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Reap unexpected benefits by centralizing your HIM department

JustCoding News: Inpatient, April 14, 2010

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Memorial Hermann Healthcare System (MHHS) in Houston includes nine acute care hospitals, one children’s hospital, three long-term acute care hospitals, three specialty care hospitals, 21 regional affiliates, a home health agency, a retirement/nursing center, 10 ambulatory surgery centers, 21 imaging centers—and only one HIM department.

Prior to July 1, 2008, however, that was not the case. MHHS’ medical records/HIM departments used to be facility-based. Each hospital had its own medical records department, its own coders, and its own vendors. But MHHS’ leadership recognized that in an era when cost savings are a must, this model was not as efficient as it could be. A restructuring of the department was in order.

So MHHS centralized the medical records departments and made the HIM department function-based, instead of facility-based, in which each facility has its own medical records department that functions alone, says Anna Wheeler, MPH, RHIA, CCS, director of coding services at the healthcare system.

“There was no need for us all to have separate coders, separate analysis, and separate release of information staff,” Wheeler says. “It just made more sense that medical record analysis is done for every facility by a group of analysts, and the coding is done for all the facilities by the coders.” Now, the coders are together in a pool and code for all of the hospitals.

For MHHS, a centralized model fit into its long-term strategic plan for organizational excellence, says Lisa Coleman, MHA, RHIA, director of HIM scanning operations at MHHS. So one by one, MHHS phased in each of its facilities. 

Better than expected benefits

The benefits MHHS experienced turned out to be greater than it planned. For example, its cost savings were higher than anticipated. “We actually saved more than we promised to save with the transition,” says Wheeler.

Where did the savings come from?

The restructuring saved salary dollars along with supply costs, says Kristi Novosad, RHIA, director of HIM operations, HIPAA, and release of information billing at MHHS. But MHHS also saved more than $1 million by rolling out one transcription platform to all of its facilities.

“Many were using different systems,” Novosad explains. “Some were using the same vendors in some cases, but they had different pricing because of volume differences.”

So the health system chose one platform that was particularly flexible and then negotiated six transcription contracts to handle all of its hospitals. Doing so allowed MHHS to negotiate a much more reasonable pricing, Novosad says.

In addition, MHHS implemented voice recognition and is now at 85% voice recognition. It also saved some money by using a single storage warehouse.

“Whenever we brought in a new hospital, whatever storage they were using, they moved their records and stored theirs centrally in our warehouse,” Novosad says.

Restructuring also improved productivity and efficiency. “Instead of having staff at all the various locations, we could pool all our resources together as one unit together in one location,” Coleman says. “That helped with productivity and work flow.”

The centralized HIM structure also helped increase standardization across the system. “Standardizing procedures so they’re the same at each of our facilities has made a huge difference for the physicians and HIM staff members,” Novosad says. “This way there’s no guesswork about what is required.”

And it allowed for forms and applications to be standardized as well, instead of being varied from facility to facility, says Coleman. The new centralized approach allowed everyone in the healthcare system to do things the same way. Standardization also makes it easier to cross-train staff members from one hospital to the other to help overcome staffing problems.

Currently each coder continues to work primarily for the facility he or she worked for prior to the transition. “So if they were at the large teaching hospital, they still code for the large teaching hospital. But if we get into a bind we have a whole pool of coders,” Wheeler says.

Instead of scrambling when both of the inpatient coders for a particular hospital are out sick or on vacation, she now has 30 other inpatient coders from which to draw.

Certainly some cross-training needed to occur, and Wheeler says initially some extra education was needed to bring everyone up to the same speed. But now she has coders who can move to any of the other hospitals and code for them if need be.

And don’t forget about the benefit of system-wide accessibility to patient information, Coleman says. Once facilities are migrated into the health system’s electronic record system, information is available online and is accessible to all the users who may need it (e.g., caregivers, or staff members who need access for release of information purposes, billing, coding, and research). 

Advice from the trenches

Don’t expect the transition to be easy, but it can be done, says Novosad. Consider the following tips from Novosad, Wheeler, and Coleman, who lived to tell about MHHS’ transition:

  • Bring everyone to the table. Get everyone involved and make the transition a team effort. This will help you get buy in, not to mention you may be able to come up with a process that works well for everyone involved, Coleman says.
  • Keep an open mind. “Be open-minded and embrace the change so you don’t get caught off-guard or left behind—because it is going to happen,” Novosad says. “It makes operational and financial sense. So be open-minded so you can be a leader and help implement that in your particular organization.” Wheeler agrees: “You do have to keep an open mind because it’s a long journey and it’s not going to be perfect at first; it’s a work in progress.”
  • Consider alternative points of view. “Especially if you’ve got multiple facilities, you’ve got to really get in there and look at things from the end user’s standpoint,” Coleman says. “We as medical records personnel may put in the medical chart one way, but the mind-set of clinicians might be a little different as to where they would find something or look for something.”
  • Set realistic goals. “You have to set realistic goals as far as your staffing and productivity,” Coleman says. Move forward aggressively, but in reasonable steps.

Novosad says to remember that the transition could be difficult in ways you never anticipated for some staff members. For example, it turned out to be difficult for some employees not to have a director or manager on-site. “No one wanted to let go of their individual attention,” she says. “So that was tough to prove that nobody was going to be left behind.”

On the other hand, some of Wheeler’s coders also found their work received more attention under the new centralized model. “When you’re in a medical record department, coding is important, but it isn’t the only area to focus on. But with a coding department, that’s what we do, and it’s the only focus,” she says.

Wheeler notes that the current model also lets her more easily identify areas that need improvement. “But the coders sometimes feel that they are probably under more scrutiny than if they were lost somewhere under a medical record department,” she says.

Editor’s note: This article was originally published in the April issue of Medical Records Briefing. E-mail your questions to Senior Managing Editor Andrea Kraynak, CPC, at akraynak@hcpro.com.

 



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