SOUTHERN CALIFORNIA JOB MARKET : THE NEW JOBS : HEALTHY CHANCES : MEDICAL WORKERS MUCH IN DEMAND

At first blush, working as a file clerk in the medical records department at the now-defunct Fox Hills Hospital did not appear to be a route to a promising career for Crystal Alexander, then a 15-year-old high school student filling in part time for a worker on maternity leave.

But 15 years later, Alexander is glad that the job was interesting enough that she stuck with it after high school. She is now a medical records consultant and is among the most sought-after workers today in the health-care field.

While much of American industry is in a slump, health care is actually growing, and workers’ salaries are rising at a pace close to the inflation rate--in contrast to overall salary increases in the United States during the past decade. Even in a recession, people continue to get sick--some would argue that they need medical services even more. Much of the job growth is in technical fields, where new equipment has revolutionized the practice of medicine. And the much-discussed shortage of nurses remains critical, according to health-care officials.

The State Employment Development Department projections for job increases in Los Angeles County between 1987 and 1992 shows double-digit percentage increases for nearly all health care job categories. For example, medical records technicians will have increased nearly 19%, according to the projections. Positions for home health aides are projected at a nearly 25% increase; physical therapist 22% and registered nurses nearly 16%.

Growth in the health-care industry does not mean that the medical industry across the board is in the pink of health. Hospitals, in particular, face new financial pressures as both government and private insurers have restricted what they are willing to pay for medical services. These new pressures have elevated the status of an often overlooked “clerical” job category--the medical records specialist--and increased the need for institutions to hire well-trained, highly motivated workers. A shortage of these medical records experts has prompted some hospitals to offer sign-on bonuses, hospital officials say.

Years ago, one could expect to find the medical records department--primarily seen as a repository for so much paperwork--”in the basement” of most hospitals, says Ruth Hauser, director of medical records at Santa Monica Hospital and president of the Southern California Medical Records Assn.

Today, her department is generally better-housed, better-equipped and gets far more of the attention of top management, Hauser said.

Alexander, who works for Los Angeles-based Design Data Resources, states the reason succinctly: “Medical records has become a revenue-generating department for the hospital.”

The department gained status in the early 1980s when the federal government changed the way it reimburses hospitals under the Medicare program, says E’Vette Zeitlow, founder and president of Design Data Resources, a medical records consulting firm that supplies workers and services to about 60 hospitals in the Western United States.

No longer would the government pay fees set by hospitals based on such factors as how long a patient stayed in an institution. The government started using diagnostic-related groups, or DRGS. DRGS reimbursement is based strictly on the type of diagnosis and procedures performed. Each DRGS is assigned a particular weight and price tag. With more than 400 different DRGSs in use, hospitals found it vital to have skilled people who could organize and analyze medical records, Zeitlow says.

The new reimbursement climate forced hospitals to be creative in packaging their services, to wring the most cash from payers.

Now, good medical records technicians and administrators “read the medical records as if it was a book to maximize on the potential reimbursement,” Zeitlow says. “They converse with physicians to determine if there is something missing from the record. They are very much experts on the clinical ways of medicine and finance. They ride a fence between the physician and the chief financial officer.”

As a consultant, Alexander says she examines the effectiveness of medical records departments for hospital clients. “If they feel that the hospital is missing out of revenue, I show them how they can increase revenue,” she says.

The medical records department also provides the basic function of channeling medical information to people who need it, as well as ensuring that the institution’s record-keeping complies with professional standards, Hauser said. “One of the big surprises for people who enter the field is the big increase in the number of people who want access to medical records. There is an increased demand from insurance companies, lawyers and medical researchers,” she says.

The medical records field covers three basic job categories, beginning with medical records clerk, coders (who code records according to DRGS categories) and medical transcriptionists, according to the Health Careers Information Center sponsored by the Hospital Council of Southern California. Those jobs require a high school diploma and brief technical training.

The medical records technician works at an advanced level that requires skills in organizing and analyzing medical records. The job requires a two-year associate degree.

The medical records administrator job requires a bachelor’s degree. In Southern California, institutions offering medical records training include Loma Linda University in Loma Linda, Charles Drew University, which is affiliated with Martin Luther King Jr. Medical Center in Los Angeles, Cypress College in Cypress, East Los Angeles Community College in Los Angeles and Mount St. Mary’s College in Los Angeles. Cal State Los Angeles is also seeking certification to offer a program.

The hospital council says salaries for medical records transcriptionists and technicians average $21,000 a year in Southern California. In a hospital, medical records technicians can make from $11 to $15 an hour, Zeitlow says. However, “I will pay from $14 to $20 an hour with benefits because I want to get experienced people,” she says. Because of the extreme shortage of trained workers, she added, some hospitals are offering $3,000 sign-on bonuses for experienced personnel.

“We are all fighting for the same people,” she says.