Changes in health care and HIM field make staff education a top priority

Good training programs help coders keep up

HIM professionals need not look far to see that staff education will be more challenging and important in coming years. Already on the horizon is the Health Insurance Portability and Accountability Act (HIPAA), and there are new regulations and policies with regard to the various prospective payment systems (PPS) now in place.

Add to these educational needs the fact that there is a nationwide shortage of coding professionals that is being partially met though newly certified recruits, and it’s clear that staff training and education should be a top priority of every HIM department.

The Chicago-based American Health Information Management Association, along with the State University of New York at Albany, is conducting a workforce study to identify new curriculums and educational content areas for HIM staff, says Claire Dixon-Lee, PhD, RHIA, president of MC Strategies Inc./WebInservice of Atlanta. MC Strategies is a health care consulting company for compliance and financial services, and WebInservice provides web-based staff training.

"There is a growing need for professional coding specialists," Dixon-Lee says. "Getting these people into the workforce and helping them gain experience is an issue and problem."

Also, there has been a recent trend in which hospital system HIM professionals are being asked to serve as educators to clinicians, case managers, and other health care staff to help them better understand documentation, coding, and reimbursement.

Other factors contributing to the greater need for HIM education are the trend of health care services moving to outpatient sites and the anticipated changes under HIPAA, Dixon-Lee says.

With a greater migration of health care services to the ambulatory care level, health care systems are seeing a greater role for trained HIM personnel in outpatient facilities, clinics, and physician offices, Dixon-Lee says.

"Issues like HIPAA will affect every member of the workforce, so how will you train staff?" Dixon-Lee asks.

Training may include sending staff to seminars and conferences, but this method can be expensive. Also, not all of the training that is needed may be available at area seminars.

"Seminars are good sources of information on a subject," Dixon-Lee says. "Seminars are what most of us use to get a pulse on what’s happening in the industry, but when you want to get some of the fundamentals of a billing system or new technology, you need to have hands-on training."

Another strategy is to give inservices to staff at quarterly or other regular intervals, but this would require employees to take hours of work time away from their jobs, and in today’s busy PPS climate this method may not be productive and practical. 

A third strategy is to encourage or require staff to do self-learning modules through videos or computer/web-based training courses. Many HIM departments and health systems have found this to be a simpler method from a productivity perspective, Dixon-Lee says. As quickly as most HIM information changes, video training may be too dated to be effective for long, she says.

Inservices can remain timely, but if these are offered in lecture formats, there is a risk that people will attend and not really listen or learn. "I’ve been a teacher for over 20 years, and I can do a lecture and people will walk away with a fragment of what I was saying," Dixon-Lee says. "But if I give them homework, role-play, or offer interactive opportunities, they’ll remember the concept at least."

People are more apt to learn when they are participating in their educational experience through some sort of interaction with the educator or material being presented. This is why computer-assisted training works, Dixon-Lee notes.

"Web-based training is an efficient way of delivering training and keeping it current," Dixon-Lee adds. "Participants are asked questions and they receive immediate feedback and can go back and learn more about the subject."

For other educational needs, such as HIPAA training, the health system itself should have an annual review of privacy and policy procedures and refresher courses, she adds.

"There are other areas where something new occurs, and HIM departments will need to do specialty training on an as-needed basis," Dixon-Lee notes. "Of course you can’t be training staff every minute, but you should keep it current with web alerts and other sources of information."

Whichever method HIM directors select, it’s important to assess the training program’s effectiveness on a quarterly basis by checking coders’ accuracy or through other means of determining how well staff have learned a particular subject, she says.

Coding changes and clarifications are issued frequently by the Centers for Medicare and Medicaid Services, so if the HIM department’s staff are not keeping up with these, the evidence will be seen in coding mistakes.

"I’d say there should be a minimum of quarterly reviews of inpatient and outpatient coding, and I’m really emphasizing outpatient right now because the changes are so frequent," Dixon-Lee says. "And there should be some kind of internal check once a month of a small sample."