By Chris Dimick
|By nature, coding is a profession full of change. However, these days everything seems to be changing at once—from documentation at the point of care to workflow to code sets to reimbursement methods. And these days, everything seems to be high priority.One thing remains a constant, however, say respondents to a new Journal of AHIMA survey—the need for professionals to manage the increasing demands for coded data.
Today’s Coding Priorities
The informal survey was completed in late June by 103 AHIMA ACE members, primarily HIM directors and coding managers (73 percent). An additional 11 percent of respondents were coding supervisors. Nearly half worked in acute care hospitals (46 percent), and about a third worked in integrated healthcare delivery systems (34 percent).
This is a profile similar to respondents in a 2008 journal survey. Comparing the top challenges respondents identified in the two surveys, however, illustrates just how much has changed in the three years intervening.
In 2008, respondents selected their top coding challenges in the following order: increased workloads due to increasing coding requirements (71 percent); adapting to MS-DRG changes (63 percent); managing revenue cycle management (58 percent); staffing shortages (56 percent); adapting to present on admission (42 percent); and coding from a hybrid record (39 percent).
None of those issues rated highly in 2011. Just 30 percent of respondents selected increased workload as a top challenge, and 24 percent selected revenue cycle manage. The other issues were selected by fewer than 20 percent of respondents.
The change may reflect a host of other pressing issues that have crowded the 2008 items off the list. In other instances, departments have addressed short-term conversion issues and moved on, such as adapting to POA and MS-DRGs.
This year, asked to rate the amount of focus or energy their facilities or departments are placing on a list of seven current initiatives, respondents indicated that nearly all are a high priority. (See figure below.)
Clinical documentation improvement led the list, with 62 percent of respondents rating it as a matter of high focus or energy at their facilities. It was followed by quality reporting (56 percent) and governmental audits (51 percent).
Only computer-assisted coding seems to be on a back burner this year, with 54 percent of respondents describing their facility’s focus this year as “low.” However, in response to a later question, 80 percent of respondents said they expected their facilities to be using CAC within five years (see farther down).
Staffing Shortages Continue
Although only 19 percent of respondents cited staffing shortages as a top challenge in 2011, the share who reported that their departments were fully staffed was notably lower than in a 2009 journal survey. That year, 60 percent of the coding managers and directors told the journal that their departments were fully staffed for all approved positions. In 2011, only 49 percent said the same.
Forty percent of respondents in 2011 said that a lack of qualified candidates was the cause, similar to 46 percent in 2009. In both years, outsourcing was the most common response to shortages, with in-house training programs and remote coding also mentioned prominently.
In the Year 2016…
Finally, survey participants were asked to look five years into the future and answer four questions that began, “At my facility in five years…”
Together they saw a near-term future where documentation is entirely electronic, codes are suggested by computers, and the need for coders has remained steady or increased.
The results are shown below, with links to a live poll on the same questions.
"For Coding, a Time of High Priorities"
(Journal of AHIMA),