Solving Professional Challenges: Three HI Leaders Share Success Stories
Health information (HI) professionals often face a scope of professional and organizational challenges over the course of their careers.
Weak data policies and understaffed teams are two of the top obstacles that can slow workflows and impact efficiency for HI teams. In a recent NORC-AHIMA workforce survey, for example, nearly half of respondents (48 percent) reported that understaffing at their organization has led to decreased reimbursement, slower claims processing, and increased claims denials.
Provider confusion about documentation requirements is another common dilemma that can stymie HI teams, says Bleu Garcia, CCS, CCS-P, medical records technician for the Defense Health Agency in Copperas Cove, TX.
“If I have to query providers about their documentation, the anatomy of a query is an hour,” Bleu says. “You have to wait for the provider response. Then they may have a rebuttal and it leads to a back-and-forth. Queries are so impactful to [HI professionals] and their productivity.”
Below, hear from Garcia and two more HI professionals who have confronted these professional challenges at their organizations and overcome them using unique strategies. They will share more about their interventions and experiences at the AHIMA24 conference Oct. 27-29 in Salt Lake City.
Strengthening Staff Through Internal Training
At the University of Texas MD Anderson Cancer Center in Houston, finding qualified coding candidates was once extremely difficult. Most applicants knew the basics of coding, but it wasn’t common for them to have experience in oncology medical coding, says Phyllis Mensah, MBA, RHIA, coding training manager in the revenue operations and coding department at MD Anderson.
In addition, coding employees who were hired didn’t stay at the organization for very long.
“When individuals came in as contract staff and we hired them, they felt overwhelmed by not having that oncology background,” Mensah says. “We recognized that in order for turnover to stop, we had to think a little bit differently in terms of how we're going to hire.”
In 2013, the organization started an employer-based clinical coding apprenticeship to help train and retain employees. Apprentices enter the program as fulltime employees and receive intensive, hands-on training in oncology medical coding. The program runs for a full year and once apprentices finish, many graduates stay on as coding professionals.
Since it began, the apprenticeship program has grown in popularity, and currently about 400 candidates apply every year for six positions, says Edith Ballard, MHA, MBA, MsHIM, RHIA, CCA, CPC, COC, CRCR, associate vice president of revenue operations and coding for MD Anderson.
“The team does a lot of work vetting and looking at applicants,” she says.
Candidates come from all over the state and beyond, some from other healthcare positions or following college graduation. MD Anderson Cancer Center also has a student internship program with local colleges and universities that helps filter potential candidates into the apprenticeship.
The program gives apprentices the opportunity to see the various roles they can work toward within the organization, Ballard says. Many have gone on to become supervisors, coordinators, trainers, managers, and directors within the institution.
Graduates of the program are more confident and understanding of their job roles and have more loyalty to the institution, Mensah adds. Since the apprenticeship started, coding staff turnover has greatly diminished.
“Our turnover is almost at zero,” she says. “They're dedicated, they're devoted, and they stay after gaining all this experience and knowledge.”
HI teams interested in starting an apprenticeship program at their organization should first design a project plan to present to stakeholders, says Ballard. Ensure you have strong team to lead the effort, she adds.
“When you present the plan, make sure to show them the return on investment, and how it could revamp your workforce,” she says. “And make sure you have individuals [who are] going to lead this program with the necessary skills to develop out the program.”
Hear more from Ballard and Mensah at AHIMA24 on October 28 at 8:30 a.m. MT.
Better Managing Data Lifecycle
As more health organizations digitize information and move to newer technologies, older data can sometimes get lost in the shuffle, says Erin Head, MBA, RHIA, CHDA, CCS, CHTS-TR, senior healthcare consultant for Iron Mountain in Titusville, FL.
“It’s great that organizations are implementing all this new technology, but there’s often a ton of data sitting out there, and organizations don’t know where it is, or what’s at risk,” she says.
When there’s no plan to manage and store older data, organizations can encounter excessive storage costs, lost productivity, and inefficient workflows. There’s also increased danger of security breaches, compliance issues, and costly fines.
That’s why it’s critical to have information governance (IG) policies in place, says Head. Information governance is defined as an organization-wide framework for managing information throughout its lifecycle and for supporting an organization’s strategy, operations, regulatory, legal, risk, and environmental requirements.
