Articles:  July-August 2007

Barbara Flynn, RHIA, CCS

Help Wanted

Sharon Rosin, Director of Career Services, Herzing College
 

Fact! Not Fiction! MS-DRGS has not been postponed!
by:  Barbara Flynn, RHIA, CCS
FHIMA Chief Delegate

Top

Help Wanted 
by:  Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
       Sharon Rosin, Director of Career Services, Herzing College

There is a shortage of trained, experienced health information management professionals. You probably already know this. The ads are plentiful, all beginning with the requirement of experience. But, what do you, as an employer, really need to get from this previous experience? What specifically does the experienced candidate have that a recent college graduate does not have? Let’s evaluate the requirements for the job.

Extensive knowledge of ICD-9 and/or CPT: Recent coding graduates all possess an up-to-date working knowledge of diagnosis and procedure coding (inpatient and outpatient) and know about CCI/OCE edits. How do you know they know? The same way that you know your other candidates have this knowledge – they are nationally certified. Recent graduates’ certifications are fresh, based on this year’s official guidelines and rules, so they do not require additional education to bring them up to date. They learned it this way.

Knowledge of DRGs, APCs: Do you know if your candidates are up-to-speed on APR-DRGs, MS-DRGs or SOI sub-classifications? Recent graduates have not only sat through a seminar on the topic (like more experienced candidates), these individuals took a test on the subject and worked with them in a protected environment which included feedback so they could learn how to do it correctly.

Abstracting and querying properly: Recent graduates have learned to code the correct way, by abstracting notes and querying the physician, as well as understanding data from superbill/encounter forms. Recent graduates have been graded on their ability to work from actual patient records (redacted) with immediate feedback so they can learn to increase their accuracy by learning from their mistakes.

Knowledge of PQRI, Pay for performance, etc.: Recent graduates have the latest reimbursement rules and methodologies built into the curriculum.  They have had more than a few CEUs this past year, they have spent weeks and months focused on understanding the most current aspects of coding and reimbursement, as well as statistical documentation.

Quality educational input: How can you know what goes on in a classroom? How can you be confident that these recent graduates are really being taught the correct way? It’s all in the accreditation. Look for graduates from an AHIMA-approved coding program sponsored by a regionally-accredited school of higher-education. The American Health Information Management Association (AHIMA) thoroughly scrutinizes the curriculum, as well as individual course contents, before approving an educational program. One step of additional proof lies with those graduates who are nationally certified (AHIMA and/or AAPC). These organizations have set the standards for the minimum knowledge required. Those that pass become certified to have this ability, regardless of how long they have been practicing.

They know what others have forgotten: You know that old saying, “I have forgotten more than you know”.  When it comes to coding, you need to have fresh knowledge, at the forefront of the staff member’s mind. It doesn’t matter that something used to be coded one way two years ago, now is now, and your claims and statistics must follow the rules of today. Recent graduates know what others have forgotten as well as what others haven’t learned yet.

E-everything: Almost all of the ads require candidates to have computer software knowledge. Electronic health records, patient accounting software, encoder, and more.  Software is a hands—on skill that must be practiced. Recent grads have this knowledge and it is active knowledge, preparing them to be ready to get to work with minimal training on your specific system.

Attitude is a lot: You do not have to worry about burn-out from a recent graduate because they are raring to get started in their new careers. There are no bad habits that must be worked through, and they are eager to do things right. This means they are very focused and pay attention to details (something everyone wants in a coder).

Reasonably priced: For a limited time only, these recent graduates are priced to get their feet in the door, rather than looking for a bump-up from their last position. Therefore, you can try these potential employees and wait until they prove their abilities before paying that higher wage. And, many schools have internship/externship programs. These give you the great opportunity to try out your new employees for FREE! No human resources paperwork until you know you want to keep them. No horrible scenes when you have to let them go if this individual doesn’t work out. Interns do need a little extra supervision, but you would supervise a new staff member anyway plus have to pay them!

