1. Brenda Bradbery Manager State-wide Education Projects 2 September 2011 NSW Health Clinical Coder Education & Recruitment Strategy

2. Statewide Education Policy Background Rationale for Education & Recruitment Strategies: New Government priorities  NPA on Health and Hospital Workforce Reform (COAG)  National Health and Hospitals Network on Hospital and Health Workforce Reform Clinical coding workforce limitations Concerns about quality of clinical coding Technological developments

3. Statewide Education Policy Sector Drivers 1. Activity Based Funding / Episode Funding 2. e-Health reforms and the e-MR o Technology improvements; requiring new skill sets o New opportunities i.e. remote coding 3. LHD KPI’s around coding timeliness, and by association, quality 4. Projected increase in hospital separations 5. NSW Clinical Coding workforce shortfall (current & projected)

4. Statewide Education Policy NSW Separations – Annual increase & projected growth (Aust Hospital Statistics: 2005-6, 2006-7, 2007-8)

5. Statewide Education Policy Coding Workforce: Shortfall Concerns NSW experiencing a shortfall of suitably trained Clinical Coders - AIHW Approx 300 FTE positions required nationally over next 5 years (greater current vacancy in NSW) - AIHW NSW Clinical Coding workforce shortfall reflected in decline in coding timelines and quality (Source: Coding Workforce Shortfall: AIHW. Nov 2010)

6. Statewide Education Policy Coding Workforce: Snapshot Skewed demographics (national) 50% aged 45 or over 90% female 50% employed part time Public sector reliance on contract coding Conduct a census of workers involved in clinical coding Reduction in education pathways VET via HIMAA & OTEN 2 undergraduate and 2 postgraduate courses remain

7. Statewide Education Policy Clinical Coding Workforce Development Proposal Three key approaches to address the shortfall: 1.Increase output of existing workforce – Up-skilling 2.Increase workforce numbers – New Trainees 3.Retain existing workforce – Education/Career Pathway

8. Statewide Education Policy Proposal (1): Up-skilling Applicant pool: Administrative staff and coding clerks Training: What is the most appropriate qualification? Certificate III Health Administration (CC) OR Certificate IV Health Administration (CC) OR?? WHY A VOCATIONAL QUALIFICATION? o Nationally recognised o Availability of C’wealth (financial) incentives/traineeships (Cert III) o Articulation into higher level quals Education Development/ Provider?

9. Statewide Education Policy NSW Health RTO - role How does NSW Health RTO assist and support Workforce Development strategies? Scope: 52 qualifications - Cert III to Advanced Diploma 12 years as an RTO Lots of experience in development and delivery of vocational education programs linked to other significant workforce development strategies eg CSOs, AINs, managers, enrolled nurses etc

10. Statewide Education Policy Proposal: Up-skilling – cont. NSW Health RTO Training Co-ordinator Educator LHD Coach LHD Coach Educator LHD Coach Educator LHD Coach Development & Delivery Model: NSW Health RTO responsible for development and delivery - opportunity for education partnerships? Training Coordinator Provision of Educators to delivery sites Development and implementation of Coding Coach role

11. Statewide Education Policy Major concern: Matching VET requirements to industry needs Units of Competency HLTCC301B Produce coded clinical data (Cert III in HA) Range limited to simple c/c situations e.g. Day Stay, Day Surgery HLTCC401B Undertake complex clinical coding (Cert IV in HA) Range expanded to include episodes in small – large hospitals e.g. discharge summaries, medical reports, medical records HLTCC402B Complete highly complex clinical coding (Cert IV HA) Range includes episodes in principal referral hospitals, specialist women’s & specialist children’s hospitals

12. Statewide Education Policy Proposal (2): Workforce Expansion Applicant pool: External Seeks to address FTE expansion Attract and recruit new staff Training, Education Provider and Delivery model as per that proposed for Up-skilling Establish an initial step in an education pathway

13. Statewide Education Policy Proposal (3): Retention & Up skill Applicant pool: Internal Scholarships for undergraduate and advanced studies Opportunities for other further studies e.g. courses for advanced computer skills or updates Continuation of education pathway Meet the need for current/improved skill sets

14. Statewide Education Policy Challenges Address employment conditions oRetention of current workforce o Incentivise return of qualified coders Will proposed strategy meet job requirements for CCs? o Do the current competencies reflect required practice levels? Stakeholder concerns o Clarity of roles & responsibilities o Level of influence in the sector Health restructure o Possible delays?

15. Statewide Education Policy Opportunities Technology - introduction of e-Health and e-MR o Introduction of remote coding o Expansion of roving (mobile) coding groups New roles – career path enrichment & linkages o Coding Coach o Coding Auditor o Coding Educator Stakeholder relationships o Potential for partnerships & further collaboration in education Health restructure o Increased momentum for change

16. Statewide Education Policy The future – brave new world! Interim strategies o Address immediate workforce shortfall o Commence a process for improvement o Try different approaches o Establish partnerships Long-term strategies o Explore higher VET qualifications for coders o Consider industrial ramifications o Make better use of technology o Maintain effective partnerships & strengthen links

17. Statewide Education Policy How to contact us Brenda Bradbery o Senior Project Officer o Phone:02 9391 9987 o Email:bbrad@doh.health.nsw.gov.aubbrad@doh.health.nsw.gov.au Maria Stephanou o Senior Policy Officer o Phone:02 9391 9864 o Email:mstep@doh.health.nsw.gov.aumstep@doh.health.nsw.gov.au