Transcript NSW Health Coding Workforce - New Strategy

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 Districts
September, 2011
Acknowledgments
 Nicole Stanzer – District Health Information Manager
 Belinda Saad – District Coder Educator
 Lizz Kopecny – former Area Quality Coding Manager
 All the Coders and Managers of Health Information
Services in the former NSCCAHS
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 coders
 A decreasing clinical coder workforce due to natural attrition and the
low profile of clinical coding in the job market
 Hoop jumping with NSW Health to have coder roles deemed “front
line” and advertised externally – seek and HIMMA website
 Insufficient coding FTEs to meet NSW Health coding deadlines,
looming ABF requirements, maintain a data quality program and
provide leave coverage
 No funded trainee positions
 Heavy reliance on expensive contract coders
Existing Strategies
 Introduction of Area Coding
 Permanent add for coders on
Educators (2) and Area Coding
HIMAA website and automatic
Manager
adds to seek.com
 Through additional hospital
funding increased our
recurrent coding workforce by
7.0 FTE across the districts
 Establishment of a NSLHD
Casual Coding pool – 3 staff
that work weekends – 3 more
staff being interviewed
 Negotiated with NSW Health
for coder roles to be
considered front line
 Establishment of the Clinical
Coder Traineeship Program
 As 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.
 Contract coders still in use
 Overtime always available
Existing Strategies continued
 As sites meet NSW Health
target coders moved to assist
other sites
 Records coded by staff and
contract coders at alternate
sites
 Removal of any non coding
related tasks from coders Regrade of Administration
level 4 Coding staff to
Administration level 5 using
appropriate tool
 Significant work undertaken
with Workforce Metropolitan
Careers Staff
 Participated in a school job fair
at Gosford advertising coding
as a profession
 Inclusion of Clinical Coding on
the NSW Health HealthWise
DVD which aims to promote
jobs in the health industry to
potential recruits
Coder Traineeship Program
Traditional
 4 Coders continue to complete
specialities under the
mentorship of facility HIS
managers
 Coding educator checks records
of speciality and acts as mentor
 Coders have access to in house
modules
 These coders will be complete
by end of September 2011
New Block Method
 Material delivered as modules
 3 funded trainee Coders come
to IM&T at Macquarie Hospital
every 2 weeks for a 4 hour
session with coding educator
 Trainee coders have an
experienced coder onsite
“buddy”
 Development of a large amount
of teaching materials for the inhouse trainee program
 Off week is a review week
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
requirements
 An increasing rate of
separations now and into the
future due to population
increases, demographic
changes and new models of
care
 Coded data is routinely audited
to ensure accuracy and
optimal funding outcomes for
the LHDs.
 Activity Based funding
 Reduce significantly our
reliance on contract coding
staff - cost
 Ongoing skills development
and changing work practices,
e.g. development of the
electronic medical record,
document imaging
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).
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
What the project reviewed
 Current LHD Clinical Coding Workforce
1.
Organisational context of each LHD
2.
Existing coder workforce education and qualifications
3.
Current award rates
4.
Organisational context for both Local Health District
5.
Current coder workforce profile and FTE
6.
Coding management and Organisational structure
7.
Current trainee coder workforce
8.
Contractors
9.
Budgets – overtime/contractors
What the project reviewed
 Challenges affecting coder productivity and Quality
1.
NSW Health Coding deadlines
2.
Coder education
3.
Coder staff turnover issues
4.
Career progression opportunities
5.
Staff leave
6.
Trainee or newly appointed coders- throughput
7.
Poor documentation
8.
Auditing requirements
9.
Coder working environment
10. Flexible working hours
Recommendations CCLHD
1. Increase the number of coding FTEs by 1.81 to meet the demand for quantity
and quality
2. Recruit 2.0 FTE Auditor roles to support an ongoing auditing program
3. Implement a new coding structure – Coding Manager, Coding Trainee, Senior
Clinical coder
4. Improve the salaries for coders – Administration 6 increase after 12 months of
senior coding experience
5. Improve working conditions –working from home, flexible hours, reduce noisy
environments
6. Enhance continuing education opportunities for existing coders – funding two
clinical coding staff per annum to undertake Intermediate or Advanced HIMAA
Clinical Coding Courses
Recommendations CCLHD
7. 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.
Recommendations NSLHD
1. Increase the number of coding FTEs by 3.55 to meet the demand for
quantity and quality
2. Increase in Assembly Staff 7.10 FTE
3. Recruit 2 FTE Coder Co-ordinators
4. Recruit 3.47 FTE Auditor roles to support an ongoing auditing
program
5. Implement a new coding structure – Coding Manager, Coding
Trainee, Senior Clinical coder
6. Fund coding pool – reduce reliance on contractors
7. Improve the salaries for coders – Administration 6 increase after 12
months of senior coding experience
Recommendations NSLHD
8. Improve working conditions –working from home, flexible hours,
reduce noisy environments- document imaging coming for RNS and
Ryde
9. Enhance continuing education opportunities for existing coders –
funding two clinical coding staff per annum to undertake Intermediate
or Advanced HIMAA Clinical Coding Courses
10. Promote 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.
Agreement in principle by Chief
Executives
 Positive response from
Hospital Executive
 To recruit additional
coding FTE’s
immediately
 Review and an enact
other
recommendations
through transition
process
Thankyou
Wendy Loomes
[email protected]
Nicole Stanzer
[email protected]