Experienced coders already know how to do the job: All new staff members will have a learning curve, however, recent graduates will not have old habits from the way things were done at their last facility slow the absorption of your organization’s systems. Recent graduates tend to have a shorter learning curve when they come into a facility because they already are in learning mode. You can train and mold these new employees much faster to do things your way and sometimes, have them functional much faster.

Need some proof? The National Association of Colleges and Employers  (NACE) completed a survey compiled in their “NACE Research: Job Outlook 2007”.

Benefits of hiring new college graduates, by percent of respondents

New college graduates are enthusiastic and motivated.     90.5%

Give us the opportunity to mold future leaders of our organization.   86.4%

New college graduates provide fresh ideas.   77.9%

New college graduates have cutting edge skills.   55.3%

It is easier to identify a diverse applicant pool at the college level.  34.2%

New college graduates will accept lower salaries than college graduates who have several years of work experience.      24.1%

It is easier to fill positions because students are centrally located.  15.1%

Source: www.naceweb.org

Health information management is a relatively new profession. The need for additional professionals is growing at a much faster rate than we can educate the coders and HIM managers of the future. There is great relief for your overload and productivity by helping the newest generation of coders into your workforce.  Extend your hand and bridge the gap from the college classroom to the future of the health information management workforce.
 

Top

Critical Issues Facing the HIM Profession Today:
One Student's Perspective
By: Anquanette Crosby, Senior Health Information Management Student

Health information management (HIM) encompasses the business aspects of health services and the information systems used to plan, finance, and evaluate patient care. The profession focuses on management principles, information systems, finance, legal and ethical issues, quality improvement, clinical data management, and the skills necessary to manage people and systems. The HIM professional works closely with physicians, nurses, researchers, administrators, and others involved in the delivery of healthcare. Health Information professionals are challenged in a number of ways to perform their duties without breaching the integrity and confidentiality of the patient whose medical information they must protect.  In my opinion, the three most critical issues HIM professionals face on a daily basis include ethical decision making, workforce deficiencies, and technological barriers.

Ethical decision making is required when the healthcare professionals must balance the needs and interests of the individual, the organization, and society. Those involved in this decision making process must consider ethical principles such as justice, autonomy, beneficence, and fairness. Many factors have contributed to the growing concern in healthcare organizations with ethical issues, including pressure to reduce costs, mergers and acquisitions, financial and other resource constraints, and advances in medical technology that complicate decision-making near the end of life. Healthcare professionals have a responsibility to address the growing number of complex ethical dilemmas they are facing, but they cannot and should not make such decisions alone or without a sound decision-making framework. Healthcare organizations should have vehicles, such as ethics committees, conflict-of-interest statements, written policies and procedures, and/or a staff ethicist, to assist healthcare executives with the decision-making process. With these organizational mechanisms, the sometimes conflicting interests of patients, families, caregivers, the organization, payors, and the community can be appropriately weighed and balanced.

The second issue is the scarcity of health information professionals.  With high-profile media coverage of security breaches and publicity related to implementation of the Health Insurance Portability and Accountability Act (HIPAA) privacy regulation, the pressing issue of properly managing and protecting health information has steadily increased the demand for health information management professionals. However, the health information management profession, like nursing and other healthcare professions, is facing a workforce shortage. The U.S. Bureau of Labor Statistics projects the need for about 97,000 new health information management workers through 2010 to fill new jobs due to industry growth—making it one of 10 fastest-growing health occupations. The high number of available jobs means immediate opportunities for recent graduates, strong prospects for long-term career advancement, and higher than average industry salaries. Health information management offers a high degree of diverse career opportunities, job satisfaction, and security. The field offers nearly 40 different work settings and more than 200 unique job titles. Diverse responsibilities include collecting, organizing, codifying, analyzing, and protecting access to information critical to effective and efficient healthcare delivery.

