The Mental Wellness of HI Professionals

Discussions about mental wellness in the healthcare workplace have increased over the past two years, with the pandemic both elevating the intensity of the conversation and highlighting the need for further consideration. How the pandemic and other challenges have affected the mental well-being of revenue cycle professionals—especially those in the middle segment of the population—however, hasn’t been discussed as widely.

Doctors, nurses, and other clinicians provide the most arduous portion of the patient’s care: direct, face-to-face care. But there is another side to this coin: the non-direct patient care side. Many coding professionals, auditors, ROI staff, and other health information (HI) professionals are equally passionate about the side of patient care they impact. Many of us understand that behind every code, chart, scan, bill, and record is a human. We know, feel, and understand that the line on the form represents a life. It is someone’s mother, father, sister, brother, child, grandma, aunt, friend, husband, wife, etc. We know this. So, for some, knowing that certain forms mean certain things—the knowledge of that patient’s condition and how it will impact the family or loved ones or the patient themselves—can begin to wear on us. As HI professionals—specifically CDI, coding professionals, and auditors—many of us know that our job is to tell the patient’s story—clearly, accurately, and correctly—to someone else, regardless of how hard, terrible, mundane, or triumphant.

As we tell that story through the composition of codes, we feel the weight of certain diagnoses. We begin to feel the emotional pain of biopsies that find cancer. We see a baby born with congenital defects and given a prognosis of a year. We feel a tinge of sadness for the parents and grandparents. We see the multiple miscarriages that women experience in hopes of having a child, only to later be told that it can never happen naturally. Oftentimes, we see their stories daily. Each time they visit, we review the record, and code or audit the visit. We see the disappointment of a young man who wants to go into the military but is denied due to an exempting condition. We see a young woman who wants to play sports but continues to have an issue and finds out her dreams of going professional are gone. We see the doctor who is used to helping patients heal being told that she has a terminal condition that cannot be healed. We see the man who struggles with admitting his wife of 60 years to a nursing home because he can no longer take care of her. We see him broken hearted. I could go on and on.

Day in and day out, HI professionals see these scenarios not because we are nosy, but because it is our job to tell the patient’s story. Was the biopsy cancer? We must know. Is the depression major? Is it recurrent? We must know. Are all the components of the care plans complete? We must know. Is this individual a victim of domestic violence or a violent crime? We must know. Knowing is where the pressure arrives. How many times can we see children diagnosed with cancer and not feel for their families? How many times can we see the pain of a prognosis but not discuss it?

There are often no outlets in these scenarios. We can’t discuss patient information, as it will lead to termination. But the pressure continues to mount. We cannot talk to family and friends about the tragedies of the job, as there could be a violation. But the pressure continues to mount. COVID-19 came to us, and the tragedies intensified, but no one spoke.

The National Center for Biotechnology Information provided the following information as a result of a study published in February 2021: “Psychological symptoms, particularly anxiety and depression, were significantly more severe than in a non-clinical pre-pandemic sample and in the general population during the pandemic. At the same time, most professionals indicated that they would not seek help for psychological concerns. These findings indicate that healthcare employers need to pay greater attention to the mental health of their staff.”¹

This statement indicates that the greater severity of depression is evident for the clinical worker, but there is the existence of anxiety and depression in the non-clinical staff as well; it’s just not as evident. Is this perhaps because we do not discuss our feelings? Do we have a nondisclosure toward all but those who we work closest with?

What is clear is that the discussion needs to begin, as currently there are more questions than answers. How do we cope? Who can we talk to comfortably and affordably? How do we deal with the stress? Not only do we deal with the emotional stress of the patient’s situation but also the pressure from administration to work harder, faster, more accurately with less resources, and with constantly changing codes, rules, guidelines, and systems.

The purpose of this article is not to provide an answer, but to begin the dialogue. Healthcare administrative professionals need mental health support but often feel least supported.

Below are suggestions for managing depression, stress, and anxiety I’ve culled from various resources:

1. If you are thinking about hurting yourself, please do not suffer in silence. Please call the suicide hotline at 800-273-8255. You can also text 741741. Someone will help you.
2. Assistance is also available on the Substance Abuse and Mental Health Services Administration’s National Helpline (for individuals and families facing mental and/or substance use disorders) at 800-662-4357.
3. Check with your employer to see if there are employee assistance program services that can be utilized.
4. Reach out to your employer. If the specialty that you are working is too overwhelming, ask for a different assignment/area.
5. If you have a religious support structure, reach out for counseling or other support.
6. Find a productive outlet.
7. Talk to your provider, and have an honest conversation about how you feel.
8. Avoid alcohol.
9. Get moving and exercise.
10. Reduce caffeine intake.

CDI, coding, and auditing professionals tend to be Type A personalities. Perfection, accuracy, and control are hallmarks of our lives and our profession. Appearing to be OK while hiding agony is common to this personality type. This is partly science, partly observation. We will never be perfect. It is OK to not be OK. It’s time to stop hiding and start talking.

Notes

1. Weibelzahl, S et al. “Depression and anxiety in healthcare professionals during the COVID-19 pandemic.” Epidemiology and infection 149 e46. 9 Feb. 2021, doi:10.1017/S0950268821000303

Tasha Bell (tbell@optimalrevenuecycle.com) is the president and CEO of Optimal Revenue Cycle Solutions.