# Presentation: 218548

## Hybrid Made SimpleVeHU Session 105

- August 22, 2007

## Faculty

- Linda Nugent, Director, HIM, VACO
- Lois Hall, HIM Specialist, VACO
- Pam Heller, HIM Specialist, VACO
- Karla Porter, HIM Specialist, VACO
- Jennifer Rollins, HIM ADPAC, VISN 2

**Notes:**
Linda

## Outline of National Professional Standards Boards (PSB)

- Medical Record Administrator (MRA) 669 – GS 13 and above
- VISN MRA Board Members
- Medical Record Technician (MRT) 675 – GS 9 and above
- VACO “Super Board”

**Notes:**
Linda
Who they each board – on this slide they can do all (appointments, promotions and SAAs)

Need for security (FedEx (do not have to copy and FedEx to all board members), SharePoint (VISN 7))

SharePoint comments from Elaine Sanders: I granted access to the HR POC for each site and they scanned the documents and saved them to the folders I dedicated for each site.  You can only do this if you are on the same network.  It was a quick way to share the info in a secure manner since the access is restricted to those involved.  You can limit who has read only and who can write to the folders.  The folders are, however, located on a PC in the desktop so if you ever change the PC out, you have to change the link for the viewers, and I believe you have to grant the access for each individual all over again.  The ISO helped me set this up. You can also have the IT staff set up a shared folder on the server, but you have to have them grant all the access and it limits the flexibility, but it will remain whether you change jobs/PC, etc.  The shared desktop folder is attached to the organizer personally and would have to change if the person or the PC ever changes.

How often they should meet.  When to review board membership.

Super Board – National PSB Members

## MRT PSBs

- MRT East/West Boards
- MRT Local Appointment Boards

**Notes:**
Linda

Who they board – MRT East/West Boards can do all (new appointments, promotions, SAAs)

		      - MRT Local Boards – appointment boards only (new appointments or promotions (VA employee moving from one job to another))  

Need for security (FedEx, SharePoint (VISN 7))

How often they should meet.

- VISN and Local MRA PSBs

**Notes:**
Linda
Who they board – VISN can do all (new appointments, promotions, SAAs)
		      - Local MRA boards are appointment boards only

Need for security (FedEx, SharePoint (VISN 7))

How often they should meet.

## Boarding Process

- HR Transmittal Checklist
- New Appointments (including VA employees moving to new position)
- SAAs (local MRT boards excluded) – must have supervisory memo of support
- Promotions (local MRT boards excluded) beyond the full performance level or as a new appointment
- Board recommendations returned to HR
- Boarding process tip sheet on HIM website

**Notes:**
Karla

HR is responsible for completing sections 1-5 of the BAF, the HR transmittal sheet (found on HIM website and in Feb HIM call mins) and fedexing the complete (including a supervisory memo to support promotions or SAAs) packet to the board chair. All boarding pkts are returned to the HR specialist who then forwards the recommendation to the Director for approval/disapproval.  Most HRs will not provide a copy of the action to the employee but employee can request a copy under the Privacy Act.

Employee is responsible to let supervisor know when they’ve had an accomplishment that is eligible for an SAA or if their promotion is due, within 90 days of that due date, remind supervisor that it’s coming up (if above full performance level must go to board but if not, supervisor and next level supervisor can promote).

Supervisor is responsible to complete supervisory memo in support of any SAA that meets the criteria.  Supervisor must also complete a memo in support of any promotion that is above the full performance level to the board or to recommend promotions to the full performance level to next line supervisor.

Board reviews the information submitted in the boarding packet against the qualification standards to board the candidate at the appropriate grade

SAAs are reviewed against the criteria for an SAA to determine if the candidate meets the qualifying criteria

## Qualification Standards	

- What is a Qual. Standard?
- What is the difference between the basic standards and job specific standards?
- How were these standards developed?
- Are we stuck with the standards as they are today?

