We interviewed HIM leaders from across the nation to find out the secrets to their success. Lou Ann Schraffenberger, Manager of Clinical Information at the Advocate Health Care, discusses the challenges of centralization, data-driven decision-making, and how to build a strong HIM team.
What are your top day-to-day challenges facing you and your organization today?
One of our biggest challenges is standardization. Though we’re all in one geographic state here, the culture of each hospital can be very different. Our challenge is getting people to consensus. The stress of the unknown can make it harder to commit, but we work together until we can agree.
HIM has changed so much in the past thirty years. Before DRGs became the method for payment, medical coding wasn’t that important. We did the coding when we got around to it. But now, with the pressure of timely filing of claims and reimbursement rules, we code right away. The documentation in the records is extremely important, and all coding must be done within 3-4 days of discharge or visit.
And in the past, HIM departments had their own structure and function. Each hospital did it their own way. But now, we know we can’t do it alone anymore. We’re trying to standardize, work together and share resources.
What we’re working toward is a general sense of best practices. We look at how each of our 12 hospitals does something and make sure we’re all choosing the best way. We did this, for example, with staffing practices. We have an imperative to be efficient — like many hospitals, we don’t have a lot of extra funding. We’re successful because we make sure every penny counts. So we look for ways to standardize optimal staffing levels across all our hospitals.
What strategies do you use to tackle these challenges?
We’re a data-driven organization. We don’t make any decision unless it’s backed up by evidence. In addition, we’re dedicated to taking care of our patients, making sure they are well and happy with how they’re treated. Those both drive our strategy.
For example, one of our biggest initiatives is patient safety. Each department has goals to make sure patients are as safe as possible. For us, in the HIM department, we want to make sure each patient’s record is accurate and has the most precise information to keep patients safe in the future. We have safeguards to prevent duplicate records, accuracy standards to ensure correct information, and strict coding deadlines to make sure our billing cycle flows smoothly. If any information is inaccurate, it can be unsafe for the patient. This also requires us to collaborate with other departments. So, we put a lot of effort into centralizing the process and into making sure our coding is stellar.
We’re also successful because we’re firm believers in education. We continually monitor the coding process. We spot-check our records to ensure the coding performed meets our standards. We also implement external reviews that give us a strong idea of how we’re doing. These internal and external reviews inform our education initiatives.
Also, often our interaction with third-party payers can inform our education process. We take a look at coded claims returned to us and analyze whether or not they are making good arguments about our coding. When they are, we bring them back to our coders and use the challenge as a way to make sure we’re continually improving.
What is your secret to your success as a HIM Director?
I’m dedicated to fostering teamwork. I know the HIM leaders and coders can’t go it alone. We have a good mix of seasoned and new associates. We make sure our experienced employees offer a helping hand to new folks so that no one is out there doing something they don’t know how to do. We work to encourage trust between coworkers so they can always reach out to ask for help.
We call it “Behaviors of Excellence.” We try to always be respectful and kind to each other and build strong camaraderie within the Advocate team. It’s a matter of being honest, transparent, and thoughtful.
When I think of a successful HIM Director, I think of someone who knows how to work with other people, including your employees, physicians, administrators, clinicians, and the patients. This is a job that you can’t do alone. Being a successful HIM Director really depends on having a partnership with the good people you work with, recognizing and drawing on other associates’ strengths, and sharing your expertise. This makes the strongest team possible.
Looking for more on how to make your hospital function more smoothly? Check out our eBook on how to reduce lost revenue in your HIM department.