Healthcare providers need an ICD-10 strategy that includes adequately training medical coders and retaining them in their jobs. With an already extremely low unemployment rate, ICD-10 coders will be very much in demand.
With the ICD-10 deadline a year away, hospitals and health systems are ramping up their staffing strategies to hire, train, and retain their medical coding workforce in time for next year's transition. But there are challenges to retraining a coding staff onto a system that's more complicated than the previous one, and to keeping those coders around once they're trained and in demand.
In September, the American Association of Professional Coders released its 2013 Healthcare Salary Survey, which reflected a rise in medical coder employment and a steady pay increase over the past three years. Certified professional coders (CPC) have a 1.7% unemployment rate, nearly half the rate last year.
With the shift to ICD-10 coming next year, providers need to have a plan so that they adequately train, but don't lose coders. Four steps are essential.
1. Manage productivity expectations
Angie Mannon, Senior Vice President of Human Resources at Inova Health System in Virginia spoke with me about the strategies Inova has implemented to prepare its coding staff of approximately 120 for the ICD-10 deadline. Mannon is in charge of hiring and retention strategy.
"I just hope the date doesn't change again. Having the date delayed cost us in some productivity. We had everything ready to go and had scheduled the training," says Mannon. "But because the deadline got pushed back, we didn't want to have people start training on the same thing for two years. You don't want people toggling back and forth between ICD-9 and ICD-10."
Inova is giving time during the normal work day for its coders to train and practice on ICD-10, but productivity targets have been adjusted to allow for this transitional period. "It's important to figure out what it would take for existing coders to work at the same level of proficiency they have now, so productivity wouldn't be affected," says Nelly Leon, director of coding and classification at AHA.
"I've heard that hospitals have plans to get their production coders to get an early start before they have to submit it externally so they can practice areas for additional training before they go live."
"What we're more worried about is accuracy than speed," says Manning.
2. Provide schedule flexibility
"Most of the concern is the learning curve associated with the transition to ICD-10," says George Argus, who works with medical coding and classification strategies for the American Hospital Association. "This learning curve will probably slow down the volume that coders typically would handle. Additional staff might be needed and additional overtime will probably be needed to meet the compliance standards."
"We recognize that learning this new system is extremely involved, so it is going to encroach on overtime and vacation time," says Mannon. "We have a limit on the length of vacations workers can take. Our PTO caps typically, but right now we don't cap after a certain accrual level for our coders." According to the AAPC survey, approximately 75% of medical coders work more than 40 hours a week.
Inova also provides a retention bonus for three years. Employees sign a retention agreement and every year they stay, they get a bonus.
"It helps us maintain our very little turnover. At our system it's less than 5% for coders, and that is way lower than our organizational turnover, which is 12%. Coders also get to work remotely, so we allow a lot of flexibility with coding staff, which helps." But hospitals are beginning to look over their shoulders.
3. Stay competitive in the market
According to the AAPC survey, medical coder jobs are increasing nationally in number and being filled regularly. Salaries also increased at unprecedented rates in 2012, according to the AAPC survey.
"Good coders are always hard to come by, even in the existing environment. So it doesn't surprise me that hospitals would take innovative approaches for vacation time or salary to handle the implementation phases and learning curve associated with that," says Argus. "Retention is a reality and I think they have to be adjusting."
Because the ICD-10 skill set hasn't quite met a demand in the market, at Mannon says Inova hasn't lost a single coder to another organization. But the provider is conducting weekly salary benchmarking reports, so it can keep pace and stay competitive.
4.Control resistance from older workers
Another cause for employers' concern: coders near the end of their careers may be intimidated by learning an entirely new system.
Mannon says a large part of retaining retirement-age workers is managing that fear. One of the key implementations was computer-assisted editing software, which suggests answers for coding and takes away a fear of inaccuracy.
"It's really computer literacy more than it's an age issue. The delay of ICD-10 put fear in the coders that didn't need to be there. Anecdotally, I would hear that they thought because of the delay that the coding was more difficult than it is. I think you view things like that from the seat you sit in. People are thinking this is more complicated than it is, when ICD-9 and ICD-10 really aren't that different."
"There is never a good time to introduce change. And it's always costly to deal with it. We've been given a year and we're trying to communicate to our members to make sure they are on schedule with where they need to be. It's tough to maneuver through those various activities and make the transition successfully," says Argus. "There will be some pain as a result of the transition, but we want to minimize that."
Chelsea Rice is an associate editor for HealthLeaders Media.
