HIM and Clinical Coder workforce issues - Victoria

1. HIM and Clinical Coder workforce issues - Victoria Vaughn Moore Department of Health

2. Background and context • Some perceptions: • Shortfall of coders and HIMs • Ageing workforce with higher than normal attrition • Profession lacks profile • Coding is not an interesting job • Activity based funding – National priority • More data, higher quality data, more timely data • Audits, internal and external • Department has reduced timelines for data submission for first time in 20 years • Increased demand for skilled, trained staff • Need to identify workforce issues impacting availability of HIMS/coders • Diversification of roles for HIMs (IT projects, research incl. Gov’t and public health roles)

3. Information sources • Victorian Dept. of Health • 2008 survey of HIMS and coders • 2009 survey of public health services • National • NCCH surveys • Review of Australian Health Informatics Workforce (HISA with Michael Legg and Associates to DOHA) • AIHW convened workshop

4. Victorian situation • Health services casemix funded since 1993 • High dependence on quality coded data • Majority of coding is undertaken by tertiary qualified HIMs (>75%) • Role diversification (in spite of increased need for classification experts) • Perception of an ageing workforce and a general shortage of skilled and trained staff

5. Victorian Workforce • 93% of HIMs/coders are female • Just over 50% of HIM/coder workforce are under 40 (10% over 55) • 43% of HIM/coders have worked in the field for more than 10 years (20% for 20+ years) • 60% of the current Victorian workforce hold Bachelor degrees • 17% Associate Diploma • 16% HIMAA certificate • 65% of recent entrants to the HIM/coder workforce hold a Bachelor degree, with the balance almost entirely HIMAA certificate holders

6. Victorian Workforce (cont.) • 52% work full-time, 34% part-time or casual (23% have more than one job) • An average of 25% of work time is spent on ‘other’ tasks • Deliberate variety in work or diversion of skilled resources? • Typical coding rate per hour appears to be 4.5 – 4.75 records per hour • Significant amounts of paid and unpaid overtime reported

7. Victorian HIM and coder labour market • Estimated vacancy situation (from employer survey) • Approx. 40 FTE HIMs • Approx. 55 FTE coders • Approx 30 HIMs working in Vic. Dep’t of Health • Shortfall skewed slightly to regional areas • Typically, there are 30 new graduates from Latrobe University each year – not all enter hospital employment and then not all of those code. • HIMAA trainee situation is less clear • Very limited unused capacity in the labour market • Health services have difficulty covering absences through annual leave etc.

8. Desirable attributes of coders • From 2009 employer survey • Attention to detail • Medical terminology knowledge* • Anatomy and Physiology knowledge* • Ability to work unsupervised • Computer skills* • Analysis and interpretation skills* • Time management skills • Blend of personal attributes and training*

9. Career image and status issues • ‘Still working in the basement’ despite some recent advances • Conflict in coding purity over DRG outcomes leads to pressure on coders • Limited acknowledgement of expertise and skill • What is the job about anyway? • Difficult to attract suitable students • Job image remains almost below the radar

10. Training issues and options • Current annual output from all sources too small • Options currently limited • further stand alone coding courses may be indicated • Post-grad. option? • Four year course may be too long, particularly for specialist coders • New grads require extensive on-the-job training • Internships, industry placements?

11. Training issues and options (cont.) • Engagement by jurisdictions and health services/hospitals in training (e.g., DoH/Latrobe) • Advisory committees? • Graduates lack practical experience, partic. exposure to real patient records • Electronic aids (Code Finder) may or may not improve quality and speed – not avail. to all

12. Training issues and options (cont.) • Marketing/positioning of courses • Competing options • Difficult to locate • Consider career image and awareness/profile of profession • Clinical costing? • Competition for staff • Training gap associated with ABF

13. Next steps • Further analysis of the data • Enlist assistance of Workforce Planning unit, Department of Health • Closer engagement with Latrobe University, HIMAA, TAFE sector and other universities • Interviews with recent grads/students • Interviews at health services

14. Wrap up • Shortfall exists but perhaps not as large as the perception • Not enough entering the workforce • Won’t go away as an issue • ABF will drive increased demand(ABF is our friend) • Issue is on the National agenda • Task is to make it a priority • Lack of a national approach to training, remuneration

15. Wrap up (cont.) • Clinical costing remains an issue • Career image needs work – how to attract more entrants to the courses • HIMAA course offers an option to equip coders relatively quickly, but further options may be needed • Engage with universities and vocational sector • Needs focus and action in all jurisdictions

16. Questions