from salary to STRESS levels, INPATIENT CODERS, Reveal themselves
By Linda Gross
With tentative Health Insurance Portability and Accounta-bility Act (HIPAA) compliance deadlines looming, providers are becoming increasingly concerned with the accuracy of ICD-9-CM coding, which determines diagnostic related group (DRG) assignment. And yet the HP3 Research Institute, a Bethlehem, PA-based non-profit health care research firm, decided to study–not coding–but the coders themselves who perform this critical function. Coding may become increasingly automated, but ultimately, accuracy rests on the shoulders of those individuals whose work so closely impacts the “financial viability of every acute care hospital in the nation,” according to HP3.
Surveying a generic sampling of acute care facilities across the country, HP3 received responses from 633 inpatient coders in 194 hospitals. The two-page, 22-question survey featured questions on job experience, education/credentialing, workplace environment, salary and demographic information. And while some findings were predictable (more women code than men and credentialed coders are paid more than non-credentialed coders), others were surprising (there’s a correlation between high job satisfaction and low advancement opportunities). Most findings, however, reflect a definitive change in the industry that will mark the years to come in health information.
Still female, today’s coder is maturing. More than 75 percent of the respondents surveyed were older than 35. She is a Caucasian, full-time employee with more than 10 years of coding experience, and there’s a 78 percent chance she has been at the same hospital for more than five years. There’s a good chance she has registered health information administrator (RHIA), registered health information technician (RHIT) or certified coding specialist (CCS) credentials (see Table 1). Seventy-six percent of the respondents have credentials, and 63 percent of all coders have earned an associate’s degree.
On average, the coder earns an hourly wage of $15.13, a figure the survey cites as “inconsistent with a high demand and low supply of coders in the industry.” Of course, this is a highly subjective number, given the hourly salary range was between $6 and $44, one of the largest ranges in the health care profession (see Table 2).
One explanation for the seeming breach of supply and demand laws appeared in the Feb. 7, 2000, issue of ADVANCE (“Where Have All the Coders Gone?”). From a budgeting standpoint, HIM services is viewed as a “non-revenue generating” department, therefore, the lack of return makes it difficult to budget additional monies for salaries.
But this line of thinking bothers Karen Rosendale, RHIA, senior director of health information management (HIM) at Columbia Presbyterian in New York City. “People always want to give credit to patient financial services (PFS) or billing departments. How do you get the climate of the culture to accept the reality that PFS isn’t solely responsible for bringing in the money?” Even though Rosendale’s HIM department doesn’t “receive the checks,” she called coding “an integral part of hospital reimbursement.”
Rosendale suggested that coders earning $10 and under may be in some type of training program, although, she admitted, “I’ve never heard of a hospital paying that low.” Linda Williamson, coding coordinator at Henry Medical Center in Stockbridge, GA, agreed. “It is way out of line for the demands of a coder’s job,” said Williamson, who suggested that the $6 to $10 hourly wage “may reflect a job that is not entirely coding.”
At the other end of the spectrum, Rosendale and Williamson both agreed the $44 per hour figure represents specialists’ wages, contract coders or even consultants. “[Outsourcing] does seem to be a trend that hospitals are moving toward,” said Williamson. The other possibility Rosendale raised for both the extremely high and low figures is that respondents provided a per-chart figure instead of an hourly rate. “Some coders may have calculated $44 based on being paid $11 per chart,” Rosendale speculated, “and they know they can average four charts per hour.” But Rosendale doesn’t think that many hospitals pay coders on a per-chart basis.
Of course, a number of factors impacted wage. Geographic region, coders’ credentials and whether the coder worked in a teaching institution all played a part in coders’ earnings, according to HP3.
And lower wages didn’t always correspondent to lower stress levels, either. As shown in Table 3, more than 60 percent claimed to be under “significant stress” in what the survey called “loud environments.”
“Coders don’t usually get their own office,” Rosendale pointed out. “In many institutions, coders are lumped into a central work area surrounded by people making requests, telephones ringing…somebody in the master patient index (MPI) has to look up a number…they can hear all these conversations.” This may sound like a typical workplace, but as Rosendale explained, the high level of concentration necessary for this analytical job may make coders more sensitive to daily distractions.
In addition to the noise factor, Williamson added, “Stress also comes from the demands of trying to keep up with seemingly constant changes in Medicare billing regulations and yearly updates to both ICD-9 and CPT, too abundant to memorize. Transposing numbers and leaving off fifth-digits are serious errors for coders.”And there is room for error. “There are a lot of gray areas,” said Williamson, “no matter how many times Coding Clinic, CPT Assistant and Medicare bulletins try to clarify issues.”
But the one question HP3 didn’t ask was, “Why do coders continue to code?” However varied the responses may be for compensation and stress level, the survey did indicate that, overall, coders derive job satisfaction from their work and consider themselves knowledgeable, highly skilled professionals (see Table 4). Although a self-assessment, it is a reassuring assertion of confidence from those in a profession marked by rapid technological advancement and government intervention certain to contribute to climate changes in the months and years to come.
* For more information or complete survey results, contact HP3 at (610) 332-2990, or visit the HP3 Web site at www.hp3.org. *
Linda Gross is an editorial assistant at ADVANCE.