Dear HIM-Interchange readers Welcome to the third Issue for 2017. I know many of you who have private health insurance will be familiar with that feeling you get when you receive your annual letter notifying you that your premium is increasing.According to the latest figures from the Australian Prudential Regulation Authority (APRA), nearly half of the Australian population (46.5%) have private hospital treatment cover, and over half (55.5%) have some form of private general treatment cover (APRA, 2017). During the March 2017 quarter, insurers benefits for 2.85 million days in hospital, arising from 1.10 million hospital episodes of care (APRA, 2017). With this volume of activity, the private health sector and its developments are of interest to us not just as consumers who have policies, pay premiums, and utilise private health care, but also as a profession.
The health industry is under huge cost pressures in both the public and private sectors. The public sector manages demandand restricts supply though waiting lists. As an uncapped funder of health services, the Private Health Insurance (PHI)sector has difficulty in managing demand and increasing provider capacity, leading to cost pressures and increasingpremiums. This is the financial consequence of meeting uncapped demand. As a result, health insurers are questionedbecause their premiums are rising at rates greater than inflation.
Osteoporosis is recognised as a National Health Priority Area in Australia, owing to the significant burden of associated disease. One in four men and two in five women aged 50 years and over will experience some form of osteoporotic fracture in their lifetime (Australian Institute of Health and Welfare, 2014). These fractures occur after little or no trauma, such as a fall from standing height. They are also known as “minimal trauma” or “low impact” fractures. Osteoporotic fractures are associated with increased morbidity and mortality and risk increases with the number of fractures sustained (Center et al., 2007). With their high prevalence and associated costs, accurate data on health service utilisation for these fractures is important to researchers, policy makers, and hospital managers for planning and resource allocation.The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, AustralianModification (ICD-10-AM) is used to capture the diagnoses in the admitted patient data in Australia. The purpose of this article is to describe the limitations of using ICD-10-AM codes for surveillance of osteoporotic fracture and to encourage discussion of some emerging clinical coding issues.
Under contract by the Independent Hospital Pricing Authority (IHPA), the Australian Consortium for Classification Development (ACCD)1 has over the last four years been responsible for the development and refinement of the Australian Refined Diagnosis Related Groups Classification System which has two classification components:
- The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), the Australian Classification of Health Interventions (ACHI) and the Australian Coding Standards (ACS)
- Australian Refined Diagnosis Related Groups (AR-DRGs) This report will provide an overview of the development of the Tenth Edition of ICD-10-AM/ACHI/ACS, which was implemented for use in Australian hospitals for clinical coding of admitted episodes from 1 July 2017.
In 2013, the Independent Hospital Pricing Authority (IHPA) initiated a review to assess long-term options for the classification of emergency care services for activity-based funding in Australia. A major objective of the approach to classifying emergency care services in Australia was to drive efficiency and effectiveness of these services through pricing and funding.This is underpinned by the collection of data that also support clinical care and other uses such as quality improvement, epidemiological monitoring, and health services research.
Clinical Coders (CCs) become the bystanders of a patient’s journey through the hospital system. They are required to read a large amount of clinical documentation in order to abstract the diagnoses and procedures and translate this information into codes. Much emphasis is placed on CC performance, especially in the areas of quality and output, and while these are important, the emotional aspects of the job appear to have been overlooked. This article illustrates that the changing demands on the coding workforce since the advent of activity based funding has made them vulnerable to the possibility of burnout and a form of compassion fatigue.
I completed a Masters of Health Information Management at La Trobe University, Melbourne, graduating in 2015. Like many other Health Information Managers (HIMs), I came to the profession in a roundabout way. Initially, I studied a Bachelor of Arts in English Literature and a Graduate Diploma in Library and Information Studies, so I was a was a qualified Librarian for 10 years before undertaking a career change to become a HIM. My first job in the health information management profession was in clinical coding at Prince Charles Hospital, Brisbane, before undertaking my current role with West Moreton Hospital and Health Service.
As a health information management professional in a private health fund, I realise the opportunities are endless for Health Information Managers (HIMs) and Clinical Coders (CCs) in this industry. For many years I have worked in a hospital setting, so starting at CUA Health was an interesting change. My very first job in health information management (I did not know at the time that this was essentially health information management, as it is not recognised as such in South Africa) was as a clinical coding specialist and the manager for the coding auditors at Discovery Health in South Africa. This role had a strategic focus in the Risk Management Division. Working on payment models based on Diagnosis Related Groups (DRGs) and casemix, I was instrumental in building an in-house coding tool, similar to 3M Codefinder, as there was no coding tool available in South Africa. This software was later made available to other users in the industry and some private hospitals. I was also part of the team working on Coding Standards for South Africa.
In October 2015, a few months before my graduation from La Trobe University, I became the successful applicant for the Health Information Manager (HIM) position at South West Healthcare (SWH) Warrnambool in regional south-west Victoria. The primary focus of the role was as Freedom of Information (FOI) Manager and HIM-Clinical Coder (HIM-CC). The eight HIMs and one CC who service the network are primarily based at the Warrnambool Base Hospital, the largest of SWH’s four campuses. One of the HIMs is contracted to the other three SWH campuses, with the guidance of the two senior HIMs. I will now take you on my personal journey and share my perspective as a new graduate, from the job application process to the end of my health information management graduate year. I hope my experiences will inform future graduates and their employers.
While searching the Internet for an article recently, I came across an article by Google Australia’s Engineering Director, Alan Noble. His topic struck a chord in his opening line: “…in the corporate world there are few more irresistible – and dangerous – forces than inertia. On the road to success lie the carcasses of countless companies whose dying words were ‘but that’s how we’ve always done it…’” (Noble, 2017). This caught my interest, as I often puzzle over how the human services sectors can be so busy and so inert at the same time. Noble argued that, once an organisation gets to a certain size and maturity, the temptation to “stay put” in a state of inertia is strong (inertia being described as “the tendency of things to keep going at a certain velocity”). But the world around the organisation is anything but inert, and to stay relevant and thrive in a changing environment, innovation is a key element.