Introduction

Across all industries, organizations recognized for their excellence have commonalities in their human-relations capabilities: most of their employees exceed job performance expectations, their existing staff are groomed to assume nearly all key positions up the line, and hiring managers are increasingly satisfied with the people they have hired. Excellence is attributed to the human relations (HR) structure and the processes that keep talented people skilled and contributing to the bottom line. Originally quantified by The Aberdeen Group in 20151, this finding is reinforced by Career Step, a premier online education provider that helps employers by focusing on successful hiring, career progression, and workforce development.

A key feature of continuing success in superior organizations is the consistency of HR approach that selects talent. Pre-hire assessments are used in 45% of best-in-class organizations for the purpose of defining the pool of strong candidates, according to Aberdeen. Career Step’s research indicates that only 22% of provider organizations use an automated pre-hire assessment, while the rest use either a manual process or none at all.

The cost of a resource-intensive manual process or of doing nothing is high. There are real costs for the overall time a company is without staff in a vacant position. Add to that the recruitment cost and employee onboarding time for staff who stay with the company, let alone repeating the cost in case of a wrong hire, and there is a real business case for pre-hire assessments.

1 Lombardi, Mollie, and Aberdeen Group. Assessments 2014: Consistency is key. May 2015, accessed April 13, 2016. www.aberdeen.com

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Workforce Trends

For the first time in our history, the American workforce has five generations actively participating. There have always been members of any leading generation who elect to continue working, but economic forces have kept members of today’s oldest generation—the Traditionalists (also known as The Greatest Generation), those born before 1946—working longer than in the past. The Traditionalists, however, will represent only 1% of the workforce in five years. Additional employment projections provided by the U.S. Department of Labor Bureau of Labor Statistics also indicate that the Baby Boomers, those born from 1946 through 1964, will represent about 22% of the workforce in 2020, down from 30% today.

Within the next five years, two generations will comprise most of the workforce. The Generation X group, those born from 1965 through 1981, will remain largely static—currently making up 23% of the workforce, this number will drop to about 20% in 2020 due to their low birth numbers. As the Baby Boomers exit the workforce, Gen X will assume workforce leadership. The work style of Gen X’ers is characterized by independence, self-development, and work commitment. Their children are the Millennials (born between 1981 and 1996), a much faster-rising generation.

Looking at the graph of the Millennials’ representation in the workforce, it is apparent that in five years they will make up more than half of the workforce. Already, Millennials are the largest living generation; according to Pew Research Center analysis, they surpassed their Baby Boomer grandparents in 2015.2

Millennials have great expectations: they want workplace flexibility and mobile access, they expect work/life balance, they expect to be paid well, and they expect good health and the means to pay for it.3

Source: https://hbr.org/2009/10/are-you-ready-to-manage-five-g

Five Generations in the Workplace

2020

2020

2020

2005

0%

Bureau of Labor Statistics Employment Projections

20% 40% 60%

Gen 2020 Millennials Gen X Baby Boomers Traditionalists

2

The youngest generation, Gen 2020 (also named iGen and Generation Z)—born from 1997 through 2012—representing about 1% of the workforce today, will grow to about 7% by 2020. Gen 2020 shows evidence of many of the characteristics of their Baby Boomer grandparents’ work ethic. They believe in the American Dream, but they believe it is up to them to make things happen. They show promise of outperforming their Millennial parents.4

With five generations in the workforce and national unemployment predicted to be below 5% in 20165, there are not only challenges in managing a multi-generation workforce, but skilled staff are also increasingly hard to find and retain.

The American Health Information Management Association (AHIMA) projects that 6,000 HIM professionals will be needed each year to fill new positions and replace Baby Boomer retirements. AHIMA most recently estimated in 2005 that only 2,000 new graduates enter the HIM field annually.6 The Bureau of Labor Statistics, however, estimates that this field will grow by 15% a year through 2024.7

In this tight job market, best-in-class organizations have developed strategies to replace and prepare younger staff to fill their vacant positions.

