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Consultants: Putting Your Mess to Rest

By Robbi Hess 
As seen in For the Record Vol. 18 No. 8 P. 26
April 17, 2006

What characteristics do successful consultants share? When is it time to consider hiring these specialized pros? Delve into this unique occupation that's gaining a broader role in the HIM field. 
What is your facility's strategy for dealing with special projects or backlogs? Staffing shortages or vacations? Meeting quality and compliance standards? If the idea of addressing these questions-let alone the root cause of the problem-triggers anxiety, you may want to consider the benefits of bringing a consultant on board. 

Why a Consultant? 

A consultant brings to the table a level of expertise to address a single crisis or to oversee an entire department. Enlisting the services of a consultant could free the HIM director to concentrate on other necessary daily tasks. 

Beth Haenke Just, MBA, RHIA, CEO and president of Just Associates, says because she concentrates on master patient indexes (MPIs), she is called in when a healthcare facility has issues with database integrity or in the way incoming patients are being captured in the database. 

"If a patient's information isn't being captured correctly, or fully, upon admittance, or if the interfaces between systems aren't properly communicating what they need in order to complete the patient data, we are called in," she explains. "When we do a cleanup, we always get into other areas with the HIM director. Other processes invariably intersect and various data integrity problems surface." 

Just says she and her employees are proponents of "knowledge transfer" in that they don't simply enter a facility, clean up the records, and walk away. 

"We can't leave them with no clue as to either how to minimize creation of duplicate records, or if duplicates are created, how to manage them after we've left," she says. 

Monica Pappas, RHIA, founder of MPA Consulting, Inc., says an HIM director will often ask for help with coding, tackling a backlog, or filling a vacancy. "Sometimes the client wants to know where their HIM department stands before they hire new management staff," she explains. "We use our expertise and do an overview of the department and put together a work plan." 

The detailed information provided by Pappas gives the director a head start on gaining control of the workflow. "We sit in the middle of the revenue cycle so there are pieces of work we do that affect revenue in a variety of ways," she says. 

Pappas says in many cases HIM departments already operate under contracted services. "Sometimes the HIM director could be managing people and contracts and we ask why, especially when a consultant could guarantee quality workflow in managing the department as a whole, rather than piecemeal [such as in outsourcing]." 

Because of a shortage of coders, it has become popular to outsource the job and not risk having an underskilled labor force affect the hospital's bottom line and its ability to be compliant. "Many people look to outsource their coding units as the first step in gaining control of the HIM department," Pappas notes. 

What's It Take?

The abilities to think on one's feet, have organizational skills, and be a good listener are often mentioned as being the attributes necessary to build a successful career as a healthcare consultant. The position relies on the ability to be both a cheerleader and a taskmaster. While some work can be done remotely, travel, travel, and more travel are part and parcel of the job description as well. 

Pappas believes professionals in the HIM arena are natural organizers and detail-oriented individuals-traits necessary to become a successful consultant. "I think that's why we get drawn to this field," she says. "You have to be very clear on what the client needs."

"We are there to uncover what they need and let them know how the services we provide can meet those needs," Just says. "We aren't walking in the door to sell them a product. We're partners in helping them gain control of their departments." 

Just says each project contract outlines the deliverables and scope. "When my managers walk out the door, they have a project outline that says we will address these issues, deliver these products, results, reports, recommendations, etc. We could say we've identified these as the issues and these are the next five things you need to do in addition to the other 10 to get the department back on track."

Pappas agrees that one trait that makes for a successful consultant is the ability to translate what the client is asking for into the services you provide. "You also have to know your limitations. I never offer a client a service I can't deliver," she says. "As an example, I can do high-level reviews of a cancer registry but would have to look to an outside source if a contract required a more detailed look at that registry."

Just says a document charter is prepared that outlines the consultant's understanding of the client's needs. "It says this is what we believe you are requesting us to do for you, who's going to do it, how it will get done, the risks you are facing relative to the project-for example, what other projects have to be successfully completed in order to keep ours on track vs. what projects we are dependent on-and the ultimate outcome." 

Quite often, the HIM department must complete certain tasks so the consultants can deliver on the promises made in the contract. 

Because some projects may have more than one leader, it is a challenge for the managers to keep both project leaders in sync, Just explains. "During the whole process we keep circling back to the original conversations, saying 'This is what we had talked about, this is what we are doing, are we still on track?'" she says. 

If a project isn't on track, the consultant or the manager on site must be able to think on his or her feet. "A client expects a certain level of immediacy when [he or she asks] a question," Pappas says.

Above all, both women agree, a respect for privacy is an absolute for success. "Even though we ask clients, at the end of the engagement, if they will serve as a reference or give a written quote, we are cognizant of the fact that we can't-and don't-talk about one client in front of another," Pappas explains. "We have to speak of our experiences in a way that doesn't in any way violate client confidentiality."

A learned skill, Pappas says, is the ability to negotiate. "Sometimes you have to explain to a client why what [he or she is] asking for is outside of the original scope of the project and [he or she has] to understand you can't do something for nothing," she says. "You have to be able to draw the line and solve problems so it's a win-win for both you and the client." 

