Incentive system for coders in medical records

Micro-level incentive Systems correlate operator speed & quality to compensate in a piece-rate environment. Since quality and speed are difficult to measure in hospitals, micro-level incentive schemes are difficult to develop. However, due to a high turnover and low productivity level of coders in the Medical Records Department at Georgetown University Hospital, it became apparent that an incentive system would be the only feasible solution to the problem. In the Incentive System, quality of each chart is tested using 25 indicators, each of which have been assigned weights. The weights were developed using a software package called “Expert Choice”. A Double Sampling Plan is used to determine the size of the sample to be inspected for quality. The speed requirements for the System were assessed via a survey conducted in the Coding section of the Medical Records Department to collect relevant information on each chart which included the financial class, length of stay (LOS) and time to code. This data was analyzed using a SAS package to identify any significant relations between the experience of the coder at GUH, LOS of patient/chart and time to code a chart for the two financial classes third party payors -- federal and non- Federal (Medicare & Medicaid and all others resp.) It was determined tat the time to code a chart varies with the LOS of the chart in each financial class and the experience of the coder at GUH. An initial analysis identified a “pure” Incentive System--one in which the speed varied proportionately with operator's pay. However, it was decided to develop a hybrid plan. This plan would pay a coder 100% of base pay if the performance of the coder was within acceptable levels of the prescribed standards; 100% of base pay plus incentive pay if the performance was above prescribed standards and 100% of base pay with disciplinary action for performance below acceptable levels of standards It is hoped that the proposed Incentive System will not only attract and retain qualified Coders to GUH, but also enhance the overall productivity of the Coding Section. A microcomputer based software package as been developed to accurately administer the Incentive System.