November 2016

Data-Driven Remote Coding Management
By Elizabeth S. Goar
For The Record
Vol. 28 No. 11 P. 14

Keeping close tabs on the performance of offsite staff results in more productive and better-educated coders.

Data have become the lifeblood of health care, holding the promise to improve nearly every clinical and administrative aspect of the system. HIM, and coding in particular, is certainly no exception. And perhaps nowhere do data hold more promise than in the management of a remote coding workforce.

Yet despite their potential, data remain underutilized by many coding managers. "In this day and age, you have to know how to use the data," says James Cronin, chief operating officer at Healthcare Coding & Consulting Services (HCCS), which uses a proprietary software to track productivity and monitor internal auditing. "A lot of coding companies and hospitals do not use the data that are right there in front of them … to make sure coders are in facilities where they can succeed, match them up with the right case mix, the right encoder, everything. All that information becomes very apparent if you just slice and dice the data that are available to you."

Getting Granular
Cronin, whose company employs approximately 200 remote coders, notes that the most significant challenges confronting those tasked with managing a remote coder workforce is to understand exactly what each coder is doing at any given time, including how many charts each coder receives during a week and the complexity of those charts. Those factors enable HCCS to set appropriate quotas. For example, it may appear a coder has fallen behind colleagues when in fact he or she has been working on highly complex charts while others are coding more general, easier charts.

The data automatically collected by coding systems can eliminate this obstacle and help managers pinpoint the cause of productivity dips among individual coders, differentiating off days or peak periods from cases where a coder may be in need of additional education or training.

Unfortunately, many coding managers are failing to leverage the wealth of data at their disposal to streamline processes, right-size staffing levels, and assist remote coders with skills development. The reason appears to be a mix of lack of awareness of the insights they could glean from data analytics and a lack of access to the robust tools needed to tap into the data's power.

"If you have a problem coder and you're getting a lot of denials, you might dig down, but I don't think coding supervisors have enough time to dig down into individual coder productivity data [otherwise]," says Angie Comfort, RHIA, CDIP, CCS, senior director of HIM practice excellence with AHIMA. "Larger facilities with computer-assisted coding (CAC) have lots of tools at their disposal to drill down with. Those facilities that don't have CAC are relying on abstracting systems. They have to run the reports and manually evaluate them."

A failure to utilize data analytics to keep detailed tabs on productivity and accuracy rates can also result in what Cronin calls the "slippery slope" of overhiring. When hospitals believe coders are falling behind, often the initial response is to simply hire more full-time employees rather than dig into data to identify areas that could be tweaked to improve speed and accuracy.

"You end up with hospitals getting very bloated coding departments," he says. "Then eventually there's a new interim CFO or revenue cycle director who looks at the metrics and says, 'We've got too many coders for the volume of patient records.'"

This can create an unwanted whiplash effect in which the directive to cut staff levels results in coders once again not being able to keep pace with the workflow or good people being let go because they are unable to achieve artificially high quotas. It is when managers are ordered to right-size the department that they will most lament their lack of objective performance data, Cronin says.

"We either have to make a decision that these coders are slower so we're cutting them or that some coders are faster and some are slower but in the end it evens out," he says. "We have to get down to the granular level to deal with individual coders on productivity in different facilities and with different chart types."

Actionable Data
Investing in the systems and analytics tools necessary to adequately track productivity and accuracy is just the first step. Next, the solutions must be available to those who can use them to make a difference. Easy access to comprehensive and comprehensible performance data can empower front-line managers and auditors in a surprising number of ways, including enabling them to more effectively coach individual coders and support the overriding goal of achieving a leaner, more accurate, and more productive coding team.

All of this is more complex when coders are remote. For example, managers miss out on the face-to-face interactions and firsthand knowledge of what is taking place in coders' lives that may be impacting productivity and accuracy, says Lou Testa, administrative director and CEO of Health Information Alliance (HIA), a nationwide provider of outsourced coding services.

"If a coder has productivity variances, you need to establish why, [and that] comes down to communications," he says. "Is it that their queue was filled with oncology charts that they aren't well versed in because they typically do orthopedics? Or is it distractions at home, from severe weather and power outages to snake infestation in the foundation of their home [or] visiting in-laws that do not respect the fact that someone works from home?"