The third critical issue is the technological advances within HIM.  In years to come, the paper hospital record will be viewed as a historical curiosity. Electronic health information technology is transforming the delivery of health care in the United States. In 2004, President George W. Bush, called for an electronic health record for most Americans by 2014. With electronic health records (EHRs), clinicians' notes may be entered in text or standard formats, fostering more complete documentation; radiology images may be captured from computerized picture archiving systems and wave forms and computerized prescribed order-entry systems allow physicians to order laboratory, pharmacy and radiology services electronically, thus reducing the time for delivery of medical services and improving communication among providers. But reports of adverse events associated with the use of EHRs are coming to light as hospitals increasingly adopt electronic information technology system applications. For example, a pediatric health care facility reported an increase in mortality among critically ill children after the installation of a commercially available computerized prescribed order-entry system reportedly required physicians and nurses to use time previously spent at patients' bedsides in front of computer screens. Hospitals will likely adopt policies and procedures that are feasible and compatible with EHR system functionalities and address areas of potential risk.

Top

PHR Resolution... Your Comments Needed!
by: Stacie Buck, RHIA, CCS-P, LHRM, RCC
      FHIMA President

Members of FHIMA, in the very near future the delegates for FHIMA will be asked to vote on the Proposed PHR Resolution below. Please read the resolution and share your thoughts on the Florida CoP. You can also join the discussion on the State Leaders CoP which is open to ALL members, not just delegates and leaders. There you will find additional background information on this important resolution.

Thank you in advance for your thoughtful feedback.

Proposed Resolution on HIM adoption of the Personal Health Record
Submitted by Missouri CSA.  Endorsed by the AHIMA Board of Directors and the PHR Practice Council

Intent:
This resolution is intended to charge Health Information Management (HIM) professionals with the responsibility of creating and maintaining their own personal health record (PHR). HIM professionals are ideally suited through their education and professional capabilities to inform consumers and healthcare providers about the benefits of the PHR. They are leading the way and serving as role models in this effort.

The American Health Information Management Association (AHIMA) through its PHR workgroup developed a definition of a PHR in March, 2005.

“ ..an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from healthcare providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR is separate from and does not replace the legal record of any provider.”

Personal health information is a valuable resource to individuals, their families, and the doctors, nurses, and other healthcare professionals who provide treatment and care. For example, in case of an emergency, having knowledge about a patient’s allergies, medications or pre-existing conditions can save a life. Yet, even as advances are being made in development of electronic medical records systems, it is still almost universally the case that a complete record of any individual's personal health information cannot be found in any single location or consistent format. The various elements of any one person's health information are likely scattered across several healthcare providers, possibly in different cities, states, or even countries and are kept currently in various combinations of paper-based and electronic record-keeping formats.

This reality means that individuals need to recognize that they are the most effective source of their own complete medical history and that by managing their own health information they can help improve the quality of care they receive.

AHIMA Consumer Education Campaign launched in March, 2005, is a public service initiative that draws upon the unique expertise of AHIMA and its 51,000 members. This campaign has allowed Health Information Management (HIM) professionals to share their knowledge of health information and medical records directly with the public—at the community level—in order to help them better understand how to access, manage, and protect their personal health information.

Objectives of the campaign:
• To increase public awareness and understanding of the issues surrounding personal health information and health records.

• To provide individuals with the information they need to better manage their personal health information and to encourage them to maintain a personal health record (PHR) in order to help improve the quality of care they receive.

• To create greater public awareness of the HIM profession and the important role HIM professionals play in effective management of personal health information needed to deliver quality healthcare to the public

From the Community Education Campaign materials…..

Preamble:

Whereas, HIM professionals, through their education and professional capacity, have a unique perspective on the concept of the PHR

Whereas, HIM professionals have a long tradition of patient advocacy

Whereas, AHIMA currently has a Consumer Education Campaign in progress with most component state association’s involvement

Whereas, HIM professionals are role models for proper documentation by their actions and their knowledge.

Whereas, a communication tool for consumers, the PHR offers the ability to interact and individualize decision support and problem solving with the care provider for the best optimal outcome.

