Non-clinical medical careers offer bright future — even for the squeamish

Mary Jo Bowie, associate professor of health information management at Mount Wachusett Community College (MWCC) and chair of its health management program, knew early on she wanted a career in health care, just not one that involved direct patient care.

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By Christina P. O'neill, Special To Central Massachusetts Health

Some of the fastest-growing occupations in health care do not require direct patient care, creating job opportunities for both new entrants and medical career-changers who can get a new lease on the use of their field of knowledge.

Driving factors behind the growth

The shift of focus from fee-for-service to outcome-based reimbursement is resulting in projected job growth for medical health information management staff, and population health management overseers, who support the needs of the emerging field of accountable care organizations that manage the health of patients under their care. These groupshave reportedly helped Massachusetts hospital systems save millions in the most recent fiscal year.

Add to this the profusion of ambulatory care outpatient clinics and urgent-care walk-in clinics, all of which need enhanced oversight in the age of outcome-based medicine, and we’re seeing data monitoring and case management evolve from subspecialties to essential parts of the big picture. The American Hospital Association (AHA) and the American Medical Association have taken note, as have the specialty trade organizations which advocate for their specific categories.

Mary Jo Bowie recalls a prescient conversation she had with her dad, a health care dean, decades ago at the start of her career. “I love anatomy and physiology, but do not ask me to touch a patient,” she recalls telling him. He replied that the data side of health care would grow, and that if she entered that field, she would never be without work. Today, Bowie is associate professor of health information management at Mount Wachusett Community College (MWCC) and chair of its health management program. She is also consultant and owner of Health Information Professional Services in Binghamton, NY.

A big factor of future growth in some of the job categories, which may not be factored into the projections, is the coming retirement wave of baby boomers, who are hitting their mid-sixties. AARP Inc. statistics note that 10,000 Boomers will be turning 65 every day for the next 18 years; a Gallup Daily tracking poll notes that only one third of them are still working at the ages of 67 and 68. Those who continue may not be dropping out of the workforce entirely, but they are switching careers, according to projections on the part of many trade organizations, including the American Health Information Management Association, which oversees medical coders among other fields. For example, nurses who want more regular schedules or who are no longer able to handle the physical requirements of nursing care delivery, may turn to careers that utilize their knowledge and discipline to oversee care delivered by others, according to Lisa Stevens-Price, Fallon Health’s vice president of medical affairs.

Code Talkers

For those with a mastery of anatomy and physiology, combined with a basic mastery of computer programs, the career path has never been better.

MWCC’s Bowie recalls that medical coding operations were once relegated to hospital basements. Now, that function has a boardroom presence because of changes in the healthcare system. With the emergence of accountable care organizations, physician groups with five or more providers will now have to look at hiring a coder to come into their own practices because of the complexity of ICD-10 and the extra work it requires.

State projections for job growth for coders, many of whom fall under the Medical and Health Records Technicians classification by the federal Bureau of Labor Statistics, stand at 19 percent from 2010 to 2022. But, she says, that may not take into account the large number of current practitioners nearing retirement age. Statistics from MWCC indicate that 23 percent of the region’s coders are over age 55 and may be expected to retire rather than retrain for the expanded coding standard, ICD-10, set to become effective on October 1, which significantly expands the number of diagnostic codes.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. The predecessor, ICD-9 dates back to 1979 andis no longer adequate to document advances in medical treatments and technology. The federal Centers for Medicare and Medicaid Services (CMS) and the American Medical Association have teamed up to help the medical community get ready to use the system by October 1, 2015. Providers have a grace period in which they can use ICD-9 to code all services delivered before that date, but must use ICD-10 for services performed that date or after, or they will not get paid.

“For every coder you have now, you will need 1.5 coders [to implement ICD-10],” Bowie says.

Margaret Gillette, MWCC’s assistant dean of health, says the school’s program currently trains students in both ICD-9 and ICD-10 so they can transition easily. MWCC also offers continuing education courses for coders who need to refresh their knowledge. Bowie also stays up to date on openings in different regions, to help students moving from the area to continue their education at MWCC.

Applicants to the program include many adult, non-traditional students – the younger generation appears to be unaware of the Health Information Management (HIM) career track, Gillette says. Bowie concurs, crediting her father, a dean of health care, for advising her in 1978 that non-clinical jobs were available that would always be secure.

Tracey Butler, a licensed practicing nurse from Athol, enrolled in MWCC’s coding program this semester to build upon her skills to include coding. She is enrolled as a full-time student while continuing to work. Butler seeks to shift her career to an administrative nursing role, or to perform case work for an insurance company.

“I decided to take my career in a different direction,” Butler said. “I didn’t picture myself going back to school at 51, but things are changing in the field very fast.”

Over the past 18 years as a nurse, she says, she’s seen many changes related tohealth care information and its usage in clinical settings, as well as the use of computers as an integral part of direct care.

Many nursing positions that do not focus on direct care now specify coding experience, Butler said, including intake nurses, minimum data set nurses in long-term care settings, facility screeners, and nurse case managers who work for insurance companies.

Computers have become an integral part of direct care as well, she said. “I pass meds with a computer, order meds with a computer, and document with a computer.”

Case Management

Meanwhile, the need for qualified case managers is growing. Worcester-based insurer Fallon Health has moved to an integrated model of care and case management in a collaborative process in which a person or family is assessed in a holistic approach to that member’s needs. This provides great possibilities for openings in non-clinical careers that provide essential care management functions.

Dr. Lisa Price-Stevens, Fallon’s vice president of medical affairs, says case managers are the interface between patients, whom insurers refer to as members, and the clinical community. Case managers in integrated programs work in care teams to address disease management, diabetes management and to advocate for what is necessary to bring patients to wellness. Case managers want to ensure that members have advocates and the ability to take an active part in their medical decisions, of particular importance with the increasing role of outpatient settings.

Most case managers have clinical or social-work background. Nurse case managers draw on their nursing background to help identify high-risk people. Behavioral health case managers who may have had solo practices and now want to work as part of a care team, are joining the ranks. Additionally, Fallon employs ‘navigators’, essentially logisticians who ensure that all departments and components of the patient’s care are operating efficiently.

“They love caring for people, but don’t want to see blood,” Price-Stevens says.

Today, there are more and more value-added career openings for case workers and many others who have an interest in or strong connection to health care. The growth in non-clinical job categories will be essential to the delivery of outcome-based health services, keeping health care costs under control without paring back on essential treatment.