**Notes:**
Lois:  A Qual. Standard is the MINIMUM requirements for entry into a series and a position.  The basic requirements are reviewed to determine if an individual has the education and OR experience to enter into the series.
Basic standards are the minimum standard for entry into the series.  If the basic standards are not met a person is not eligible for the series.  Basic standards reduce the potential that unqualified people are considered for positions.
The job specific standards are the basic experience, education, knowledge, skills and abilities required for a specific position.  
The standards were developed based on a variety of factors.  Requirements in 5005/16 outline, very broadly, specific standards for qualifications in general.  A number of position descriptions were reviewed to find tasks common to each position and existing professional standards and job expectations were also reviewed.
We have one opportunity to review, update and change the qual. Standards.  These standards have to be negotiated with all unions on a national level, so it is not an easy process to change.  We have submitted some changes for renegotiation and will let everyone know the progress (or lack of progress) as we proceed. 

## 669 Qualification Standards

- Administrative in nature
- Standards for GS 5-14
- Full performance levels
- CHIM-12 vs. 13
- GS 14

**Notes:**
 Lois
The 669 series is reserved for those who perform administrative type duties, such as privacy officer, supervisor, lead or  Chief HIM
Although GS5 is included in the  669 it’s very unlikely that anyone would actually be placed in the 669 as a 5. There is a 2 grade span for the qualifications 7-11, then 12, 13 and 14.
Qual for GS 7 are entry level skills for someone new to the administrative series and with little experience.
9-11 are staff or supervisory positions with increasing levels of skills and responsibilities.  11 is the full performance level for a non-supervisor.  The full performance level indicates that the majority of the people performing a position would be at that grade.  Facilities can promote TO the full performance level.  If you had a privacy specialist, for example, that you wanted to promote to a 12 and the PS had no supervisory responsibility the position would go to the appropriate board for a determination.  The functional statement and complexity of the medical center are taken into consideration when determining promotion above the full performance level. 
GS 12 is considered the full performance level for a CHIM.  The average non-tertiary care facility CHIM is a 12. 
GS 13 is for CHIMS of large, highest level complexity medical centers or those who are Chief of a multi-divisional integrated health care systems.  VISN  CHIMS would also be considered for a 13
GS 14 is for those who work at a national level.  The Undersecretary for Health or designee must approve all 14s.  The Undersecretary has delegated  approval authority to the Director of Health Data and Informatics 

## 675 Qualification Standards

- Technical in nature
- GS 4-9
- Full performance levels
- Coder 7 vs. 8
- GS9

**Notes:**
Lois
Grade range for 4-9, with 1 grade increments (e.g. 4,5,6).  
GS 4 is entry level position with no experience in the field at all  but who has some basic knowledge.
GS 5 is entry level for a new RHIT graduate with no experience.  GS 5 is entry level for an ROI clerk, coder or other who position who has  some experience but no education.
GS 6 for the more experienced employee, who can perform at a higher level with little or no supervision.
GS 7 coder-this is the coder who is performing specialized coding and has no experience in the full range of coding.  For example a coder who does only outpatient clinic visits and who’s previous experience was working in a Drs. Office
GS 8 coder-this is the full performance level for a coder.  The coder at an 8 is doing the full range of coding, inpatient, outpatient, surgical, invasive procedures, etc.  The coders DO NOT have to be at a large tertiary hospital, but do have to work for a facility that offers varied services.

## Functional Statements

- Functional statements must reflect what the person is actually doing
- Cannot have the same FS for entry level and full performance level coders
- HINT: It’s O.K. to actually include the grade specific quals. in your FS

**Notes:**
Lois
Many of the FSs we have seen have been very outdated and not accurately reflected how HIM tasks are performed today.  This has actually hurt some employees as the FSs were so poorly written the employee may have gotten a lower grade then she was entitled to.  Your FS does not have to be elaborate, but must include the tasks and duties performed. 
Many facilities have the same FS for coders but show a variation in coding productivity, and a corresponding grade variation.  In a FS productivity is not reviewed or taken into consideration, the actual tasks or jobs performed are.  For entry level coders the FS must reflect the fact that the coder is entry level and will not be performing the full range of coding duties.
To make life easier-it’s fine to include the actual grade specific qual. Standards in your FS’s.  Of course the person must be performing the quals or have the ability to perform the quals. and if required the complexity must be present (you can’t write an FS with the 14 qual. Standards if you’re a facility coder).

