'Show me the money:' Hiring, retaining coders
Benefit in hiring from outside
"Spoil 'em rotten, pay 'em lots of money, let 'em do what they want, and then cut their throats if they don't give you what you need."
"Really?"
"Yeah, pretty much. Except for the felony part. You can even quote me on that one."
Judy Sturgeon, CCS, hospital coding senior manager at The University of Texas Medical Branch (UTMB) in Galveston, shared some tips with Hospital Access Management on recruiting and retaining coding staff, whom she admits are rather "inclined to be job hoppers." She speaks from experience, but relates happily that among her 16-member staff, she has a number of "lifers" employees who have been in the department for 15-25 years.
Sturgeon's staff are responsible for inpatient hospital DRG, day surgery, and observation coding for the most part, although they work with other departments and pitch in when needed, as well as coding for labor and delivery and the PT/OT department.
The three basic tenets she espouses on hiring and keeping staff are:
- You have to understand where your coding staff are coming from.
- You have to pay them what the market says they're worth.
- You have to provide some pretty good benefits.
In return, Sturgeon says, you'll get a competent, content staff.
Recognizing the challenges inherent in recruiting and keeping coders on staff, she admits that "coders are difficult to retain because everyone pays more and they're inclined to be job hoppers and go to the highest dollar."
Sturgeon, who has been coding herself for 19 years, says UTMB enjoys a geographical advantage that attracts coders. "[We're] not in the middle of a medical center where you can just go across the street, work at a different hospital, get your $5 raise every two years, and then just keep going back and forth depending on who's the highest bidder," she says.
The only hospital of any "comparable" size is in Houston, which is about 50 miles northwest. Though they might pay higher salaries in Houston, she admits, employees have to deal with the environs of a major metropolitan area, which to some may be a boon and to others a benefit. But beyond geography, Sturgeon says the benefits she can offer employees make UTMB an attractive spot for coders.
Lure them in with benefits
Regularly research and benchmark salaries for coding employees, Sturgeon emphasizes. "You have to do market adjustments regularly on high-turnover staff. Some of the biggest issues in high turnover is No. 1 find out why they're leaving," she says.
If it's more money, you need to do some adjusting. "If it's that they can't stand the boss," she adds, "then you have to figure out who's more valuable: the boss or the staff. And one of them has to go or stop what he or she is doing.
"Let's just say I've outlived a lot of bosses at UTMB," she concludes, with a laugh.
Sturgeon uses a software system that tracks her employees' productivity and when they are working. And because she works in a university center, open 24 hours a day, it doesn't necessitate adherence to banking hour work days. "So if [staff] want to come in and work weird hours because it suits their personal schedule or their day care" or if someone needs to take a day off, but has no vacation days, they can do it, she says. Once an employee logs on to his or her computer, the software will show the time he or she has worked.
"Having the right staff, paying them what they deserve, being as flexible with benefits and opportunities and education as you can... A lot of places don't provide for [coders'] continuing education and they don't reimburse you for your CE hours and the costs of your recredentialing every year. Our department does that," she says. And though your hospital might not be able to pay the highest-dollar salaries, Sturgeon says you can make up for that with attractive benefits and additional accommodations such as flex time or education reimbursement.
Buy-in from the big guys
Sturgeon's answer on how to obtain buy-in from administration is a short, blunt, four-word phrase: "Show them the money."
"I can say we do an average of $10,000 a chart, an average of three to four charts an hour, times seven productive hours a day," she says that means about a quarter million dollars off the hospital's A/R in one day. "The bottom line is if you can show them the money, they will cough it up."
Hiring managers should "show" administration proof of their need for hiring additional coders, offering higher salaries, or providing for overtime. "If you don't have the coder to get the bills out," Sturgeon asserts, "then they don't go out. And if the bill doesn't get out, the money doesn't come in. [Administrators] don't have the money to pay the bills, and then someone is yelling at them."
Money saved equals money earned and making administrators see it in that light can make the difference in your hiring options.
Speaking the same language
When she began her career, working in an acute care lab in medical technology, she says, "my family started threatening to hose me down with Clorox before I came into the house." At that time, they didn't have a name yet for AIDS ("some strange immunological disorder") and no code for hepatitis C and B. A lot has changed.
Then, Sturgeon entered the world of coding and has been there ever since. She thinks her background gives her a foot up in managing a coding staff.
When hiring staff, she says, the hiring person and the interviewer should understand the complexities of the particular coding job they are looking to fill. Speaking of her own staff, she says, "it helps that the person who's in charge is one of them. I've come up in the ranks. I understand what they deal with. I understand the pressures, I understand the documentation, and I'm willing to turn around and support it to staff who don't understand.
"If you're going to manage a coding staff and don't understand it, you better take their word for it," she recommends, or find someone who does understand and who you can trust. She characterizes coders as usually up front, literal people who'll answer you truthfully. "So, if you're not in the middle of it yourself, you need to understand and respect that they are and they are serious clinical professionals and they have an amazing depth of medical knowledge."
Starter positions
UTMB didn't always have starter positions in the inpatient DRG coding department, but now the center hires coding and reimbursement assistants with no credential required. Assistants might learn the systems to get charts running, basic ICD-9 coding, and how to look over charts to see for instance if all end-state renal disease patients on the transplant list have correct coding. In interviewing applicants for such entry-level positions, Sturgeon looks "for someone who is hungry," wants the job, and is persistent.
If that person doesn't have a credential, that's not as important to Sturgeon as his or her passion is. The person with the credential, she says, might think, "This is boring. I've already done this. And I'm not making $60,000 already like they said I would when I went to school." Sturgeon says if she has six applicants and one is "interested and enthusiastic" that's the one she would hire.
Though UTMB tends to hire from within and promote mobility, Sturgeon says, "I go out of my way to take people in from the outside if I can." Why? Because "we need more coders," she explains. "We won't need to keep moving them around in a circle in the facility. Part of the responsibility to get more coders in the hospital is to stop moving people around your facility and add more coders. Yes, you're going to have people who aren't as trained on the systems but you have to look at the long-term goal vs. the short-term goal."
The problem with sign-on bonuses
Who could find anything bad about sign-on bonuses? Though she doesn't say they don't work, Sturgeon says, "the problem with just offering a lot of money to get someone to move here is you've got someone who is mobile and will move to the highest salary. They're not likely to be the ones who stay." But if you do provide sign-on bonuses, you must provide something equivalent to the staff you already have "or they'll be mad and they're going to go someplace else," Sturgeon says.
As head of her department, Sturgeon says its imperative that she be able to show administration the value of the work her group does and the cost of not doing it. Understanding the real value is imperative, too, in retaining staff. "When the whole department knows that the people who run the place understand their value and their needs, that makes a difference," Sturgeon says.
"Spoil 'em rotten, pay 'em lots of money, let 'em do what they want, and then cut their throats if they don't give you what you need."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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