Electronic Health Reporter

Guest post by Michele Hibbert-Iacobacci, vice president, information management and client services, Mitchell International.

Employee morale is a constantly at the forefront of the healthcare industry because of on-the-job stress, do more-with-less mentalities and a consistent cost containment focus. With the introduction of ICD-10, employees who work in healthcare as medical coders will be expected to maintain productivity and produce quality coding. We are changing the communication language used between payers and providers and have an expectation that everyone speak the same language as of a specific date.

Although difficult to attempt in a short time frame, this language change has been coming for many years and we should be ready by October 1, 2015. While the industry has been given more time to prepare, this transformation will still have an effect on the medical coding professional from a morale perspective, let’s face it – do coders know ICD-9 or what? Most have ICD-9 memorized so change will be a very new condition for the medical coder to deal with.

Steps to mitigate morale issues should be reviewed and/or introduced to minimize pushback and employee attrition. Skilled coding professionals are needed in the industry, they are valuable and the ICD-10 language barrier is one that requires specific steps to maintain medical coder involvement.

Having worked as a coder for many years, I can attest to the following as ways of boosting morale:

Training

Training is the single most powerful morale booster for coders – the more they know, the better they feel. Coders also love healthy competition and the ability to know more and provide advice for collaborations. Excellent training programs for coders in ICD-10 have been made available by national organizations like the American Health Information Management Association (www.AHIMA.org), local state AHIMA organizations, American Association of Procedural Coders (www.AAPC.com) and American Institute of Healthcare Compliance (www.aihc-assn.org).

Constant Communication

Communicating through on-line coding communities and associations alleviates the angst coupled with, “Am I doing it right?,”especially if you are the lone coder in an organization. Larger organizations are creating their own social networking for communication and collaboration. It’s amazing what coders learn when they venture outside the walls of the business they are providing a service for when dealing with “what if” situations and resources. Having outside resources empowers coders to do a quality job and have the chance to demonstrate initiative – all great qualities we look for in skilled coding professionals.

Level Set Expectations

Coders need to be aware from the start that productivity will take a “hit” – they will not be able to memorize as readily as they did for ICD-9 and the many rules with ICD-10 will need to be applied appropriately and carefully. A focus in the beginning should be on quality of coding to mitigate morale issues, and then later work on the productivity. Being prepared up front with dual coding experience will also help and provide insight to coders on why it takes longer to code as compared to ICD-9.

Quality of Coding and Productivity

As a manager, consideration of the quantity of coding needs to be explained and measured appropriately for the ICD-10 production numbers. The closest example we can review for history of production is the implementation in Canada of ICD-10. There are many differences and the expectation in the US is that our production issues will be unique to our healthcare system. Canada did a staggered implementation across four years and they have single payer system for healthcare. The US system involves different coverage types and different insurance policies not only in health, but in workers compensation and auto insurance coverage. According to various coding groups, we can expect at least a 30 percent drop in production for diagnosis and procedure coding.

Employers need to be prepared to hire and not expect the existing coding staff to keep up the production in ICD-10 that was done using ICD-9. To not plan for this expense could lead to employee dissatisfaction because of the continuous demand and potential overtime needed to keep production in check. In addition, if your coding is outsourced, be prepared to pay more for the service as more personnel will be needed by your vendors.

Pay for Performance

Paying coders for performing well is an industry standard when using ICD-9 today. Movement to ICD-10 will affect productivity and salaries of coders if they currently operate in this environment. Those who don’t change the pay-for-performance model to emulate what realistic goals are, will breed poor morale. In addition we may see more “cherry picking” of files to be coded whereby the coders start to choose the easier files and leave the complex behind. Evaluation of any pay-for-performance program should include the view of change, which should be monitored as coders become more proficient.

The transition to ICD-10 involves an understanding of your business and how this new system affects it. Coders can be of significant value in understanding the gaps between in ICD-9 and ICD-10 and utilizing their knowledge in the conversion is beneficial to a smooth transition. Involvement of the coding staff creates ownership of the processes and creates an environment that will embrace the change they will be part of.

Involving coders in “train the trainer” programs to impart information to other staff demonstrates confidence in the employee’s abilities while giving the employees a significant portion of the implementation process. As in any industry, being involved creates high job satisfaction and goes hand-in-hand with communicating effectively. With a job as intricate as coding, this is simply a must have in the recipe of success.