## VISN 2 MRA Board Experience

- VISN 2 MRA board consists of three members (a chair, a secretary, and one board member).
- The board has processed five one time special boarding packets, one new appointment and one new hire from across the VISN.
- Our Experience
- Lessons Learned

**Notes:**
Jennifer
The VISN 2 MRA board consists of 3 members, a chair, a secretary (my position) and one board member.  We originally started out with four members but one of the members has since left the MRA series.
To date we have processed 5 one time boarding packets from across the VISN and 2 new appointments.
Our experience: 
Application Process
Notification Process –We received no notification locally that we had been selected to participate on the board and no notification that our own packets had been sent nationally to be boarded.  We were notified by the national HIM group that they had received our names as members of the VISN board.
The majority of our direction came from the conference call that the national HIM group provided and the packets that they distributed. 
At times it was clear that our HR group had less information then we did.  This did not discourage us from continuing to contact them with questions – we figured that they needed to learn along with us.
And just when we started to get the hang of things...our chair took a new position outside of the 669 series. 
Currently in the process of recruiting for a new board member so we have an alternate.

Lessons Learned

 That no one has all the answers and that no matter how hard we tried we were going to make mistakes because this was a new process.
 We as the board our responsible for making sure that we have all of the information we need to appropriately board someone even if it means contacting HR or the individual numerous times.
 That it was our responsibility as a board to be objective about the one time special boarding process.  This was difficult at times because we know and work with the people we were boarding.  We had to continue to focus on the fact that we were verifying that the functional statement and the qualifications of the individual on paper met the boarding criteria.
That when we had a question that it was beneficial to ask the question in more than one place.  If we got the same answer we felt confident about the answer and if we received a different answer then it was a learning opportunity for more than just our board members.
For the one time boarding the board is only responsible for boarding the individual at the grade level and not the step but for new hires the board makes a recommendation on both the grade and the step.

## Forms

- Board Membership
- Worksheets
- Board Action Form
- FAQ

**Notes:**
Pam

Each board consists of 3-5 individuals but at a minimum there are 3 voting members: a Chair, a Secretary and one additional member. It is recommended that at least four individuals are trained to serve on a board as a member cannot board employee’s that they supervise and to allow for absences of board members.  The members have to be at the same grade level or above the group being boarded, i.e., a GS-9 MRA cannot board a GS-11 MRA.  The secretary of the board may or may not be a voting member depending on the board’s composition.  If the secretary is not a voting member, the board needs to be composed of 4 members so 3 of the members have voting privileges.   Board members will serve either a 1 year, 2 year or 3 year term.  At the end of the initial term, all new members will be selected to serve a 2-year term.  Thus, members will rotate off the board on a staggered basis so one member from the previous year.

The secretary of the board completes worksheets to document actions of the board, such as review of functional statements against the qualification standards for the initial boarding and promotions and review of criteria for Special Advancement for Achievement.  I’ll cover in more detail the criteria for SAA on a later slide.

VA Form 10-2543 Board Action is the only official form of the board.  This form documents the official actions of the board for all appointments, promotions and SAA.  Board actions are returned to your facility Human Resources (HR) and are processed through the facility Director for approval/disapproval.  After the Director takes action, they are returned to HR.  If your facility HR does not automatically forward you a copy, you may request a copy. 

The Hybrid FAQ which answers many of the questions you may have about the boarding process and rules can be found on the VHA HIM web page.  The next slide covers some of the most frequently asked questions with responses.

## Sample FAQ Questions

- Appeal rights
- No reconsideration process for one-time special boarding decision
- Eligible for promotion consideration on anniversary date of grade
- Incomplete packet submitted
- Grandfather the employee at the existing grade
- Return package to the facility to add the missing information
- Return to the Board or the HR Technical Advisor could add the additional information for approving official to consider in their final decision

**Notes:**
Pam
What are my appeal rights if I do not agree with the outcome of my boarding? There is no reconsideration process for the decision on the one-time special boarding to apply the qualification standard. You will be eligible for promotion consideration on your anniversary date of grade.  If, at that time, you are dissatisfied with the decision, you may request reconsideration.  There are different processes for promotion consideration to the full performance level and above the full performance level.  

