By Dom Nicastro
The last month of the year can be a bit stressful. Closing out the books on the prior year. Making sure you leave time for all the holiday get-togethers. The traffic. The lines. The people.
It adds up.
If you’re an HIM director, it can be hectic in your healthcare facility, too. Not that it’s smooth sailing the first 11 months of the year.
Either way, you deserve a few treats yourself this holiday season. Make a few wishes, and who knows?
In fact, we gave an HIM director just that – the platform to make a few wishes this holiday season.
So, the floor is yours, Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CIC, director of Health Information Management and privacy officer at Granville Health System in Oxford, North Carolina. What do you wish for?
I wish contract companies would quit poaching my coders.
Most contract companies allow remote work. They pay more than small, county-owned facilities like Durling’s can afford, she says.
“Most coders soon find out it isn’t what they expected and the work isn’t always guaranteed, but by then their job has been filled,” Durling adds. “As a manager, I feel bad when I can’t let an employee come back. Some also limit the notification time they will allow staff to give, which can make them ineligible for rehire.”
I wish I could implement a full CDI program.
What are the struggles here for HIM directors? What gets in the way of realizing a full program, and what can HIM directors do in light of not being able to have a full program? First, you must decide where CDI fits into your organization’s tree. Does it come under HIM and its coders or does it come under the revenue cycle and work with the utilization review/case management team?
“If leaders can’t agree on this aspect then they can’t agree on how to champion for the position,” Durling says. “I think CFOs don’t understand the role and the benefit to the organization and thus won’t approve the necessary funding for an experienced CDI specialist. Since this role is new, I see a lot of leaders making due with coders or clinical staff minimally trained in coding, which means you may be missing some important skills.”
I wish the CMS website was more user friendly.
Use professional organization websites and references relative to what you are reviewing, Durling says. When CMS releases a new regulation that will impact family practice physicians, wait a few days or a week then check the American Academy of Family Physicians website.
“They get their experts to review the new rulings and regulations,” Durling says, “and then they boil it down in terms that their members can understand and apply to daily practice. This usually works for any specialty. I also find that state Medicaid websites and some [Medicare Administrative Contractor] sites have more user-friendly search features to find what you need than the CMS website.”
I wish my staff knew how hard I champion for them with administration.
A good leader needs to spend their time educating the C-suite on what their department does and how it impacts the organization and community. Durling takes this seriously.
“While we all know HIM is responsible for producing the claims that brings in the money we are widely considered a non-revenue producing department,” she says. “I’ve worked to find ways to be innovative to cut costs and actually bring in some revenue. By doing this, it keeps HIM in the eye of the administration, and they can see the importance we play in all aspects of the daily operations and how we can be a valued community partner.”
I wish payers reimbursed more realistically so our salaries could be more competitive.
Coder salaries are often not truly competitive, and managers can be underpaid–and even overpaid at times. Some get lucky. They avoid the day-to-day operational work because they have other managers under them for each service area they supervise, while others are underpaid if they must do everything because they don’t have the same supervisors or managers.
“This is because smaller hospitals still have the same work requirements, but no funding to support extra staff,” Durling says. “If payers paid more realistically, I think it would greatly impact compliance and hospital care.”
I wish Santa would come and work for me a day!
“Since Dad is usually Santa, I think in our environment Santa would be the CEO,” Durling says. “I would have him do just what I do every day: on a day of back-to-back meetings, juggle a staff member calling out sick, and some ‘crisis’ from another hospital area, all while dealing with staff drama or conflict.” HIM can be the “forgotten department that everyone knows exists, but no one could tell you exactly what we do,” she says.
I wish more hiring managers thought outside the box when it comes to hiring coders instead of just focusing on the credentials.
What should hospitals focus on when hiring coders? Work experience, skills, and personality are far more important than focusing just on the credentials.
“I also think that some managers think one credential is better than another, when in reality you are going to train them to do things the way you want them to do it, regardless of their credentials,” Durling says. “I have been around since before coding credentials even existed and sometimes we forget that good policies, procedures, and training can allow anyone with some aptitude and a willingness to learn to be a great coder.”
Oftentimes, you’ll see a coder who has a long list of credentials who can’t do the day-to-day job. What does that tell Durling? Maybe they are good at taking tests or memorizing material, but not good at applying the material.
“I just think too many managers take the easy way out and think the credentials alone can allow them to find a successful coder, or because they had luck in the past with one type of credential they will only hire those with that same credential, which severely limits their pool of candidates,” she says. “Step outside your comfort zone and you may find a whole world of great employees you never saw before.”
I wish we could offer more services to help our patients be better stewards of their personal health information and healthcare in general.
Durling says she’d like to work with her marketing department to educate their community on the importance of accurate health information and why it’s important to protect that information. She would like to help educate local providers that are not fully complaint with HIPAA learn to be compliant, so everyone can provide the same protections. She’d liked to help create a database of verified patients where patients who don’t have any picture ID can be easily verified so they have alternative methods to service their needs and protect their information.
I wish I could pay my coders what I know they deserve.
Durling says her staff members multitask, but they are not being compensated for all those other duties.
“We lose good staff members to larger hospitals just because of the higher pay,” she says. “The other problem is location. Because we are rural, we have a smaller local pool of qualified candidates, which means that jobs are harder to fill. We also don’t have the ability to offer remote coding because the high cost of [electronic health record] integration causes us remain a hybrid record system with a lot of paper chart elements.”
Smaller hospitals struggle with a smaller candidate pool, broader job duties hybrid systems, and lower salaries.
“This is why so many small rural hospitals are merging with larger facilities or corporate healthcare agencies,” Durling says, “but if we lose that community attachment, will it truly benefit the community in the end?”
I wish I could win the lottery and afford to revamp and update my department like I want.
“I would do a major remodel to our work area to make it more user friendly for the way we work today, as well as upgrade equipment to reflect our changing tasks,” Durling says. “I would spend the necessary money to back scan all our old records and integrate all our service areas so we could truly be a fully electronic medical record.”
“I would also use some funding to create a group to champion for smaller, rural hospitals at the government level,” Durling adds.
I wish the hospital staff and community realized just how much HIM really does for the hospital, the community, and patients.
Often board members, like the hospital staff in general, don’t know exactly what HIM does.
“I would like to speak to them at each new board installation to talk about what we do and how we serve the facility, providers, and the community,” Durling says. “I would also wish to be able to talk to them about significant changes such as things like ICD-10, HIPAA, or even issues that impact our department such as identity theft. I normally don’t get asked to present to them on these types of topics, but I believe they need to know what to expect and the impact it will/could have on our facility and our community in order to make appropriate decisions moving forward.”
Email your questions to editor Steven Andrews at firstname.lastname@example.org.