HIM 440 Module 2 Current Issues Short Paper Example

Four Pressures on One Department: Current Issues in Health Information Management at Kettle Creek Medical Center

[Student Name]

Southern New Hampshire University

HIM 440: Management of Health Information Services

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Four Pressures on One Department: Current Issues in Health Information Management at Kettle Creek Medical Center

A new health information director inherits every problem at once. At Kettle Creek Medical Center, the first month brought calls from the chief financial officer about unbilled accounts, from the medical staff office about delinquent records, from the compliance officer about coding accuracy and from coders worried about their jobs. This paper summarizes the department's current issues in four areas, staffing, departmental relationships, productivity and compliance, and ranks them by the risk they pose to the hospital and its patients.

Where the Information Came From

The summary draws on four sources gathered during the director's first month: the department's productivity and backlog reports for the last quarter, human resources data on vacancies and departures, the most recent external coding audit and a series of one-on-one conversations with every supervisor, six coders, two documentation specialists, the chair of the medical records committee and the director of patient financial services. The conversations were as important as the reports, because they revealed how each group understands the same problems differently.

Staffing

The department has 44 positions and ended last year with 24% turnover, concentrated among coders and release of information specialists. Since 2021, 61% of coders have worked from home, which widened the hiring pool but also made it easier for coders to leave for remote jobs elsewhere. Two coding positions have been open for four months. Remote work is not the problem in itself. Bloom et al. (2015) ran a randomized experiment at a large call center and found that employees working from home were more productive than office colleagues and quit at about half the rate, although some later chose to return to the office for social reasons. At Kettle Creek, remote coders have had no regular team contact, no clear path to advancement and pay that lags the regional market, which may matter more than where they sit.

Departmental Relationships

Three relationships are strained. Coders and clinical documentation specialists disagree about query practices, and coders say documentation specialists send them charts before physicians have answered open queries. Physicians resent reminder calls about incomplete records, which they see as clerical pressure, while the health information team sees incomplete records as a compliance risk the physicians created. And the patient financial services department blames health information for the unbilled balance, even though about a third of held accounts are waiting on documentation from physicians, not on coders. Each group sees its own piece of a shared process.

Productivity

Table 1 summarizes the department's main productivity measures against internal targets. The largest gap is in unbilled accounts: discharged accounts not yet coded and billed total about $7.4 million, roughly 5.6 days of average daily revenue, against a target of three days. Scanning of paper documents runs three days behind, which delays coding for some accounts, and release of information requests take nine days on average.

Table 1. Productivity Measures, Last Quarter

Note. Department reports for the last quarter; composite data.

Compliance

Compliance issues carry the highest external risk. Delinquent records currently exceed the threshold the hospital uses to meet accreditation expectations, which ties delinquency to average monthly discharges, and an accreditation survey is expected within ten months. The most recent external coding audit found 91% accuracy for principal diagnoses against a hospital target of 95%. O'Malley et al. (2005) showed that coding errors arise at every step from the patient's encounter to the coder's reading of the record, so the audit's errors may reflect documentation as much as coding skill. Release of information must also meet federal deadlines. HIPAA generally requires a response to a patient's access request within 30 days, and Lye et al. (2018) found that many leading hospitals gave patients inconsistent information about formats, fees and timing. Kettle Creek's nine-day average meets the deadline, but a spot check found two patient requests quoted fees above federal guidance.

How the Issues Connect

The four areas are linked. Vacant coding positions and slower productivity raise unbilled accounts, which strain the relationship with patient financial services. Physician delinquency slows coding and threatens accreditation at the same time. The scanning backlog affects both coding and release of information. Turnover makes every other problem harder, because new staff need time to reach full productivity and accuracy. A plan that treats each issue alone will miss these links.

Ranking the Issues

Ranked by risk, record delinquency comes first because it threatens accreditation, which the hospital cannot afford to jeopardize. Coding accuracy is second because errors carry compliance and financial exposure. Unbilled accounts are third, since they strain cash flow but are partly outside the department's control. Staffing and turnover are fourth only because their effects are indirect, although they feed every other problem. Relationships and release of information fees come fifth and sixth, and the fee errors can be corrected immediately through retraining.

Early Actions Within Ninety Days

Some issues can be eased while longer plans are developed. The director will correct the release of information fee schedule and retrain staff within two weeks, since the fix is simple and the risk is real. A weekly huddle between coding, documentation integrity and patient financial services will review the list of held accounts together, so each group sees which accounts wait on physicians and which wait on coders. Remote coders will be brought together monthly, in person or by video, and the director will ask human resources for a market pay review for coding positions. Finally, the medical records committee will receive a monthly delinquency report by physician, which gives the chair the information to address outliers directly rather than leaving reminders to clerical staff. None of these steps solves a root cause, but each lowers risk or builds trust while the milestones develop a fuller plan.

Conclusion

Kettle Creek's health information department faces pressure from every direction, but the pressures share causes: vacancies, a documentation process split across groups that do not trust each other and measures that nobody reviews together. The next milestone will define benchmarks for each area and gather the data needed to plan improvements, starting with delinquency and coding accuracy.

References

Bloom, N., Liang, J., Roberts, J., & Ying, Z. J. (2015). Does working from home work? Evidence from a Chinese experiment. Quarterly Journal of Economics, 130(1), 165-218. https://doi.org/10.1093/qje/qju032

Lye, C. T., Forman, H. P., Gao, R., Daniel, J. G., Hsiao, A. L., Mann, M. K., deBronkart, D., Campos, H. O., & Krumholz, H. M. (2018). Assessment of US hospital compliance with regulations for patients' requests for medical records. JAMA Network Open, 1(6), Article e183014. https://doi.org/10.1001/jamanetworkopen.2018.3014

O'Malley, K. J., Cook, K. F., Price, M. D., Wildes, K. R., Hurdle, J. F., & Ashton, C. M. (2005). Measuring diagnoses: ICD code accuracy. Health Services Research, 40(5, Pt. 2), 1620-1639. https://doi.org/10.1111/j.1475-6773.2005.00444.x