HIA analyzes the results of coder productivity and accuracy audits to identify when problems are starting to percolate. Testa notes that because HIA focuses so heavily on communication, the company is able to share even negative audit results with coders without fear of being misunderstood or having their words misconstrued.

Phone calls are "time suckers," he says, but nonetheless they are imperative to ensure managers and coders are connecting on a personal level. "People get disgruntled working remotely if they're not being kept abreast of the events within either the company or the facility," Testa says.

In other words, establishing regular communications with remote coding teams is critical, not only to ensure they are informed of important developments but also to establish trust and to make remote teams feel engaged and part of the organization. This is important because it ensures remote coders are not only engaged but also comfortable enough to speak up when something is preventing them from maintaining their usual workloads, hopefully before data analysis reveals a dip in productivity or accuracy. This, in turn, lets coding managers respond with a solution to prevent backlogs and repercussions.

Managers must find ways "to create that corporate culture and make sure that they're responsive to staff needs," Testa says, noting that in addition to conference calls and e-mail, HIA uses "social media to keep the corporate culture healthy and have our remote staff connected."

Nurturing those lines of communications has helped HIA maintain a family-oriented environment among both its onsite and remote coding staffs.

Data and Other Challenges
Underutilization of data and weak communication channels are among the top issues confronting managers of remote coding operations. But they are far from the only challenges. Compliance with HIPAA and other privacy mandates, ensuring remote coders can troubleshoot any technology issues that arise during the average workday, and having adequate backup in place should natural disasters or other issues knock coders offline are all concerns.

To address these matters, Comfort recommends establishing comprehensive policies and procedures that cover everything related to the initiative, from how equipment is returned when a coder leaves employment to workspace requirements and connectivity expectations. This should be the first item in any remote coding program's to-do list, she says.

"There are so many nuances that I didn't even think of before I started writing my white paper for the company before sending our coders home," Comfort says, referring to her previous position at a hospital system where she managed 50 remote coders.

At the end of the day, however, one of the best ways to ensure remote coding teams are operating at peak productivity and accuracy is to tap into the power of data. Continuously monitoring performance and stopping small issues from becoming major problems will generally keep a program running smoothly.

"It's critical to incentivize productivity and accuracy so that it's not just pass-fail," Cronin says. "Either coders are doing well enough that they get to keep their job or they're not doing well enough and we're going to terminate [them]. … If they work faster, they should be rewarded for that, since there is a direct correlation between how much they're able to get done and how much HCCS charges."

That leads to yet another data-related challenge, which is to resist the temptation to use productivity and accuracy data as a punitive tool. To combat this tendency, HCCS takes a positive approach by employing proprietary software to collect the productivity data and deliver audit results in aesthetically pleasing reports designed to benefit coders.

"Right from the first conversation that we have with a prospective employee, we tout our internal auditing and productivity tracking program and tools as major benefits to the coder so that they can be constantly improving their skills over time in a measurable way," Cronin says. "It's funny, we don't want our employees to feel like just numbers, but we are absolute fanatics about data."

For every health care organization, it often comes down to a numbers game. And when it comes to maintaining an efficient, well-oiled remote coding team, those data are invaluable.

— Elizabeth S. Goar is a Tampa, Florida-based freelance writer specializing in health care and HIT.

ENGAGED CODERS = HAPPY CODERS
For Dina Nedorost, RHIT, CSS, director of coding and data operations with Thomas Jefferson University Hospital in Philadelphia, finding the best ways to communicate with her staff was a top priority when her department went remote several years ago. For her team, consistency is the key.

"Find a routine so that folks know what to expect and know that there are clear channels [of communication]," she says. "Just be extremely clear. Let them always feel connected by how, and how often, you communicate."

For Thomas Jefferson's remote coders, that includes biweekly "coding huddles" plus mandatory onsite work days once per month. Nedorost also encourages her team to communicate with each other outside of mandatory calls and meetings, saying "it keeps a healthy environment so they aren't feeling quite so isolated."

Her focus on coder engagement and communications even extends to onboarding and training new remote employees. Nedorost manages both these processes via WebEx, so new hires are able to remote directly into a hospital system to see exactly what they will be doing.

Additionally, "Consider workflow challenges and scheduling," she says. "We are all about employee engagement [and are] extremely flexible with schedules. They can start as early as 5 AM and go as late as 6 PM. It helps them stay happy and engaged and makes up for that piece where they don't feel connected."

— ESG