Business Case
As the coding supervisor, you have a staff of 9 who are responsible for NACRS coding. This involves coding all ED and dialysis visits. Some patients are discharged home after treatment in the ED and these charts are scanned. For patients who visit the ED and are admitted, the records have to be located before they can be coded since they are in paper format.
All ED visits and dialysis charts for a certain month have to be coded and the data submitted to CIHI with a 45-day turnaround time. For example, if the team was coding charts for the month of June, everything has to be completed by August 15, (45 days after the end of the month of June). Some coding is outsourced to an independent coding company each month since the team cannot complete the coding of all the ED and dialysis charts on a monthly basis.
Coders sign up to code one day of ED visits. This means that the individual coder will code all visits for that day for patients who were seen in the ED and sent home and for those patients who were seen in the ED and then admitted to hospital. Two team members code dialysis charts for five days each per month.[unique_solution]
Many coders have no issue coding the scanned charts, but they are reluctant to complete the “admits” as these charts are usually more complex. This coding is also very time-consuming since the charts are in paper format and, in many cases, they are unassembled. Time is spent trying to locate the physical charts and then code them. Some coders only code the scanned charts for the day that they signed up for, ignore the “admits” and move on to another day, leaving a huge backlog of outstanding “admit” charts that need to be located and coded at the end of each coding month. This not only slows things down, but it creates a significant amount of tension between those coders doing what is required and those that are not.
Even with a team of nine coders it is necessary to outsource the coding of many ED charts each month. The cost of this is significant and you have been informed that outsourcing has to stop within a few months.
It should be noted that there are two coders who prefer coding the “admits”. They enjoy the challenge of trying to locate the charts. They also work very well together as their own “mini-team”, and find the “admits” more interesting than the scanned charts. It also helps to keep their coding skills at a high level. They have suggested that they would like to take on coding all the “admits” each month. This which would enable the other coders to concentrate solely on scanned charts.
You want to see if this might work and if the team could meet the 45-day deadline with less stress on everyone. It might also allow the hospital to eliminate outsourcing.
You must prepare a business case for this based on monthly projections. To do so, you will need to determine work availability in order to see how many hours are available for coding along with current productivity levels.
The following information has been collected based on current productivity.
ED Admit 4.29 charts per hour/30 charts per 7 hour day
ED scanned 10.71 charts per hour/ 75 charts per 7 hour day
Days to code dialysis charts 10 days per month
The hours available are based on current shifts and take into account requested vacation time. Staff work an eight- hour day with one half hour for lunch and two fifteen- minute coffee breaks. It does not take into account any meetings or other duties during this time.
Attached are the spread sheets with the hours for each coder for a period of three months. With both the hours and the productivity rates you can now calculate how much time is required to code the ED, ED admit plus MH, and the dialysis charts for each month. Coders 1 and 4 will locate, pull, code and abstract all ED admits if your business case is accepted.
Assignment
Using the CHIMA PPB, Writing a Business Case, as a guide, prepare a business case for this. As a note of caution, keep your recommendations realistic based on the facts you have. Don’t, for instance, suggest that all records be scanned to make it easier for the coders or that the hospital purchase a CIS. That is beyond the scope of this project.