2 Fry, Richard. Posts. Millennials overtake baby boomers as America’s largest generation. April 25, 2016, Accessed May 12, 2016. http://www.pewresearch.org/fact-tank/2015/01/16/this-year-millennials-will-overtake-baby-boomers/

3 Desal, Anna. Scanning the HIM environment: AHIMA’s 2015 report offers insight on emerging industry trends and challenges. Journal of AHIMA; vol. 86, issue num. 5; May, 2015; Accessed April 12, 2016. http://bok.ahima.org/doc?oid=107636#.VsJ7ovkrJD

4 Meister, Jeanne C., and Willyerd, Karie. Generational issues. Are you ready to manage five generations of workers? Oct. 16, 2009, accessed April 12, 2016. https://hbr.org/2009/10/are-you-ready-to-manage-five-g

5 Bureau of Labor Statistics data. Employment projections program. May 2016; accessed May 12, 2016. http://data.bls.gov/timeseries/LNS14000000

6 by the American Health Information Management Association. The future of health information management. 2005, accessed April 12, 2016. http://bok.ahima.org/PdfView?oid=28655

7 Medical records and health information technicians: Occupational outlook handbook: U.S. Bureau of labor statistics. Dec. 17, 2015, accessed April 13, 2016. http://www.bls.gov/ooh/Healthcare/Medical-records-and-health-information-technicians.htm#tab-6

Percent change in employment, projected 2014-24

Note: All occupations includes all occupations within the U.S. Economy.

Source: U.S. Bureau of Labor Statistics, Employment Protections program

Medical Records and Health Information Technicians

Health technologists and technicians

Medical records and health information technicians

Total, all occupations

16%

15%

7%

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Technology Assisted Assessment

In 2015, AHIMA recognized several influences in the competitive market for medical coders, medical transcriptionists, and clinical documentation improvement (CDI) staff. The data is growing increasingly sophisticated and requires an educated workforce. According to AHIMA research8, an estimated 80% of medical data is clinically relevant, and it comes from EHRs, lab and imaging systems, physician notes, medical correspondence, and other sources. AHIMA confirms that there is a growing shortage of HIM professionals, including the highly skilled medical coders who practices rely on to correctly bill for provided medical services.

In addition to the increased complexity of information that staff must interpret, the shifting demographics of the workforce will require 28,000 new HIM professionals by 2024. The market is going to pay well for good coders, medical transcriptionists, and CDI team members.9

With a growing need for HIM staff members and investment in their training, making the right hiring decisions is crucial to an organization’s bottom line. Pre-hire assessment can provide the insight needed to make the right decision.10 Once a practice has chosen an assessment tool, training on the new system should be provided to current HR staff, who will be the ones working with the results of the assessments.

8 Desal, Anna. Scanning the HIM environment: AHIMA’s 2015 report offers insight on emerging industry trends and challenges. Journal of AHMIA. Vol 86, issue num. 5, pp. 38043, May, 2015, accessed April 12, 2016. http://bok.ahima.org/doc?oid=107636#.VsJ7ovkrJD

9 Bureau of Labor statistics. Medical records and health information technicians: Occupational outlook handbook: U.S. Bureau of Labor statistics. Dec. 17, 2015, acceded April 12, 2016, http://www.bls.gov/ooh/Healthcare/Medical-records-and-health-information-technicians.htm#tab-6

10 Lahey, Zach. Aberdeen Group. Aberdeen Group Research access http://v1.aberdeen.com/launch/report/research_report/10326-RR-advanced-prehire-assessments.asp. Published 2016. Accessed June 8, 2016.

