consider training other healthcare or HIM professionals
• Think outside the box
Planning is Key!!
• Preparing for ICD-10:• Service Line Consolidation• Resource Planning & Staffing• Post Graduate Program
Consolidate Service Lines
Sample Productivity ImpactBaptist Health System, AL
ICD-10 Budget Additions 2015
• Four (4) additional positions– 2 IP and 2 additional Post Graduate positions (7/1/15)
• ICD-10 Capital Labor - $4,350• ICD-10 Retention Bonus - $35,000• Contract Assistance - $20,000• Consulting - $52,000• Additional Physician/Coder training - $17,230
Prioritize Coder /CDI/MD Training
Practice Makes Perfect
• Education & Training
• Keep dual coding
• Payer testing
• Shadow charting (CDI, coder and MD collaboration)
Prepare for Go Live
• Eliminate coding backlogs
• All coders onsite for first 2 weeks
• Mandatory “overtime” first 60 days
• Address recruitment challenges
Post Graduate Program• How are we going address ICD-10 staffing
challenges?
• Train, mentor and hire new graduates– Launched in January 2014
– Two year commitment
– Seven graduates trained on ICD-9 & ICD-10
– One wage level below a Level 1 coder
Post Graduate Program
• Detailed training plan
• Each coder assigned a mentor
• Regular meetings with post grads
• All onsite during training
Post Graduate Program
• All started on OPDs and ERs• Must achieve 96% or above, for 3 consecutive
weeks, before being moved off 100% review• Moved next to Inpatient and Outpatient for
more specific training
Post Graduate Program• Inpatient Training:
– Started on PSY, Cath (IP & OP), OB/GYN • Progression time:
– 12-15 weeks on PSY– 11-13 weeks on Cath– 10-13 weeks on OB/GYN
• IP Cardiology and Orthopedics• General Surgery and Medicine
Post Graduate Program• Outpatient Training:
– Simple surgeries (GIs, Cataracts, Pain Blocks, etc.)• Progression time:
– 7-8 weeks on simple surgeries– 8-13 weeks on intermediate surgeries
• Complex surgeries (Ortho, Cath, Cardiology)• OBV coding, charging, infusion/injection next
Post Graduate Program
• Training coders that code both Inpatient and Outpatient
• If a permanent position becomes available, post graduates can apply before or after the 2 year commitment.
Post Graduate Program• Current post graduates
are progressing • Building loyalty, specific
facility training • New graduates are
eager to learn and many want to code
• Project savings of $593k over 2014 and 2015
Think Outside the Box• Hospitals are finding success with these programs• AHIMA apprenticeship opportunities• HIM Connections Survey:
– 52.38% of hospitals surveyed by HIM Connections indicate they have implemented, or considered an apprenticeship program for entry level candidates.
• Provides staffing resources beyond ICD-10• Planning is key to being prepared!
Journal of AHIMA
• Article: A Foot in the Door
• Journal of AHIMA, January 2015
• Kayce Dover, MSHI, RHIA and Chloe Phillips, MHA, RHIA
Questions/Comments
THANK YOU!
Kayce Dover, MSHI, RHIAPresident & CEO, HIM Connections
Chloe Phillips, MHA, RHIACorporate Director of HIM & Clinical Revenue, Baptist Health System
