Keeping a Close Eye on Coding Productivity

Vol. 18 •Issue 21 • Page 28
Keeping a Close Eye on Coding Productivity

Facilities are using a wide range of tactics to improve coding efficiency.

Efficient, effective coding practices directly impact a hospital’s bottom line. With a shortage of experienced coders in many parts of the country and ever-changing coding rules, facilities are using a wide range of tactics to improve coding productivity. Electronic solutions, physical location and tracking efforts are just some methods to scrutinize coding productivity.

Last year, 745 new MS-DRGs went into effect, and facilities are currently faced with integrating the more than 500 new codes that are part of this year’s inpatient payment prospective system rule. These are just two of the many changes constantly facing coders and impacting their ability to maintain efficient, accurate coding.

Constant Education

The sweeping changes brought about by MS-DRGs led Marie Munro, CCS, coding supervisor at Indian River Medical Center in Vero Beach, FL, to seek outside help to educate the seven-member coding staff. “I wanted to be sure everyone understood [the changes],” Munro said. “We needed everyone’s buy-in because of the extent of the information we would need under MS-DRGs.” Educational sessions addressed coders, physicians and other specific groups. A post-audit showed that everyone’s accuracy went up from the pre-audit. Munro said education needs to be an ongoing, continuous effort for everyone.

Facilities that don’t take a close look at coding productivity, Munro said, will see their case mix go down. They also will be under increased scrutiny from payers and government agencies, as well as probably lose money, she said. “They definitely need to train. Constantly keep people informed,” she advised.

Electronic Avenue

Another way to affect good coding productivity is with electronic tools. Dubois (PA) Regional Medical Center (DRMC) implemented electronic medical records (which was supported by grant #1UC1 HSD156083 from the Agency for Health Care Research Quality) and Web.Strat, an electronic encoder from HSS Inc. (now owned by Ingenix Inc.) 3 years ago.

The new processes have helped DRMC increase productivity from 5 days from patient encounter to coding down to 2-3 days, explained Joanne Genevro, director of revenue management. The coding backlog also went from $5 million down to $1 million. Before, coding backlogs would easily mushroom into long-term problems. Now, unexpected backlogs are minor blips on the radar screen. “I think we’re where we want to be,” Genevro said.

Location and Management

DRMC also moved its coding staff from the medical records department to the revenue management department. Before the move, Genevro said that productivity was horrible because of phone calls and interruptions from patients seeking the correspondence clerk. Removing coders from that environment helped somewhat in improving productivity, she said. “At the same time, becoming part of the revenue management department and realizing the role coding plays in that function has helped revenue management auditors effectively question codes as they audit chart documentation,” Genevro explained. “Acknowledging coding as part of the revenue cycle has helped everyone understand the outcomes of the decisions they make. Coding can make or break your reimbursement.”

Genevro recommends that facilities look at their processes. “So much of productivity has to do with the process,” she said. When the hospital went from manual to electronic processes, Lois Weir, CCS, coding supervisor, found that it was taking much longer to deal with coding queues. As she and other managers studied the processes, more and more problems came to light and they needed to continually look at processes. People change, workflows change.

Kevin Cahill, chief information officer of BizTech Healthcare Solutions Inc., Freehold, NJ, has spoken about coding productivity at several regional HIM conferences. His own experience working in hospitals provided him with a solid background in improving processes. He worked at a hospital that went from being $10 million in the hole to having $100 million in the bank 10 years later. “That’s a pretty dramatic turnaround,” he said. The facility used information technology to help with efficiencies and improve the bottom line.

One of the most salient points of Cahill’s talks is that coder productivity is central. “The coding department is crucial to the hospital,” he stressed. “It affects the bottom line. If money is not coming in, you can’t provide better patient care.” He believes that creating a pleasant, motivating workplace for coders is important. “My philosophy is that you need to get people to want to come to work on a daily basis,” Cahill said. Flexible work hours and the right management style can go a long way in impacting productivity. Managers who don’t treat their employees well don’t get the work out of them. “If employees are fully motivated you can’t get more out of them,” he said.

Measurements and Tracking

Pamela Goans, chief operating officer and senior vice president for Precyse Solutions, Wayne, PA, said that most hospitals only focus on coding productivity when it affects their days not final billed (DNFB) or service costs. She cited one multi-facility client whose vice president of revenue cycle said the organization was managing fairly well after MS-DRGs went into effect. “But, they ended up finding that some of the metrics they weren’t watching as closely were really being impacted, such as the cost of delivering coding,” Goans explained. Overtime and contract coders forced an increase in costs of 15 percent. The hospital maintained quality but couldn’t maintain productivity. Precyse helped the organization reduce the administrative tasks of coders.

Goans recommends that hospitals begin by measuring the current productivity of individual coders. “If you don’t know the productivity of the individual people, you may have more people than you need to handle the process,” she noted. Many hospitals have a few really strong coders that drive the productivity. With MS-DRGs typically causing a 15-17 percent decline in productivity, it’s important to know who is carrying the department and who may be falling behind.

Goans said hospitals should establish each coder’s productivity by chart type and compare each against the group. “That’s the best way to start. Establish a baseline and compare that against the benchmarks that are out there so you can really determine your exceptions,” she noted.

Tracking is essential, she said, because coding is “definitely becoming a more complex environment.”

Cahill agrees. The migration from the 20,000 ICD-9-CM codes to the more than 200,000 that will come with ICD-10-CM is one of many future changes that will ensure that “coding will not be diminished at all,” he said. “If anything, coding will be more involved in financial and clinical outcomes.”

Beth Walsh is a writer/editor focusing on HIT.