Need for Pre-Hire Assessment

Pre-Hire Assessments Give You Your Money’s Worth and Then Some

Pre-hire assessments are used

Year

-ove

r-ye

ar im

prov

emen

t

Pre-hire assessments are NOT used

Hiring Manager Satisfaction

Time to Hire Cost per Hire

Source: Aberdeen Group, May 2015

8.0%

6.0%

4.0%

2.0%

0.0%

-2.0%

7.6%

5.4%

3.3%

5.6%

1.7%

-1.3%

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Benefits of Pre-Hire Assessment

Benefits of making the right hiring decision have a ripple effect throughout an organization. When the right candidate comes on board, the new employee hits performance goals more quickly than others and remains with the organization past that critical one-year mark, by which time many unsuitable hires have left. According to the Aberdeen data, at the end of the first year, 89% of “right hires” are still with organizations that use pre-hire assessments. Organizations not using pre-hire assessments report a 75% retention rate. Further, this pool of right hires creates the base for internal promotions, and the best-in-class organizations using pre-hire assessments report hiring from within a full 25% more often than other organizations11.

Costs of a Bad Hire

In a 2015 study12, The Harvard Business Review points out that the cost of a bad hire can be $12,500 in turnover costs alone. The piece underscores the toxicity of bad employees and cites a 2012 CareerBuilder study13 that put the true cost of the bad hire closer to $25,000 (according to 41% of its employer respondents).

The real costs include a resource-intensive search, manual assessment, and hiring and onboarding costs to ready a new employee as well as the cost of COBRA and unemployment taxes on top of the wasted wages paid to the bad hire. According to a piece published in Forbes, the numbers vary according to the position. Higher-level positions cost more to replace than entry-level (as shown in the Forbes research in this chart).14

11 Lombardi, Mollie, and Aberdeen Group. Assessments 2014: Consistency is key. May 2015, accessed April 13, 2016. www.aberdeen.com

12 Torres, Nicole. It’s better to avoid a toxic employee than hire a superstar. Harvard Business Review. Dec 9, 2015; accessed May 13, 2016. https://hbr.org/2015/12/its-better-to-avoid-a-toxic-employee-than-hire-a-superstar

13 Ibid.

14 Myler, Larry. Forbes. Hiring: Why A bad candidate is worse than no candidate. April 29, 2015, accessed May 13, 2016. http://www.forbes.com/sites/larrymyler/2015/04/29/hiring-why-a-bad-candidate-is-worse-than-no-candidate/#52390ec11c86

Position Type Turnover Cost as Percent of Annual Salary

Entry-level, Non-skilled 30-50%

Service/Production 40-70%

Clerical/Administrative 50-80%

Skilled Hourly 75-100%

Professional 75-125%

Technical 100-150%

Supervisor 100-150%

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Need for Post-Hire Assessment

Once the right medical coder is hired, they must have additional training to continue developing their skills. Increasing existing coding skills to take advantage of all ICD-10 offers takes commitment on the part of the organization to not only to hire the best but also to keep the staff well trained.

Medical record review has an interpretive quality, and so coding is, by nature, subjective. Subjectivity implies variability in outcomes between one coder and another. Just as there are different guidelines for each organization, when two coders review the same record they may report unique codes.

It is important to remember that continued training after hire is not just about finding a code. It is about understanding how the documentation links to accurate codes and ensuring correct reimbursement. Different interpretations can arise from generational differences as well as differences in the experience of the coders. The way to maintain a consistent approach throughout the organization is to provide the training to upgrade and fine tune the skills of the HIM staff.

Examples of Assessment ToolsDifferent Types of Tools

There are many technological assessment strategies that perform in-depth reviews of HIM staff skills. Pre-assessments to determine the candidates’ core abilities include screening questions, video recruitment, social media, career portals, and assessments of candidates’ soft and hard skills. After hire, additional tools can assess and enhance staff coding abilities.