Why Make the Leap? 

For Just, the transition from the corporate world to consulting was a gradual process.

"I've consulted independently and for other companies since 1984. I was hired by a company 10 years ago that wanted to get into master patient index cleanup and I had done that work in prior consulting situations," she explains. "I was eventually approached by a large hospital that wanted to outsource work to me. I got a partner and the company has grown from there." 

Just believes the impetus behind her company's growth is the push toward electronic health records (EHRs) and regional health information organizations (RHIOs). "In order to get those initiatives up and running, you have to have clean patient identification data and that's brought visibility to what we do," she says. "There have been a gradual number of organizations that have attempted a switch to EHRs over the past few years with disastrous results because they had so many duplicate patient records. The doctors were getting frustrated because they knew they had seen a patient but because of 'dirty' data, office staff couldn't locate the records."

For Pappas, a love of HIM propelled her into consulting in 1983 when she started out as a sole proprietor. "That was the year the government implemented the DRG [diagnosis-related group] system for paying inpatient Medicare claims," she recalls. "Some of the work was subbed to a public accounting firm and because those firms can't go into a hospital and attest to financial adequacy without knowing coding and the role it plays in financial audits, I was brought on board." 

Over the next 20 years, her consulting business grew to more than 500 employees before it was purchased by a public company in 1998. Her current business is organized around a core group of healthcare professionals who have ownership stakes in the company and work closely with clients to improve information and processes. 

Skills Sought in Employees

To come on board with either consulting company, both women agree that the prospective employee must have the proper education, credentials, and, if possible, experience. Just says new graduates, who begin at ground level, must work side by side with a project manager. To begin at the project manager or director level, the employee must have experience in either general management or in an HIM department. "We prefer to see people who have run an entire department rather than a specific area within a department," Just says. "The person with department background understands the workflows and what HIM directors are faced with on a daily basis." Just says because her clients tend to be larger facilities, she looks for candidates who have worked in those environments. In addition to impressive credentials and experience, consulting hopefuls must be adept organizers and communicators.

"While we can teach many of the skills necessary to succeed, there are some that are personal strengths that simply can't be taught-they can be honed or sharpened but with some skills, you either have it or you don't," Just explains. "We have a set methodology and techniques and tools that we use and, with the right person, those can be integrated into the skill sets and strengths the employee already possesses." 

Pappas says credentialed new employees are easier to assimilate. "We have a lot of tools that we've developed over the years as a way of helping the credentialed professional integrate themselves into what we do for our clients," she says. 

Growing a Business 

A consulting business is built and grows around the strength of its reputation, Pappas says. "We get a lot of return clients who were happy with the service we provided them the first time around," she explains. "It is a lot of word of mouth and referrals, as well." 

"Because we are so client and quality focused, that reputation gets around the industry," Just says.

A Bigger Role? 

While consultants may be taking a more active role in the industry, Just and Pappas agree that it is not unique to their field of work. 

"As the baby boomers age, there are a lot more of us out there saying we've hit the business world hard, built our careers and our resumes, and we've found a niche," Just explains. "We still want to be working but we want it on our own terms." 

Pappas says consultants have taken on a more broad role than when she started in 1983. "There weren't nearly as many consulting firms and the growth in the industry tells me there is a demand for what we provide," she says. "The service we provide is very complex and when you can offer a global perspective, you become a valued partner." 

The field is also becoming more "virtual," Just says. "I can do a lot of work from home or other remote locations and almost every facility that I go into has VPN [virtual private network] or some other remote access tool." 

Healthcare facilities may also look to consultants as a money-saving measure. But that depends on negotiations. "A facility knows that when they hire me, [it is] buying a piece of me and they know that every client is touched by the company owner-that gives [it] a level of security as [it knows it] will get high-level results," Just says.

Like virtually every other career, healthcare consulting is becoming more specialized on a daily basis. No one person can be an expert on every aspect of coding, compliance, and legal issues-another reason why facilities are looking to outside sources to be their experts in the areas in which they may be weak. 

Pappas says while healthcare consulting may not be a glamorous role, it is one in which she has control of her own destiny. "Not everyone is cut out for this work," she cautions. "You are constantly dealing with different individuals, in different environments, on an almost daily basis."

The Bottom Line 

Over the next several years, Just believes the work will become increasingly complex not only because of an organization's need to electronically link records within its own four walls but also because of the evolution of RHIOs. 

"The challenges and the reality of patient identification-and the task of linking that information-are becoming a logistical nightmare, one that algorithmic software can help with, but not completely solve," Just says. "A substantial percentage of MPI records have data integrity issues that will make it virtually impossible to link them. It will be a monumental task but not an insurmountable one. Software will help, but it will require a combination of people, process, and technology for electronic record linkage initiatives to be successful." 

The hurdles awaiting any HIM department will be easier to overcome with the help of seasoned consultants who can wade through the paper trail and come out the other side with a viable, working solution.

- Robbi Hess, a journalist for more than 20 years, is a writer/editor for a weekly newspaper and a monthly business magazine in western New York.