Investing in Apprentices Pays Dividends for Employers

By Lisa A. Eramo, MA

When Mary B. Parks, JD, RHIA, CCS, director of health information at St. Joseph’s/Candler in Savannah, GA was charged with replacing inpatient contract coders with in-house staff, she did what most directors do. She dove into a candidate search in the hope of finding coders with that coveted combination of credentials and experience. When the search didn’t yield results, she contemplated hiring individuals without coding experience and training them herself. However, she knew she probably didn’t have the time, and she didn’t want to put minimally-trained staff into a production environment that could cause compliance risk.

“That’s when I saw that the AHIMA Foundation had an apprenticeship program, and it caught my eye,” Parks says.

The AHIMA Foundation is one of 46 public-private partnerships awarded a grant through the US Department of Labor (DOL) to expand high-quality apprenticeship programs that combine didactic training with vital on-the-job experience. The foundation received $4.9 million of the total $175 million federal grant to fund the Managing the Talent Pipeline in Health Information Apprenticeship Program, which has helped more than 100 employers fill staffing gaps and upskill current employees since the program began in 2015.

The best part? The grant pays for all books and training materials, including the curriculum, meaning it is free to the employer and involves minimal training preparation. It even covers the certification exam at the culmination of the program. In addition, AHIMA Foundation staff are ready and willing to help employers every step of the way. The program ends in September 2020, but foundation staff say there’s still plenty of time for prospective employers and apprentices to sign up.

Through the apprenticeship program, Parks was able to hire and train two individuals who had health information management (HIM) experience but no hands-on coding experience. Now, one of them—an RHIT—codes outpatient surgeries. The other—a CCA-certified coder—codes outpatient oncology services. “They were able to hit the ground running when they came out of the intensive training,” Parks says. “It’s an astonishing program.”

The program also enabled three outpatient coders to achieve CCS credentials and move into inpatient coding roles, helping Parks achieve her goal of reducing inpatient contract coding hours. The organization also has a sixth apprentice currently in the program—an RHIT graduate who completed her practicum at St. Joseph’s/Candler and who is on her way to becoming a CCS-certified hospital coder.

Meeting Workforce Demands through Apprenticeship

Helping organizations meet their goals is a priority for the AHIMA Foundation, says Keith D. Terry, MBA, CHPC, interim executive director of the AHIMA Foundation. “It’s an employer-driven program,” he says. “We can design this around an organization’s needs.”

The AHIMA Foundation continues to be sensitive to employers’ needs, and worked with the DOL to approve the addition of several HIM roles to the grant’s scope in 2018 based on employer demand—including professional fee coder, privacy and security officer, and inpatient coding auditor. The DOL also recently approved an expanded scope of work that allows the AHIMA Foundation to recruit for various non-HIM apprentices to assist in meeting grant deliverables—including home health aides, phlebotomists, and nursing assistants.

“Regardless of the type and size of your organization, this model of apprenticeship is flexible and adaptable enough to meet any type of workforce need,” says Bonnie Aguda, MM, senior manager, grants and sponsored projects, at the AHIMA Foundation, adding that this widespread appeal was the primary reason why the DOL chose the AHIMA Foundation as a grant recipient.

After employers identify what specific apprentice roles to offer, they’ll work directly with the AHIMA Foundation to fill out paperwork, draft job descriptions, recruit apprentices, and devise a training plan using AHIMA’s curriculum.

“Our administrative team can really hold employers’ hands and walk them through this process,” Terry says. “We try to make it as easy, simple, and seamless as possible for employers.”

Employers don’t need to navigate the program alone, Aguda says. “We make sure all of the boxes have been checked, and we work with employers to make sure they can kick off their program successfully,” she says.

This includes working with employers to identify potential funding to offset any hiring costs. “We try to connect employers to someone in the state who can answer specific questions about state-level incentive programs—a workforce group or state agency that can provide additional funding,” Aguda says.

Making an Impact Nationwide

The AHIMA Foundation’s apprenticeship program has been implemented in locations across the country and is seeing positive results. Currently, employers in 38 states are participating in the program. This includes critical access hospitals, large academic institutions, departments of public health, long-term care hospitals, and community health centers.

“The program has had a positive effect in Missouri in terms of growing the healthcare industry,” says Neil Perry, Missouri state director, office of apprenticeship at the DOL in St. Louis, MO. “Employers really like the ease of the program.”

Madeline Boehm, program specialist at the Montana Department of Labor and Industry in Helena, MT, agrees. “It has been a game changer for healthcare apprenticeship in Montana without a doubt,” she says, adding that 30 Montana employers are using the AHIMA Foundation curriculum and/or funding.

“We have a lot of facilities that service very small communities, and they need funding support to do any sort of expansion, training, or education,” Boehm says. “This program has been wonderful for those facilities.”

One facility was even able to increase its revenue despite the fact that patient volumes have remained the same. Boehm attributes this increase to more compliant coding and billing now that employees are trained and certified. The online education modules that are used to train apprentices through the program are especially helpful for those living and working hundreds of miles from a college or university, making it ideal for individuals in rural areas, she adds.

Apprenticeship also addresses the challenge of recruiting and retaining qualified staff—especially in rural communities with an aging population, Boehm says. “When you’re looking at a community of 1,200 people—and half of them are age 60 and above—retention and recruitment are critical,” she adds.