11 Lombardi, Mollie, and Aberdeen Group. Assessments 2014: Consistency is key. May 2015, accessed April 13, 2016. www.aberdeen.com

12 Torres, Nicole. It’s better to avoid a toxic employee than hire a superstar. Harvard Business Review. Dec 9, 2015; accessed May 13, 2016. https://hbr.org/2015/12/its-better-to-avoid-a-toxic-employee-than-hire-a-superstar

13 Ibid.

14 Myler, Larry. Forbes. Hiring: Why A bad candidate is worse than no candidate. April 29, 2015, accessed May 13, 2016. http://www.forbes.com/sites/larrymyler/2015/04/29/hiring-why-a-bad-candidate-is-worse-than-no-candidate/#52390ec11c86

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A pre-hire assessment tool provides insight into candidates’ knowledge and skills before a manager makes a hiring decision. These tools offer a range of capabilities, including automation of applicant tracking and coding and providing instant scoring and detailed reporting. The tools are generally available online 24/7 to applicants.

A coding assessment tool provides insight into staff members’ existing foundation of experience and knowledge in medical coding. Coding assessment tools are based on assumptions about coding staff: they are goal oriented in the work place, staff are practical and self-directed, and relevant instruction and assessment matter to them and their employers.

Example Tools

There are a number of tools in the market designed for managing the hiring process for HIM staff, including medical coders and transcriptionists. Two best-in-class tools are offered by Career Step.

Career Step’s Pre-Hire Assessment Tool offers best-in-class technology to:

• Test on an objective (multiple choice, true/false) or practicum model.• Select questions from an existing library relevant to the specific position. • Customize for an organization’s specific use, including the development of questions unique

to the organization and testing on specific codes the practice wants to capture such as primary, secondary, E/M, DRG codes.

• A report when an applicant completes the pre-assessment tool.• 24/7 candidate access to the pre-assessment tool.

Career Step’s Coding Practice Tool offers best-in-class technology to:

• Assist in post-hire skills validation.• Provide coding practice to expand existing skills in PCS and CPT coding, for inpatient-to-out

patient, emergency department, and same-day surgery. Coding assessment also identifies areas for additional education.

• Provide coding rationale to learner after each case, reinforcing education

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Conclusion

Managing a five-generation workforce in a tight job market for HIM professionals requires improved strategies to hire, train, and retain good medical coding, transcriptionist, and CDI staff.

• Best-in-class organizations have figured out that pre-hire assessments can help them achieve their staffing goals. Through pre-assessment, organizations can winnow the field of applicants down to those whose skills appear to qualify them, reserving their more intensive HR efforts for the superior candidates they want to interview and hire.

• The cost of replacing a bad hire is high—up to 100% of a skilled hourly staff member’s annual salary—and this includes sunk costs of wasted salary, COBRA, and HR costs for recruitment and hiring.

• Retaining staff through continuing education is vital in an HIM market where the growth rate of positions is more than twice the national average for all employment categories. Continuing education for coding teams will increase organizations’ long-term satisfaction with their workforce and improve employee value up the line.

Best-in-class organizations look within for up to 75% of their open position replacements. These organizations use pre-hire assessments to hire the right fit at the start, train their medical coding staff well, and retain a reliable, professional HIM staff.

Career Step’s automated and customized tools support a best-in-class hiring process and continuing education, which can lead to increased revenue.

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About The Author

Laurie A. McBrierty, MLT, ASCP, Career Step Vice President of Product ManagementLaurie brings close to 30 years of experience in healthcare, healthcare information systems, and product management to Career Step, where she drives the product management of the company’s offerings. Prior to joining Career Step, Laurie served in various executive positions with companies such as xG Health Solutions, WellPoint, Resolution Health, QuadraMed, Kaiser Permanente, SoftMed, 3M HIS, and Stanford Health Services. She has also served on various boards and committees within the American Health Information Management Association (AHIMA) and is a respected leader in health information management. Laurie holds a bachelor’s degree in Information Systems Management from the University of San Francisco.

About Career Step

Career Step is the education partner of choice for some of the largest and most respected names in healthcare. Providing innovative technology, programs, resources, and expertise it helps organizations evaluate, educate, and expand critical knowledge and skills to stay ahead of today’s evolving healthcare challenges. Learn more about Career Step’s Corporate Training programs at www.corporatetraining.careerstep.com.