New coding credentials, workplace shortages top AHIMA concerns
AHIMA pres and pres-elect discuss 2002
Attracting more people to hospital information management (HIM) jobs and moving toward electronic documentation are two of the chief priorities for the HIM profession, according to the current president and president-elect of the American Health Information Management Association (AHIMA) of Chicago.
"Right now there’s a great need for coders," says Barbara A. Siegel, MS, RHIT, director of health information for Hackensack (NJ) University Medical Center. Siegel is the president-elect of AHIMA.
"What we’re doing here is trying to look at the needs of employers and industry in general for HIM professionals," says Barbara Odom-Wesley, PhD, RHIA, president of AHIMA and president of Medpro Services in Arlington, TX.
Hospital Payment & Information Management asked Siegel and Odom-Wesley to provide an overview of the key issues affecting the HIM profession for the next few years. Here’s what they say:
• Workplace shortage: This will continue to be the biggest challenge facing the industry.
"We’re seeing workforce issues in different parts of the country, and certainly where I work in the New York metropolitan area everyone is always looking for coders," Siegel says. "Having trained and skilled staff and attracting and training them has really become a priority for many health care organizations."
Generous salary levels should make the profession attractive to people looking for a career change. Compared with 1999 salary survey data, 2001 AHIMA member survey data reveal a 28.1% increase in salary levels for coders, with salaries now more than $30,000 a year on average, Siegel says.
"Coders with years of experience can have salaries in the $50,000 to $60,000 range," Siegel adds.
AHIMA plans to identify the opportunities and roles that HIM professionals will be asked to fill in the future, as well as take a look at the impact of the economy and technology on the industry, Odom-Wesley says.
"We’ve commissioned an extensive research study," Odom-Wesley says.
AHIMA is working with the Center for Health Workforce Studies at the University of Albany, State University of New York, to assess current and future HIM workforce needs, shortages, and salaries. Funded by AHIMA’s Foundation of Research and Education, the study will assess current and future HIM employment needs. It also will show how technology will change the profession and will identify directions for professional education curriculum and accreditation policies.
• Electronic documentation: Electronic coding and computerized medical records are on the horizon, but these efficiencies still will leave a need for trained coders, Siegel says.
"There still will be a need for individuals trained in coding to do analysis and validity checking and report information," Siegel says. "It will be a learning opportunity for individuals who have coding skills to move on to another level when this does happen."
Health care organizations are moving closer to computerized records, but because coding will continue to be linked to reimbursement, these will require coding specialists to review and edit, she says.
"It requires a great deal of analysis and attention," Siegel adds.
Electronic documentation will make it easier for health care organizations to collect data for reimbursement audits, research, and planning.
Web-based technology, in which charts can be accessed from remote locations through the use of special passwords, could help improve coding job recruitment, Siegel suggests.
"Coders could work from home, and this will open up opportunities for a lot of people who cannot go to work on a regular basis, but who still can do coding at any time of the day or night if the information is provided," Siegel says.
• Expanding the HIM role: The challenge for HIM professionals will be to show the value of a computerized patient record and to help ensure its validity, Siegel says. For example, HIM professionals could be involved in quality improvement initiatives by helping to coordinate data collection and making certain analyses are valid and accurate.
"I’m finding in some organizations that I’ve worked in that sometimes information doesn’t get collated in a way that would make sense for an organization," Siegel says.
Collaboration between the HIM department and clinical departments could be a crucial aspect of quality improvement, she adds.
"Sometimes, nurses are put into the role of data collection when their time could be better spent working with the patient," Siegel says. "Data collection doesn’t need to be done by the clinical staff because there are ways to collaborate and raise the bar and acknowledge that HIM-credentialed individuals have capabilities and knowledge to do this."
Make data collection more efficient
Another way the HIM role could be expanded is by having HIM professionals involved in prospective quality improvement projects, Siegel suggests.
"There are a lot of people doing research and audits and data collection for accreditation organizations, and often that data collection might be duplicative, so there should be a way to streamline that," Siegel says.
The challenge to HIM professionals is to show how they can make data collection more efficient, Siegel adds.
• New coding credentials: AHIMA has adopted a new coding credential and now has three credentials, Odom-Wesley says.
The new credential is the certified coding associate (CCA), an entry-level credential that will be launched later this year. A coder designated as a CCA will have to pass an approved coding program, which now can be located outside of formal universities and junior colleges, Odom-Wesley says.
The other two designations are for certified coding specialist (CCS) and certified coding specialist for procedural coding in ambulatory settings (CCSP).
AHIMA is trying to meet the needs of the diverse HIM work force by providing coding credentials from the entry level up to doctorate educators, Odom-Wesley says.
Another change is that there are more associate’s and bachelor’s programs available to candidates for HIM careers, Siegel says. "And we’re moving into the master’s level."
For people who are interested in the profession but who do not want to make a long educational commitment, the coding certificate programs would be a good entry point, Siegel says.
"We’re finding more people doing web-based learning, so there’s more opportunities out there for coding certification programs," Siegel says. "There are a lot of people who’ve been unemployed recently and maybe are looking for something different to do."
• Federal privacy rule: "The big challenge is bringing all health care providers into compliance with privacy regulations by the April 2003 deadline," Odom-Wesley says.
"We’re conducting a series of privacy workshops across the country, and we get a wide variety of people to attend these," she adds. "We also produce printed and on-line materials, and additionally, our house of delegates is considering offering a privacy credential."
HIM professionals may take a privacy training program on-line through AHIMA, and the organization will continue to inform members about changes, Odom-Wesley says.
HIM professionals need to keep in mind that the Health Insurance Portability and Accountability Act (HIPAA) has only set the floor level for privacy regulations. States still can and do enact even tougher regulations, Odom-Wesley says.
Consumers hold providers accountable
"Texas is ahead of the game, and we have some legislation that is more stringent than HIPAA," Odom-Wesley says.
The fuel driving this movement toward privacy is the recent call for provider accountability to consumers and an increased focus on patient rights.
"Consumers hold us accountable now for how their information is used and who has access to it and how it is maintained," Odom-Wesley says. "There was a time when the patient had trouble getting a copy of his own medical record," she adds.
Hopefully, privacy regulations will improve the relationship between providers and consumers, Odom-Wesley says. But the challenge will be to give consumers some guidance that will help them become better informed and more active participants in their own health care, she says.
From an HIM perspective, the regulations will affect all paper, oral, and electronic transmissions of patient coding information.
HIM staff discussing patient codes could be overheard, so they will need to be vigilant about confidentiality, Odom-Wesley says.
"I recommend that every employee sign a confidentiality statement each year, and we need to have policies and mitigation guidelines in place, so that if there are employee breaches of privacy, there are penalties associated with that," she says.
"It’s a matter of quality of care, because if patients don’t feel comfortable that their information is confidential, then they’ll start to withhold sensitive information," Odom-Wesley says. "And that could jeopardize the quality of care received."
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