Making choices – ethics and actions

This is the third assignment in the Virtual Capstone Project. The project began by using one virtual community, the AHIMA Engage community, to explore and stimulate ideas and solutions by accessing community members and resources. The assignment challenged you to identify and use proper communication tone and content. Next, you completed the decision matrix tool and understand that the systematic evaluation of the selected criteria results in a physician office coding outsource as the best business decision. As you prepare to meet with the CFO, you reflect on how that business decision will dramatically and irreversibly impact the lives of your physician coders.

This assignment contains three parts in one written paper:

  • Part 1: Appraise the Ethical Dilemma
  • Part 2: Describe Both Sides of the Controversy
  • Part 3: Choose an Action

To begin this assignment, first read the scenario below and then perform the steps in the three parts that follow.


You report to the CFO office and bring the Decision Matrix with you. The CFO is impressed with the decision matrix business tool and reviews it in detail. The following details are discussed during your meeting:

  • LiveWell is small, local hospital that is the single largest employer in the county.
  • You feel that the marketing director has not given proper consideration to an outsource of staff and believe the public relations impact will be very negative for LiveWell.
  • The physician office coders are very much dependent on their coding positions at LiveWell. You share that one physician office coder is 4 months pregnant and that 2 coders provide healthcare insurance for their entire family. One coder has a disabled child at home.
  • You confess to the CFO that you have drafted a plan for quality improvement (QI) for the physician coders as an alternate solution. Both you and Alyza are committed to rectifying the poor quality performance and correcting the physician income problem identified by Dr. Crowe. Your QI plan impacts any coder who is performing below the 92% required quality standard. The QI plan steps are detailed in the table below.

Quality Improvement Plan Step

Responsible Party

  1. Set up meeting with impacted coders and review the Quality Standard findings.

You, the Director and Alyza

  1. Notify Coders that they must enter a mandatory retraining program to meet the quality standard of 92%.

You, the Director

  1. Notify Coders that retraining will only occur in the office; no remote work is allowed.

You, the Director

  1. Retraining will be completed over a 90 day period.


  1. Coding accuracy will be re-measured at the end of the retraining period


  1. Disciplinary action to follow for coders who have not met 92% quality standard.
    1. LiveWell Disciplinary Action Policy will be followed.
    2. Re-measurement of quality standard will occur in 30 day increments.
    3. Additional disciplinary action will occur for coders not meeting the 92% standard up to and including dismissal from employment at LiveWell.
    4. Coders who meet 92% quality standard will move on to step #7.

You, the Director

  1. Coders who meet the 92% quality standard will stay in the office for 30 additional days.
    1. Another re-measurement will occur to ensure maintenance of the required 92% quality standard.
    2. Coders who maintain the 92% standard will return to remote coding locations.

You, the Director and Alyza

  1. Future annual performance reviews will include a completed quality measurement for all employed coders to ensure continuing maintenance of the 92% quality standard.

You, the Director and Alyza

The CFO thanks you for your input and for the pro-active Quality Improvement Plan. He asks you to leave your QI plan as well as the Decision Matrix with him and the meeting wraps up.

ONE WEEK LATER: You are summoned to the CFO’s office. You arrive at his office and see that the CEO, Laramie Trudoux, and Suzanne, the HR Director, are both in attendance, along with the CFO. Ms. Trudoux welcomes you and asks you to take a seat. She then indicates that MHP has been contracted for all coding at LiveWell – Physician Coding, Inpatient Coding, Outpatient Coding and ER Coding. MHP will also manage the coding services under your direction. All 25 coders and Alyza, the coding manager, will be notified that their jobs have been discontinued and will cease employment in 60 days (2 months from today).

The HIM staff will decrease from its current level of 52 to 26 persons in two months but the CFO explains the MHP guarantees a 94% quality coding standard and will complete the entire coding volume for $237,000 less annually. (This expense savings considers salary and full benefits for all 26 staff members.)

As the Director of HIM, you are faced with an ethical dilemma. Your position of Director places you in an upper level management position of a small, local hospital and you are a representative of the hospital. The upper level management team is responsible for the long term goals of the facility and for meeting the goals of the facility. LiveWell hospital and partner physician offices employ over 1000 people in the community, and all employees depend on the future of the healthcare business.

Completing the Assignment

You will complete the three parts of this assignment in a 2-3 page paper, labeling each of the three parts and using at least two resources. One of your resources must be a published professional code of ethics, such as the AHIMA Code of Ethics. Please use citations in your submission to support your original content.

Following is some suggested reading to help prepare you for this assignment:

Part 1: Appraise the Ethical Dilemma

  1. Appraise the ethical dilemma described above and consider the choice made by the CEO to outsource the entire coding team of 26 persons. Articulate and explain how the CEO’s decision would affect both the company’s and the community’s best interests.

Part 2: Describe Both Sides of the Controversy

  1. Summarize the origin of the physician income complaint which led to the consideration of these two business options (Full Coding Outsource and Director’s QI Plan).
  2. Detail the business decision options and their competing perspectives.
    • Include financial, staffing and ethical perspectives at a minimum.
  3. Analyze the problem by defending both options. While not required, a multi-columned table would work well here. For example:

Business Option

Defend the Option

Full Coding Outsource


Roll out the Director’s QI Plan 

Part 3: Choose an Action

  1. In a 1-2 paragraph summary, state your choice of action if you were the Director of HIM and were asked to roll out the CFO’s decision to outsource all coders and the coding supervisor positions.
    • Would you act and roll out the decision – notify all 26 staff that their jobs are ending in 60 days and work through the dissolution of their jobs? Would you refuse and offer your resignation? What other courses of action might be available to you? What would your chosen course of action be in this professional job and in this professional scenario, and why?
    • Be sure to indicate how your personal and professional ethics influence your choice of action.
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