Create a plan to retain coders, CDI specialists
February 5, 2014
CDI Blog - Volume 7, Issue 1
The road to ICD-10 has been a long one, and we still have many miles ahead of us. Organizations have invested a significant amount of time and money into this venture, and even though October 1 is rapidly approaching, there’s still work to be done before and after implementation.
So how can you ensure your efforts will pay off and your workforce will be in it for the long haul? Consider implementing a coder and CDI specialist retention plan to reward your staff for their efforts and provide incentive for those who stay along for the ride.
This is the approach taken by the HIM department at Boca Raton (Fla.) Regional Hospital. In 2010, the HIM department started thinking about readying the hospital for the transition to ICD-10. “We recognized that we needed to lay the groundwork to build the foundation of a solid credentialed coding department to get us through,” says Rudy Braccili Jr., MBA, CPAM, the hospital’s executive director of revenue cycle services.
Now, the hospital is ahead of the curve, having implemented a training and retention program for coders and CDI specialists.
The road to retention
In late 2010, Boca Raton Regional Hospital employed 16 coders, all but one of which were certified, according to Braccili. The hospital’s HIM director and coding manager were also uncertified.
“We needed to beef up our coder credentials in our department to ready ourselves to be able to think about taking on ICD-10,” says Braccili.
To begin preparing for the journey ahead, the hospital recruited a certified HIM director and certified coding manager, he says. With this new management in place, the hospital began to revamp the coding department by taking the following steps:
- Rewriting job descriptions. The hospital transitioned from a structure that allowed just one coder position to a hierarchy involving three levels of coders, says Braccili. “We took on building a career ladder path for coders by creating three different levels of coder positions and related job descriptions, each requiring certification,” he says. The highest level of coders, who work on complex inpatient cases, fall within level one; coders working on less complex outpatient or ambulatory surgery cases fall within level two; and entry-level coders are at level three, he says.
- Requiring certification. The hospital allowed incumbent coders two years to obtain certification after implementing the new departmental structure, according to Sabita Ramnarace, MS, RHIA, CCS, CHP, director of HIM and privacy officer at Boca Raton Regional Hospital, and an AHIMA-approved ICD-10-CM/PCS trainer. The HIM director, coding manager, and inpatient and outpatient lead coders obtained the designation of AHIMA-approved ICD-10-CM/PCS trainers. “We really feel well positioned in terms of HIM leadership to have a solid position to coach and mentor our coding team and our CDI team through the ICD-10 transition,” says Braccili.
- Facilitating training and absorbing costs. In late 2012, the hospital rolled out computer-based and classroom ICD-10 training for all coders and CDI specialists, he says. The hospital paid for all of the training and exam fees. Allow your staff to complete this training while they are on the clock. “Give your employees some time while on the clock to do a lot of this training,” says Ramnarace. Take advantage of supplemental contract coders while your full-time staff completes the required training, she adds.
- Including all coders and CDI specialists. Many organizations are offering retention policies for inpatient coders only, according to -Ramnarace. But because of uncertainties surrounding the ways in which ICD-10 will affect coder productivity, her hospital opted to extend training, certification, and its retention program to CDI specialists and outpatient coders as well, she says. Providing the same training for everyone will allow staff members to fill in for each other if productivity suffers after ICD-10 implementation, she says.
Creating a retention plan
With all of the resources invested in preparing the hospital’s workforce, a retention plan was essential, Braccili says. But your organization doesn’t need to reinvent the wheel when developing a plan of its own. Adapt the following strategies that worked well for organizations like Boca Raton.
Offer several bonus payments. The retention program at Boca Raton Regional Hospital offers four bonus payments for its coders (all three levels), coding/CDI managers, and CDI specialists, according to Braccili. Eligible staff members who opt into the program receive the payments on predetermined dates, but some payments are conditional.
Employees who opt into the retention plan receive their first bonus payments April 25, 2014, but employees must reimburse the hospital for the initial payments if they voluntarily or involuntarily leave the hospital prior to January 1, 2015, according to Braccili.
“The following three payments are rewards for staying to that milestone,” he says. “It’s a carrot and a stick for payments two, three, and four.”
In addition, not all bonuses are created equal. The final bonus, paid to retained employees October 21, 2016, is the largest bonus of the four, Braccili says. The initial bonus is the second highest of the four, he says.
Consider bonuses for employees who come on board after the start of the retention program. Braccili thinks the hospital will need additional per diem and contract coders as October 1 draws near, and he recommends that other hospitals consider using such resources until the full impact of ICD-10 is realized. However, he is unsure whether Boca Raton will bring more full-time coders on board.
“We will use outside services until the volumes and productivity levels settle themselves out,” he says. “We will ensure we have the right number of full-time coders once it becomes clear how many we need.”
For this reason, the hospital’s retention policy includes contingencies for coders and CDI specialists hired after the date of the initial payout, Braccili says. “Our strategy is to handle it on a case-by-case basis and to bring in people with sign-on bonuses depending on when they join us,” he says.
Get everyone involved. Your ICD-10 steering committee can coordinate most of the planning for a retention policy. As the HIM director, Ramnarace cochairs this committee with Braccili, she says.
Although the HIM director is instrumental in creating your retention policy, there are several other key players that must be involved in the process, he says.
“Don’t do it in a vacuum,” Braccili says. “Work with your HR team and make sure your senior leadership is aware.”
Get your chief financial officer involved early so you can obtain financial approval for each bonus payment and any necessary rate increases, Braccili says. Meet with your HR department regularly because these professionals should also play an integral role in the process.
Consider asking for outside help, too. The hospital brought a consultant on board to provide insight into what other hospitals are doing to retain coders, says Braccili.
Examine your budget. The costs associated with training, certifying, and retaining coders and CDI specialists are necessary expenses, Braccili says. The difficult part is rewarding these employees without spending money out of fear, he adds. Getting the best quality and value for your money is essential. “It’s all a matter of budgeting and prioritizing,” Braccili says.
Don’t forget about other perks of the job. The retention policy is just one piece of the total compensation package, Braccili says. Other incentives also encourage coders and CDI specialists to remain with an organization. Consider base rates and applicable bonus programs before developing a retention policy, he says.
“It’s the complete package you want to look for when you go to an organization, not just the retention policy,” Ramnarace says. “You want to make sure you’re happy with your management and you’re happy with your benefits.”
Don’t underestimate the importance of providing your staff a quality work life and approachable management. “Treating them with dignity and respect in a good, positive work environment goes a long way,” Braccili says. “Value them, invest in them, and reward them for being loyal to your facility.”
Editor's Note: This article was originally published in the February edition of Medical Records Briefings. For additional information about how CDI professionals are planning their retention efforts read Bonus structures help programs retain staff through ICD-10, published in the January edition of the CDI Journal.
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