NSW Health Clinical Coder Education Recruitment Strategy Brenda

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

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

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)

Statewide Education Policy NSW Separations – Annual increase & projected growth (Aust Hospital Statistics: 2005 -6, 2006 -7, 2007 -8) 3, 100, 000 8. 0% 2, 866, 104 2, 900, 000 7. 0% 2, 700, 000 6. 0% 2, 500, 000 5. 0% 2, 300, 000 2, 100, 000 4. 5% 2, 000, 150 4. 0% 3. 5% 3. 0% 1, 900, 000 1, 700, 000 2. 0% 1. 9% 1, 500, 000 02 -'03 03–'04 04–'05 05–'06 Growth 06–'07 07–'08 Separations 08–'09 09–'10 1. 0% 10–'11 11–'12 12–'13 13–'14

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)

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

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

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?

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

Statewide Education Policy Proposal: Up-skilling – cont. 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 NSW Health RTO Training Co-ordinator Educator LHD Coach Educator LHD Coach

Statewide Education Policy Major concern: Matching VET requirements to industry needs Units of Competency • HLTCC 301 B Produce coded clinical data (Cert III in HA) • • Range limited to simple c/c situations e. g. Day Stay, Day Surgery HLTCC 401 B 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 HLTCC 402 B Complete highly complex clinical coding (Cert IV HA) • Range includes episodes in principal referral hospitals, specialist women’s & specialist children’s hospitals

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

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

Statewide Education Policy Challenges • Address employment conditions o Retention 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?

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

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

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. au • Maria Stephanou o Senior Policy Officer o Phone: 02 9391 9864 o Email: mstep@doh. health. nsw. gov. au