Upgrades and flexibility may ease worker shortage

Some hospitals let coders work from home

There are a variety of good reasons why HIM departments might consider allowing coders to do their work in home offices, but the most important one is to give employees an attractive flexibility that will help with recruitment and retention.

"It helps tremendously with recruiting because this is primarily a woman’s profession," says Cheryl Servais, RHIA, MPH, president of HIM Consulting Services of Dallas. Servais was scheduled to speak about new technology for coders and work in remote locations at the American Health Information Management Association’s 73rd National Convention and Exhibit, scheduled for Oct. 13-18, 2001, in Miami Beach, FL.

With a national shortage of coders that ranges up to 20%, providing coder employees the option of working out of a home office could save considerable money in recruitment costs, Servais says.

For the $10,000 some hospitals are paying as a sign-on bonus to coders, the hospital could easily pay for a very nice home office, she adds.

"A lot of women can’t work full time, and some have to have a flexible schedule because of family obligations, so a number of people who may have had to drop out of a hospital job market are now able to be productive and available because of remote site work," Servais says.

Coders working from a home office could work in the evenings, and they can schedule their working time around day care and soccer practice, Servais notes.

For urban employees, it gives them more time with their families because they won’t have to commute to work, which in some places takes up one or two hours out of every work day.

In turn, the hours in which coders do work at home often are more productive hours, Servais says.

"They often are more productive because they can concentrate more easily without the usual office interruptions," Servais explains.

Another benefit is that when an employee needs to relocate because of family considerations, the hospital could still employ that worker through a home office and telecommuting, Servais notes.

"The outsourcing companies are taking full advantage of this in that they don’t particularly care where an employee lives," she says. "For outsourcing companies, the main advantage is saving on all the travel expenses and widening the recruitment circle, and they’re taking full advantage of that."

A drawback is that not all employees are well-suited to work at home.

"We did a survey, and I think it was about 10% who answered the survey said they really didn’t enjoy working from home," Servais says. "Those are people who have a strong social need in their work setting."

On the other hand, many respondents said exactly the opposite: "Others said the good part was you don’t have to interact with all those idiots from work," Servais says.

How will you pay home-based coders?

Hospitals that decide to offer coders the possibility of working in home offices should keep in mind these issues:

  • Establish a wage model. Some employers are paying home-based workers exactly the same way they pay hospital-based staff, but this model is increasingly giving way to one in which supervisors set up some sort of piece-work pay for coders, Servais says.

"They may pay for X number of charts or some other productivity mechanism," Servais says. "There is a fear among supervisors that if I don’t see you, I don’t know how you’re working."

Benefit packages for full-time work vs. contractual arrangements without employee benefits also need to be worked out, she adds.

  • Prevent communication problems. Managing workers at remote sites can be tricky. Managers might have trouble adjusting to not being able to look over a worker’s shoulder, or employees working at home might feel as though they are no longer a part of the department, Servais says.

Dealing with these remote site workers requires a different management approach. Managers should be aware that it’s easy to forget about workers who are not in the office, so there should be an effort to make regular teleconference calls or perhaps to send out a weekly electronic newsletter that talks about coding issues, Servais suggests.

"Since the manager can’t walk around to workers’ home offices, the manager could use e-mail or the telephone to keep in touch," Servais says. "It does change the way you manage your department."

  • Help workers set up their home offices. Employers vary greatly in how much financial or infrastructure assistance they provide for coders’ home offices.

Some may give employees the computer equipment that will be used, and others may leave the hardware up to the employee but will give them the necessary software, Servais says.

"Some of the facilities have even inspected the home office for OSHA requirements and set up the work environment on behalf of the employee," she adds.

  • Take advantage of new coding technology. Some emerging technologies could radically change the health care marketplace and coding process, Servais predicts.

Voice recognition technology already exists to allow a physician to dictate notes that a computer turns directly into text, eliminating the need for transcribing, Servais says.

Taking this a step further, natural language processing software translates the physician’s words into specific codes.

For example, the physician might describe the patient as having wheezing, coughing, and a fever, indicating the patient has pneumonia, Servais explains. "The software is smart enough to pick out the fact that the physician said the patient has pneumonia, and extracts that from the text and runs it through another software package that recognizes that pneumonia equals a certain code number."

The pneumonia coding then is implanted into a listing that coders can review for accuracy.

"There are people predicting they can do coding from the physician’s mouth to billing with no human intervention, and in my mind that won’t happen," Servais says. "But this type of technology will change the way coding is done."

Sometime in the next decade, coders likely will be assigned the job of editing and verifying instead of doing initial search and selection of codes.

"Technology will change the process from having someone who starts from scratch to having someone look at a list of codes to make certain they make sense," Servais says. "Coders then can use their brains and be more productive because they’re not just being paid to key numbers into a system."