Upskilling Existing Staff

When Shalina Richie, RHIA, HIM coordinator and privacy officer at Lake County Health Department and Community Health Center, a federally qualified health center in Waukegan, IL, heard about the apprenticeship program, she knew it would be an excellent opportunity to upskill two charge capture analysts, both of whom had billing and data entry experience but no coding credentials. This lack of formal training had continued to pose challenges. As charge analysts, they were responsible for validating all CPT and ICD-10-CM codes, identifying omitted charges, appending modifiers, and more. “Without the coding knowledge, they didn’t necessarily know what they were missing,” Richie says. “We saw that this was posing a roadblock for a thorough review.”

Although the organization mandated the apprenticeship for both analysts, two billing specialists who work rejections also decided to participate voluntarily. In addition to completing online learning modules, each of the four medical coder/biller apprentices is shadowing colleagues in four areas of the revenue cycle—coding/charge capture, health records, central billing office, and front desk operations. “This gives them a well-rounded view of the entire revenue cycle so they see how each phase of the cycle affects the others,” Richie says.

So far, the apprenticeship program has benefited the organization in several ways. In addition to performing a more comprehensive review of charges, analysts have gained a greater appreciation of how coded data affects reimbursement, medical necessity, and quality improvement. The two billing specialists are now better able to identify trends and opportunities for provider education.

Another benefit is that as the organization expands its services to include labs and drug screens, apprentices can easily adapt to code and audit these services with ease. The program has also enabled process efficiencies. Apprentices who receive their coding credentials can query physicians directly rather than ask a credentialed coder to do it.

Finally, apprenticeship improves employee retention, Richie says. “It’s truly an investment that we’re making in these employees to not only further their careers, but also in terms of being able to retain that knowledge,” she says. “Our patient population, the services we provide, and our payer mix are very unique to our organization.”

Helping New Professionals Land on Their Feet

After graduating with her associate’s degree in HIM, Makema Massey, RHIT, CCS, spent several years looking for a coding job. It wasn’t until she landed an apprenticeship position at Tampa General Hospital in July 2017 that doors finally began to open. After completing the apprenticeship program and gaining an additional year of inpatient level 1 trauma coding experience, as well as her CCS credential, her career took an interesting turn—employers started to recruit her.

One employer, Lakeland Regional Hospital, was particularly impressed with the knowledge she’d gained through the apprenticeship program and offered her a position as a remote coder. She ultimately accepted the job; however, she set her sights on eventually landing an auditor position. That goal became a reality when WellCare Health Plans, Inc., her current employer, recruited her as a special investigations unit auditor, a role in which she audits physician billing to ensure that it complies with all coding guidelines, payer requirements, and state and federal regulations. Once again, her AHIMA training made her stand out among candidates with far more auditing experience.

She urges other HIM professionals to consider apprenticeship. “Opportunity is waiting,” she says. “Anyone can follow in my footsteps.”

Transitioning Into New Roles, Solidifying Expertise

When Karen Hatch, RHIT, CPMA, CMAS, CCS, CPC, CIC, COC, medical records director and privacy officer at Colorado Canyons Hospital and Medical Center in Fruita, CO, was informed that their health system’s long-term care facility was closing, she knew the apprenticeship program could provide certified nursing assistants and medical assistants with an opportunity to transition from patient care roles to several available medical coding and billing positions. “When I saw this program, I said we can’t afford not to offer this,” Hatch says. “We benefit because we don’t need to hire someone new, and we know the training they’ve received. They can step right into positions for which they’re qualified.”

The health system also currently has a nurse enrolled in the clinical documentation improvement (CDI) specialist apprenticeship program, three professional fee coders enrolled in the hospital coder program, and one hospital coder enrolled in the professional fee program. Hatch says this coder cross-training has already opened the lines of communication between departments. “They’re more open to coming together to have a discussion about the coding before the bill goes out the door,” she adds.

Hatch and the IT director are serving as privacy/security officer apprentices, and Hatch hopes to eventually obtain her CHPS credential. “The knowledge I’m gaining through the apprenticeship will help solidify the knowledge I need to carry out my function,” Hatch adds. “It ensures I’m aware of current regulations—that I stay apprised of what’s going on and stay up-to-date.”

Launching the program was easy, Hatch says. “The AHIMA Foundation really did the bulk of the work,” she says. “They told me what to do and when to do it, and I just followed their instructions. They did a phenomenal job of getting us set up and started.”

Proponents offered the following three reasons why employers should sign up for the AHIMA Foundation apprenticeship program:

1. Fill staffing vacancies. Stop spending time and resources searching for skilled workers in a limited candidate pool—or settling for those who aren’t a good fit.
2. Upskill current employees. Help current staff obtain credentials or move into new and emerging roles using cost-effective education.
3. Improve retention. Invest in employee education to increase organizational loyalty and reduce costly turnover.

Although some organizations may shy away from apprenticeships out of fear that employees will leave after completing the program, Hatch urges managers to consider. “What we’re finding is that when you give them this opportunity, they know you have their best interest in mind, and they’re likely to be more loyal and stay,” she says.

Lisa Eramo (leramo@hotmail.com) is a freelance writer and editor in Cranston, RI, who specializes in healthcare regulatory topics, HIM, and coding.