January 23, 2017

Developing Quality Productivity from Coders

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In the coding world, productivity makes the world go round – or, there’s so much emphasis on productivity that it seems that way. Most coders can meet or exceed productivity benchmarks, but are most coders achieving quality productivity? In health information management (HIM), it can be easy to have your eye on the prize, but not take into account potential casualties (quality, coding staff, teamwork, employee growth) along the way.

How do you get the best quality and productivity from your coders? I have a few helpful tips.

  1. Set reasonable productivity goals. Evaluate the case mix index for the facility and average census. Take into account the number of programs your coders have to access to code a single account. As many facilities have already done, consider ICD-10, especially ICD-10-PCS coding, as an additional factor. Setting unattainable productivity goals can lead to temptations to take shortcuts when coding charts, particularly if the coder is using a computer-assisted coding (CAC) system.
  2. Utilize audits that are educational rather than punitive. Coders who have a positive experience with audits will learn and grow and become more beneficial to the facility. When audit results are presented to coding staff as an educational and growth opportunity, more than likely your coders will come away better at what they do. When audit results are used as punishment, coding staff may not improve their coding skills. Punishment based on audit results creates a stressful and unfriendly environment for the coder. The lasting effects of this can inhibit coder curiosity and desire to improve and grow. Coders working in fear are not as productive and accurate as coders who work in a positive environment, as they tend to focus on looking over their shoulder or waiting for the other shoe to drop. Remember the old adage, “you catch more flies with honey than vinegar.”
  3. Recognize that coders have a lot of balls in the air at once. Coders have a lot on their minds when coding each account. Multiple decisions must be made regarding POA assignment, principal diagnosis and procedure, queries, secondary diagnoses, anatomy/body part key/device key for PCS coding, abstracting, DRG assignment, work queue navigation, code accuracy, and time spent on every account. 
  4. Introduce coder recognition/rewards. Little things can mean a lot. Consider implementing a monthly newsletter and recognize individual accomplishments. This can be especially unifying for facilities with largely remote staff. Recognize birthdays with cards or e-cards. Celebrate accomplishments publicly, such as participation in local American Health Information Management Association (AHIMA) chapters, promotions, or other accomplishments in HIM. Thank them for a job well done or meeting a goal. 
  5. Minimize overtime requirements. Heavy overtime requirements can lead to coder burnout. Coders are thinking intensely all day. When considering department goals and needs, remember that a coder can only code so many charts per day accurately – even in the busy times. Ensuring a good work/life balance will yield higher productivity and accuracy per coder.
  6. Allow them to use their PTO for personal time. HIM management should work to minimize unexpected department downtime. Realistically, all department downtime cannot be avoided, but when it happens, set a policy in place so coders don’t have to use up their PTO earned to get paid for department downtime. A coder’s PTO is earned for them to take time off to do something they choose to do, not to be used for gaps in work or computer issues. 
  7. Allow them to take sick days when they are truly sick. Coding charts requires clear, detailed, and concise thinking – something that is very difficult to do when ill. A sick coder will probably make errors that they would not otherwise. 
  8. Create a positive team environment. Coding is such an individual job. Each coder has his or her head in computers and books, working to meet individual productivity goals. Have fun moments periodically. An email contest, a riddle, fun fact of the day, or an occasional lunch or potluck can bring people together and foster a positive team feel, particularly for remote staff. 
  9. Make team goals. Having a coding team goal can be unifying as well, and positive recognition can reinforce the team and create a feeling of inclusion for everyone.
  10. Consider allowing flexible schedules, within reason. Particularly for coders who work remotely, some flexibility in the schedule can have a positive impact on recruitment, retention, and employee satisfaction. 

It’s true that you can’t possibly engage everyone and get them all on board, but you can engage the majority of your staff, and it can be well worth the effort. Coders who feel valued, appreciated, and invested in will provide more quality productivity and be a reliable resource in crunch times.
Sandra L. Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Sandra L. Brewton, RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer, is a senior healthcare consultant for Panacea Healthcare Solutions, a Career Step company. She has more than 20 years of experience in health information management (HIM). Her responsibilities at Panacea include inpatient record audits, recommendations for medical records operations and coder/provider training in documentation quality improvement and ICD-10 and CPT® coding guidelines. Previously, Sandra supervised the inpatient coding department of a major university healthcare system.