If the package submitted to the Board for the one-time special boarding was incomplete, the Board could grandfather the employee at the existing grade, return the package to the facility to add the missing information and return it to the Board, or the HR Technical Advisor could add the additional information for approving official to consider in their final decision.  After the one-time boarding, if management determines the functional statement is inaccurate and does not reflect the assignment which is considered to be a higher grade level that the employee currently holds,  the supervisor can re-write the functional statements and submit a request for promotion consideration to the appropriate management official for grades up to the full performance level or  through the appropriate management official to the appropriate advancement Professional Standards Board for grades above the full performance level. 

## Boarding Summary To Date

**Notes:**
Pam 
The boards completed the initial one time special boarding, which was to evaluate each hybrid employee’s qualifications against the qualification standards.  If documentation was submitted, the board also considered any professional achievement during the employee’s VA career for special advancement for achievement.  After the initial one-time special boarding, only achievements meeting the SAA criteria after the initial boarding date will be considered if recommended by the supervisor and supported by a supervisory memo which is forwarded to the appropriate board.  Employees will continue to notify their supervisor and submit information for consideration for SAAs. Any submission to the board after the initial one-time special boarding is management’s responsibility and typically will take place on the employee’s anniversary date of appointment or last promotion.  The next slide will cover the SAA criteria.

The graph displays recommendations made by the 669 and 675 boards.  These are recommendations that are processed through the facility Director for approval or disapproval. During the one-time special boarding the board did not determine the step, only placement in the appropriate grade as the step is set by the facility.  However, the step was only recommended for new employee appointments. 

## Special Advancement for Achievements (SAA)

- Professional attainments in health care management, education, research, and patient care that are recognized at the national or international level, or are published in a recognized journal within the employee’s occupation
- Attainment of certification by an appropriate national certifying body, unless such certification is a condition of employment within VA or meets the criteria in the qualification standard for promotion to a higher grade
- Academic achievement by the completion of a higher-level degree in a field related to the Department’s health care mission, unless the degree is a condition for promotion under the applicable qualification standard

**Notes:**
Pam
Various factors are considered when a SAA is submitted. SAAs are discretionary and must be recommended by the supervisor and supported by a supervisory memo which is forwarded to the appropriate board. 

The employee must demonstrate a high level of performance and the potential for assumption of greater responsibility and the criteria delineated in VA Handbook 5017, Part V, subpara. 4.e. must be met.  

For example, a SAA for achievement of credential.  The board would review if the credential was issued by a national accrediting body related to the professional field, such as AHIMA or AAPC; if the credential requires a proctored test and requires skills above the entry level.  If the individual was previously awarded for the SAA (i.e. Special Contribution Award), they are ineligible to be awarded again.   Obtaining a credential in a field unrelated to the series, such as a Medical Laboratory Technician credential would not be approved or taking a class for a week and earning certification without a proctored test would not be approved.

Achieving a higher-level degree in a field related to VHA’s mission that is not  required for promotion to a higher grade in the occupation, may be considered when the other requirements for a SAA are met, e.g. demonstrated high level of performance, potential for assumption of greater responsibility, etc.  Per VA Handbook 5017, if the degree is part of the qualification standard for any grade level, a SAA for the same credential may not serve as a basis for a SAA. 

Individuals at the top step of their grade cannot receive an increase to base pay; however, they can be recognized with a Special Contribution Award per Part III of this handbook providing they have demonstrated a high level of performance and potential for assumption of greater responsibility, and by meeting one of the examples of professional achievement.

## Special Advancement for Achievements (SAA)

- Election to office in a professional organization at the state or national level in recognition of significant and distinguished contributions to the employee’s occupation
- Recognition of outstanding and exceptional achievement by a professional or academic organization
- Independently producing or serving as a principle assistant or major contributing member on research producing publishable results that advance patient care or medical science
- Appointment to a university faculty position
- Appointment to a State licensing board or national certifying or accrediting body related to the practice of the employee’s occupation

- QUESTIONS

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