1. Department of Human Services HIM and Clinical Coder workforce issues - Victoria Vaughn Moore Department of Health

2. Background and context Some perceptions: –Shortfall of coders and HIMs –Ageing workforce with higher than normal attrition –Profession lacks profile –Coding is not an interesting job Activity based funding – National priority –More data, higher quality data, more timely data –Audits, internal and external Department has reduced timelines for data submission for first time in 20 years Increased demand for skilled, trained staff Need to identify workforce issues impacting availability of HIMS/coders Diversification of roles for HIMs (IT projects, research incl. Gov’t and public health roles)

3. Information sources Victorian Dept. of Health –2008 survey of HIMS and coders –2009 survey of public health services National –NCCH surveys –Review of Australian Health Informatics Workforce (HISA with Michael Legg and Associates to DOHA) –AIHW convened workshop

4. Victorian situation Health services casemix funded since 1993 High dependence on quality coded data Majority of coding is undertaken by tertiary qualified HIMs (>75%) Role diversification (in spite of increased need for classification experts) Perception of an ageing workforce and a general shortage of skilled and trained staff

5. Victorian Workforce 93% of HIMs/coders are female Just over 50% of HIM/coder workforce are under 40 (10% over 55) 43% of HIM/coders have worked in the field for more than 10 years (20% for 20+ years) 60% of the current Victorian workforce hold Bachelor degrees –17% Associate Diploma –16% HIMAA certificate 65% of recent entrants to the HIM/coder workforce hold a Bachelor degree, with the balance almost entirely HIMAA certificate holders

6. Victorian Workforce (cont.) 52% work full-time, 34% part-time or casual (23% have more than one job) An average of 25% of work time is spent on ‘other’ tasks –Deliberate variety in work or diversion of skilled resources? Typical coding rate per hour appears to be 4.5 – 4.75 records per hour Significant amounts of paid and unpaid overtime reported

7. Victorian HIM and coder labour market Estimated vacancy situation (from employer survey) –Approx. 40 FTE HIMs –Approx. 55 FTE coders Approx 30 HIMs working in Vic. Dep’t of Health –Shortfall skewed slightly to regional areas Typically, there are 30 new graduates from Latrobe University each year – not all enter hospital employment and then not all of those code. HIMAA trainee situation is less clear Very limited unused capacity in the labour market Health services have difficulty covering absences through annual leave etc.

8. Desirable attributes of coders From 2009 employer survey –Attention to detail –Medical terminology knowledge* –Anatomy and Physiology knowledge* –Ability to work unsupervised –Computer skills* –Analysis and interpretation skills* –Time management skills Blend of personal attributes and training*

9. Career image and status issues ‘Still working in the basement’ despite some recent advances Conflict in coding purity over DRG outcomes leads to pressure on coders Limited acknowledgement of expertise and skill What is the job about anyway? Difficult to attract suitable students Job image remains almost below the radar

10. Training issues and options Current annual output from all sources too small Options currently limited –further stand alone coding courses may be indicated –Post-grad. option? Four year course may be too long, particularly for specialist coders New grads require extensive on-the-job training –Internships, industry placements?

11. Training issues and options (cont.) Engagement by jurisdictions and health services/hospitals in training (e.g., DoH/Latrobe) –Advisory committees? Graduates lack practical experience, partic. exposure to real patient records Electronic aids (Code Finder) may or may not improve quality and speed – not avail. to all

12. Training issues and options (cont.) Marketing/positioning of courses –Competing options –Difficult to locate Consider career image and awareness/profile of profession Clinical costing? –Competition for staff –Training gap associated with ABF

13. Next steps Further analysis of the data Enlist assistance of Workforce Planning unit, Department of Health Closer engagement with Latrobe University, HIMAA, TAFE sector and other universities Interviews with recent grads/students Interviews at health services

14. Wrap up Shortfall exists but perhaps not as large as the perception Not enough entering the workforce Won’t go away as an issue ABF will drive increased demand(ABF is our friend) Issue is on the National agenda –Task is to make it a priority Lack of a national approach to training, remuneration

15. Wrap up (cont.) Clinical costing remains an issue Career image needs work – how to attract more entrants to the courses HIMAA course offers an option to equip coders relatively quickly, but further options may be needed Engage with universities and vocational sector Needs focus and action in all jurisdictions

16. Questions