At Iron Mountain, Head consults with organizations of all sizes to help them access their workflows, identify risks, and develop comprehensive plans for information governance.
“Many don’t know where to start and struggle to see the bigger picture, making it essential to compare policies and best practices with other organizations to find the most effective approach for each unique situation,” Head says. “IG can be challenging when some stakeholders focus solely on costs, others are concerned with risks, some prioritize implementing technology, and others are unaware of the risks associated with not having a proper IG program in place.”
Clients come to Head from all different points in their IG journey. In one recent case, a health organization was rapidly expanding and acquiring new facilities. Each acquisition, however, brought along legacy information, applications, and outdated practices. Head helped the organization conduct an IG assessment and develop a roadmap to centralize and standardize its information management practices.
Many facilities within the organization had valuable patient care areas occupied by onsite stored information. The IG program enabled the organization to remove or digitize the information, freeing up space and enhancing operational efficiency, Head says. The group also successfully implemented a new retention policy.
In another case, a health organization experienced a cyberattack that led to staff being offline for an extended period and unable to use their electronic medical record. This created a significant backlog of documents waiting to be scanned.
An IG assessment revealed inefficiencies in the organization’s scanning process and other information management practices. Head helped staff develop an IG program that led to improved operational efficiency, reduced backlogs, and enhanced preparedness for any future cyberthreats, she says.
To develop a strong IG program, Head recommends involving key stakeholders department-wide from the start. It also helps to regularly review and update IG policies to adapt to new regulations and technologies.
“Design your IG program to be flexible and scalable for organizational growth and change,” she advises. “Partner with a trusted IG expert to gain an objective third-party perspective on your practices, benchmarking them against industry best practices to drive improvement and efficiency.”
Hear more from Head at AHIMA24 on October 29 at 12:45 p.m. MT.
Boosting Provider Education
Provider confusion about how to properly document care encounters can create a host of problems for HI teams.
“When there’s lack of provider education, there is information that is not getting captured,” says Bleu Garcia, CCS, CCS-P, medical records technician for the Defense Health Agency in Copperas Cove, TX. “If we’re not being proactive with education, the data and the patient’s record is going to suffer. It may be missing key information.”
Yet, educating providers about documentation requirements and new changes is not always easy, says Garcia. Coders may be unsure how to get providers to change old habits or find some providers intimidating to engage with, she says.
At the same time, providers don’t typically turn to HI professionals when they’re uncertain about documentation rules.
“They will not come to us, we have to go to them,” Garcia says. “It takes reaching out, and it’s always going to be the health information professional or the coder.”
Such challenges are what led to Garcia develop a novel provider education program at the Defense Health Agency. The program includes quarterly in-person meetings with providers and weekly coding tips, which Garcia calls: “Coding Tip of the Week.”
The emails share a snippet of information about a documentation rule or a reminder about a recurring documentation problem that coders are seeing. In quarterly meetings, Garcia shares more in-depth information with clinicians and listens to any concerns.
“One of the biggest advantages of being in-person is that when you’re speaking to them, their questions come to mind and they’ll ask,” she says. “Somebody will piggyback off one question and ask another. It opens up a conversation.”
Garcia also has an office in the clinic and has an open-door policy, where providers can visit anytime and ask documentation questions.
Since Garcia’s provider education strategies were put in place, her organization has seen improved provider documentation, less confusion, and overall stronger communication among providers and HI professionals, she says.
For HI professionals who want to strengthen provider education, a key piece of advice is to focus not only on what you’re saying, but how you’re saying it, Garcia says.
“Health information professionals have to work on their speech presentation and their presence when on-camera and in-person,” she says. “[When] doing provider education [in a virtual meeting], the energy can be lower. You have to bring up your energy level so that people can be more engaged. You can’t be too nervous or worried about what they’re going to say. You are the expert.”
When developing provider education protocols, Garcia also suggests HI teams have a clinician ally. Connecting with an amicable provider can help bring other providers to the table and open the lines of communication around documentation challenges.
“Having a provider to advocate for the coders is helpful,” she says. “Having them on your side helps spread positive energy among the other providers.”
Hear more from Garcia at AHIMA24 on October 28 at 2:30 p.m. MT.
Alicia Gallegos is a freelance healthcare journalist based in the Midwest.