This monthly blog highlights and discuss emerging trends and challenges related to healthcare data and its ever changing life cycle.
By Matt Monk
If you are a fan of the classic TV show I Love Lucy, you probably remember the time she was arrested in Paris for unknowingly using counterfeit money. The major problem was a language barrier between Lucy and the police officer. In order to solve her problem, they had to use three different translators to tell Lucy how she can get free. You can view the scene at the following link: https://youtu.be/V1xMDn-Btkk.
This scene illustrates the complexity of a typical hospital. Any hospital wants to give quality care while utilizing their limited resources to the best of their ability. But everyone seems to speak different languages. There is the clinical language of taking care of the patient. There is quality control and compliance, which makes sure care is performed safely and in the right way. There is IT to make sure all information is available to care for the patient. And there is the business office to make sure revenue is funneled into the hospital in a timely fashion. How can all of these diverse areas of a hospital or healthcare organization come together to achieve a common purpose? The answer is in the data provided by coding. Consider the following scenarios:
- The chief financial officer studies the hospital’s case mix index and asks if there is any way that this can be higher in order to secure additional reimbursement for the hospital.
- A performance improvement analyst receives the latest patient safety indicators from the Centers for Medicare and Medicaid Services (CMS) and wants to evaluate how their hospital is doing in providing quality care.
- An infection control specialist notices a potential trend of people being infected with Coli and wants to evaluate how many people are being treated for this bacteria.
- The JCAHO Committee is preparing for a visit from the Joint Commission and wants to prove that physicians are performing procedures they are credentialed to perform.
- A CEO is considering opening a wound care center and wants to find out how many patients are being treated for wounds in their facility to justify this new service.
- An urban hospital notices that most Medicaid patients that come to the ER are coming Monday through Friday between 8 a.m. and 5 p.m. when physician offices are open. They want to know why most patients are coming to their facility in those times.
- A cardiothoracic surgeon has been approved for a clinical trial for a new heart valve and wants to make sure the facility is properly reimbursed for the procedure.
- The daughter of an elderly patient contacts the business office of the hospital to determine why Medicare is not covering the test the physician ordered.
In each of these scenarios, the answers can be found within the data provided by coding. Typically, the coders of a facility or healthcare organization are rarely seen. A typical coder will spend at least eight hours in front of a computer in a remote area of a facility, or even several miles or states from the facility (made possible with the aid of technology). This can cause a coder to seem disengaged from the facility they are working with, and it may cause other departments to misunderstand the role and importance of the coders who work for their facility.
Because of this, it is imperative that a coder feels engaged with the facility where they work. The best way to do this is through advocacy. A good definition of the word “advocacy” is “to provide support.” Here are four ways that a coder can be an advocate:
1. Be an advocate for the facility
The coders are the storytellers of a healthcare organization. Their ability to translate clinical data into information that can be utilized by different areas of an organization can support the facility with the endeavor of showing other entities the quality care provided by the organization. The accuracy of the story that coders tell can support future operations of the organization and give the community peace of mind that the organization is providing quality care.
2. Be an advocate for other departments within that facility
Because of value-based purchasing and the increased use of the internet to publish data on the care provided by healthcare organizations, many different facilities are looking at the information provided by the coding department. However, most people in other departments do not understand how this data is derived or the guidelines that are used by coders to code a record. A coder can utilize their skill sets in educating other departments on how coding information is developed by responding quickly and efficiently to inquiries from other departments and maintaining up-to-date knowledge of coding guidelines in order to explain and support the data that coders provide.
3. Be an advocate for the patient
It may seem odd that a coder can be an advocate of the patient since they have no interaction with patients and their role mostly takes place after a patient leaves a facility. But what if the person who is coding a record places themselves within the shoes of that patient? A typical hospital visit is a stressful, sometimes life-altering event. The focus for the patient needs to be on getting better and recuperating after their visit to the facility. If a coder does not do their job correctly, it may mean that a patient receives a bill they did not expect, causing more stress to an already vulnerable patient. A coder may not administer treatments or determine diagnoses, but their job can go a long way in providing peace of mind for the patient.
4. Be an advocate of yourself
The typical college training for a coder can be done within one to two years. However, that does not mean that a coding professional becomes an expert within that time. When a new coding professional begins their career in a facility, it can take up to additional one to two years to become an expert in the computer systems used by that facility for their jobs and in coding the records of that facility. Because of the continuing education requirements of coding certifications and because healthcare is always changing, the training of a coder is never done. A coding professional can become an advocate for themselves by embracing the training required for their certification, in becoming more knowledgeable of diseases and treatments, and taking advantage of opportunities to be an advocate for the organization, its various departments, and the patients they serve.
Matt Monk (Matt.Monk@BHSALA.COM) is internal coding auditor at Brookwood Baptist Health.