Health Reform Brings Changes, More Work for HIM

Andrea Kraynak, for HealthLeaders Media , March 25, 2010

The legislation will also have indirect effects on HIM departments—for example, the sheer volume of their work. That's a lot more coding, a lot more requests for information, a lot more insurance companies to deal with, a lot more transcription. In fact, it means a lot more of almost everything HIM staff members manage on a daily basis.

"Where there is more volume, there is more work," Grzybowski says. "So there will be an impact on resources needed, which is unfortunate given the labor shortage already in existence for HIM."

"Unfortunately, that problem will probably continue for a while," Rode says. "But hopefully as we move toward increased EHR capabilities, that may help. ICD-10 may also help to make coding easier and more accurate as well by eliminating vague codes."

And that could be very important as the bill contains provisions for additional fraud and abuse. Providers have seen in the past that when the government looks into reducing waste and abuse, HIM departments tend to see additional auditing activity. Grzybowski believes this will be no exception.

"An increased emphasis on conducting audits, both internal and external, will occur as greater volumes mandate greater need for quality checks and controls," she says. "In addition, many of these audits will provide for recapture of reimbursement from providers to help fund the enormous expenses, which accompany this reform bill."

But whether the additional funding set aside in the Act will translate into new auditors or just increased volume by those already in existence remains to be seen. However, the government may simply expand the programs it already has (e.g., Recovery Audit Contractors), Rode says. He also believes the government may focus on auditing for deliberate fraud, as opposed to, for example, abuse in the form of coding errors.

Regardless, HIM departments will need to update their processes and increase their efficiency to keep up with patient volume increases, according to Grzybowski. This includes using technology to improve workflow, and electronic document management systems.

"Use of consultative and interim staffing resources should also increase due to both the labor shortage and the increasing use of technology," she says. "Overall, change management skills will also be essential."

HIM directors may come to appreciate the Act's emphasis on quality and having good data, both of which highlight the HIM department's role in managing information.

And finally, the reform could bolster hospital bottom lines, formerly hindered by receivable problems when patients couldn't pay for their care. "It could well stabilize healthcare organizations, which will be a positive in the long run for everyone," Rode says.

Andrea Kraynak, CPC, is senior managing editor of Medical Records Briefing and HIM Connection. She may be reached at

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