Whereas, the PHR empowers consumers to take an active role in their own healthcare

Whereas, access to past and current patient health information is necessary to provide care

Whereas, documenting life time health status and risk assessments enhances the decision making process

Whereas, the PHR allows for the consumer to actively contribute to the coordination of multiple providers

Therefore, let it be:

Resolved, that all HIM professionals are charged with the responsibility of creating their own PHR in the format of their choosing and to the level of complexity with which they are most comfortable, but containing all of the elements outlined in the AHIMA/AMIA joint position statement for consumers of healthcare.

Resolved, that all HIM professionals are charged with the responsibility of ensuring all pertinent information from each healthcare encounter is properly documented and maintained in their PHR.

Resolved, that all HIM professionals are charged with the responsibility of remaining informed and knowledgeable about the current trends and continuous development of the PHR concept.

Note:  FHIMA can join the Florida Geographic Community of Practice (CoP) by going to www.ahima.org.  At the AHIMA home page, look for the My AHIMA log-in box and enter your AHIMA ID number and password.  At the next screen, Click on Communities of Practice, then click on the Passport icon to "Join/Visit Communities."  Click on the "G" for Geographic and find Geographic: Florida (Community for the State of Florida).  Click on the square to the right to join!
 

Top

Diversity Resolution... Your Comments Needed!
by: Stacie Buck, RHIA, CCS-P, LHRM, RCC
      FHIMA President

Members of FHIMA, in the very near future the delegates for FHIMA will be asked to vote on the Proposed Diversity Resolution below. Please read the resolution and share your thoughts on the Florida CoP. You can also join the discussion on the State Leaders CoP which is open to ALL members, not just delegates and leaders. There you will find additional background information on this important resolution. Thank you in advance for your thoughtful feedback.


Proposed Resolution on Diversity
Submitted by Diversity CoP members: Dwayne M. Lewis, RHIT, CCS , Vera Rulon, RHIT, CCS and  Stacie L. Buck, RHIA, CCS-P, LHRM, RCC

Supported by the Board of Directors

Intent:

This resolution is intended to advance AHIMA’s commitment to a culture that respects diversity throughout its organization, the federation and the HIM profession at large. To achieve this end, this resolution calls upon AHIMA and its affiliates to:

• Adopt meaningful, actionable and durable diversity practices to expand the real opportunities available to all HIM professionals, including opportunities to fully participate in AHIMA.

• Engage the AHIMA community in advancing the goals of enhanced professional opportunities for all and improved value of the membership experience.

• Respect the individual sensibilities, personal beliefs, differences, and privacy and other rights of all HIM professionals and AHIMA members.

• Monitor the impact of these practices to improve and strengthen them over time.

Preamble:

Whereas, human diversity can be defined as differences in race, ethnicity, nationality, gender, sexual orientation, socio-economic status, age, physical capabilities, and religious beliefs;

Whereas, all humans are possessed with unique, rich cultural histories, backgrounds and personal experiences deserving of universal respect and acceptance;

Whereas, the July 2006 AHIMA Volunteer Diversity Analysis demonstrates that as an organization AHIMA is less diverse than the US population even as the student population promises future diversity in AHIMA membership;

Whereas, it is believed that greater diversity enriches and adds value to AHIMA membership, the HIM practice experience, and the innovation and creativity of AHIMA;

Whereas, the AHIMA Code of Ethics clearly states that the “inherent dignity and worth of every person” should be respected.

Therefore, let it be:

Resolved, That AHIMA’s Board of Directors will design and implement a standing Diversity Management Program that enables participation by national and state leaders of AHIMA and its membership.

Resolved, That the AHIMA Diversity Management Program will serve as an effective means for expanding professional opportunities for all and volunteer leadership opportunities in the AHIMA and its affiliated organizations.

Resolved, That Component State Associations affiliated with AHIMA should be encouraged to adapt and implement AHIMA’s Diversity Management Program practices to better serve their members.

Resolved, That AHIMA’s Foundation of Research and Education should seek funding to expand scholarship opportunities for students with characteristics currently underrepresented in the HIM profession and the faculty that teach them.
 

Top