ICD-10 will cause a temporary drop in coding productivity of 50 percent and a permanent drop of 20 percent. Many hospitals are taking a blended approach to addressing this gap, using technical improvements and other strategies to avoid having to double their coding workforce. Still, there is no doubt that the simultaneous transition to ICD-10 in every hospital and physician practice in the country will produce an extreme strain on the availability of resources.

Even before ICD-10 was introduced, experienced medical coders were in demand. In a Salary Survey conducted for for AAPC in 2010, Wells and Ericson found that, while overall unemployment was near 10 percent nationally, unemployment for credentialed coders was significantly lower – between 5.6 and 6.8 percent. Even if the 6.8 percent of presumably available coders are ready and willing to code ICD-10 charts, it won’t come close to meeting the nationwide demands. As a result, there is a real risk to hospitals and physician practices that enough coding resources simply won’t be available on October 1, 2014.

As a result, we expect hospitals to see at least three key pressures on their coder staffing level over the next year:

• The best trained and most experienced coders will be recruited heavily by the national coding outsourcing firms. Ironically, these same firms will be standing ready to sell you back those resources at a profit.
• The overall salary of experienced coders will rise significantly as competition heats up for those resources.
• Some smaller percentage of coders will choose to leave the workforce rather than re-train for ICD-10.

Strategies

To mitigate these risks and to avoid having to use expensive outsourcing resources to meet coding needs, hospitals should consider using a blend of human resource strategies to support recruitment and retention in the coding workforce.

These strategies include:

Initiatives to improve the perceived quality of the work environment. Many hospitals are introducing work-from-home strategies, increased flexibility in shift scheduling, and increasing opportunities for public recognition of the coding staff as ways to encourage coders to remain in / join their teams.

Increasing salaries. The drive to add coding resources will most certainly cause a general rise in coder salaries nationwide. Healthcare providers in competitive urban environments will probably feel this more, but the proliferation of national coding vendors with work-from-home programs means that even the most rural institutions will see salary pressure.

Retention plans. The coders most in demand will undoubtedly be the most experienced and most highly trained. The very act of training your workforce for ICD-10 makes them all that more attractive to your competitors. Those senior resources already trained as ICD-10 trainers are particularly at risk. Several hospitals I’ve worked with have trained their supervisor-level coders to be ICD-10 trainers, only to lose them immediately after training, to a competitor.

Many hospitals choose to make their retention plans a penalty – if you leave the workforce before a certain date, you repay the cost of your ICD-10 training. This is a valid approach, but goes against the previous suggestion that you work to improve the coder’s perceptions of your workplace. Also, national coding vendors recognize that many coders are under such provisions, and do not consider paying the penalty as an obstacle, in order to fill their own positions.

A more positive strategy to consider is paying coders a retention bonus. Many employees consider the loss of a bonus to be a stronger motivation than a penalty. The possibility of a bonus will likely improve perceptions of loyalty, and a competitor for your staff is probably less likely to provide matching of potential bonuses as a hiring incentive.

The same strategies that improve work/life and employee perception, are effective during recruitment. Employers have always recognized that current, happy employees are one of the best sources of leads for new hires. By focusing on improving the quality of work and the work environment for existing employees, and providing recruitment bonuses to current employees, hospitals can maximize the value of this important internal resource.

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