MT Exchange Medical transcription exchange

Wow, the article on Mandatory Credentialing certainly created quite a lot of dialogue. I’m always glad if I can spark some discussion and get people thinking in different ways.

The comments (here and at my Facebook wall) became so extensive and involved, I decided to post a followup on the same topic, to address some of the issues raised in the comments.

What is the purpose of credentialing?

Well, this seems to be an issue for everyone. MTs want it to mean that they get paid more. Lea Sims, Director of Communications and Publications for AHDI, posts in one of her comments:

Credentialing should not be embraced because it earns you more money or gives you a professional advantage… (snip) Credentialing is about moving the profession forward, not the individual.

Let’s take a look at the reasons AHIMA gives in support of credentialing:

Let me highlight a few points there:

• Whatever the reason, credentialing makes a professional a trustworthy and likelier candidate for gainful employment and career advancement.
• Credentialed professionals receive better compensation from their employers
• Greater chance for advancement in one’s chosen career

Can someone at AHDI explain to all us MTs “out here” why MTs shouldn’t expect the same things HIMS professionals get from their credential?

I read this to my husband, who looked at me like someone had completely lost their mind, then said, “Well, what’s the purpose of moving the profession forward if it isn’t to make more money? It’s always about the money.” You might want to disagree with that statement because he’s an accountant, but he does have a point. There seems to be a big disconnect here between the esoteric philosophy and the practical reality.

Mandatory credential/licensing - again

I’m not at all opposed to credentialing. I am opposed to licensing and mandatory credentialing.

Lea also states: You don’t see nurses, therapists, techs, etc, balking about their mandatory licensing/registry exams.

This statement is based on the assumption that medical transcriptionists have as much responsibility in the patient care process as professionals who actually see the patient face-to-face. Apparently, my disagreement means I think MTs are just secretaries. Having been a secretary, I’m going to go out on a really unpopular limb and ask - what’s wrong with being a secretary? I’ve done secretarial work, legal transcription, general transcription and medical transcription. I will note there were only 2 differences between the first 3 and the last .

1. Medical transcription has a specialized vocabulary and format, just as legal transcription does.
2. As a group, doctors are absolutely the most abysmal dictators I’ve ever encountered in my over 30 years of transcribing and secretarial work.

I’m sure this won’t make me a lot of friends, but folks - I’ve done clinic, specialty, subspecialty, pathology, radiology, acute care, ER, operative reports - just about every type of medical transcription there is and it’s just specialized secretarial work.

And I’m going to point out a reality: not only are attorneys as a whole really good dictators, I will argue that the documents they produce are JUST as important to the lives of people as the medical records and they, at least, understand that when they put their signature on a document, or advise their client to sign a document, the transcriptionist or secretary isn’t the one responsible for what’s in that document.

Bambi says:When I dictate my records, slowly and clearly of course, I don’t get to hang the phone up secure in the knowledge that the MT on the other end is qualified, sane, certified, or has a clue. [Emphasis added]

Let me tell you a story along those lines. Years ago, when I started my business, one of my large clients was a large insurance company. I did a lot of transcription for the risk management department. The director of that department insisted that I transcribe verbatim, with no corrections or changes. It drove me absolutely crazy. One day, when I complained to him about this, he told me something that has stuck with me ever since. He said he knows I’m smart and know what I’m doing and can make corrections and flag errors - but I don’t transcribe all the reports, I won’t transcribe all the reports, he has no idea which ones I will do and which ones someone else will do or how long I will even be transcribing for this insurance company - and his people need to be trained to dictate the reports so they are correct, regardless of who transcribes them.

Wow - imagine a dictator taking responsibility not only for the accuracy of the finished document, but the accuracy of the dictation! Why is it we feel we have to take responsibility off the shoulders of physicians when their dictation has far more impact than a manufacturing company’s risk management assessment report? So we can feel like our role is more important? All I can say is - wow.

Are employers supporting credentialing?

My blog post started because someone stated something as fact, without supporting it. Here’s another statement I’m not seeing supported in fact.

Lea Sims: Well, many employers are making it a requirement. Our CMT numbers are on the rise. Whether we will ever see that evolve to a mandatory credential remains to be seen, but again, it’s about demonstrating a unique value to healthcare delivery.

and

Julie - the first step was getting MTIA to release their position statement in support of credentialing. A small step, certainly, but an important one. Since that paper was released, we have seen a big influx of employer-sponsored RMT and CMT study groups. Webmedx, for example, has made the decision to get every one of their MTs credentialed by next year and to hire only credentialed MTs after that (or so I’m told). That’s not necessarily a trend, but all trends start small. I can absolutely tell you that credentialing was on the lips of every employer I talked to at the MTIA conference last week.

I’d say it’s starting really, really small. A quick review of the various web sites indicates that a few employers are offering premium pay for the CMT, some offer test prep. I only found one (All Type) that reimburses an MT after s/he has passed the test.

Very few employers state a preference or requirement for the credential beyond the premium pay. The only company requiring it was Transcend/TRS, and then only for QA positions.

I could have spent more time looking but I’ll leave it on the shoulders of the people who make the claim to provide links to show it’s gone beyond boardroom discussion.

The employers need to do more than talk. If they support a credentialed work force, then they need to go all-out and make a commitment to getting MTs credentialed. It simply isn’t going to happen down at the individual MT level to “advance the profession.” Why should Susie Transcriptionist care about “advancing the profession” when she’s having a difficult time getting work, having her pay cut, and trying to juggle bills and schedules? Let’s talk about the hierarchy of needs, here. If her employer isn’t demonstrating a commitment to credentialing, why should she?

Is it too late?

So, just for the sake of argument (and clarity), am I hearing you say that you perceive the role of the MT to be primarily secretarial? One only of administrative support to the physician? If that’s the case, then I would agree that no credential would be necessary. I would also argue that such a role is the least valuable to healthcare right now and the most likely to be marginalized and automated. And explains why SRT and EMR vendors have been able to quite easily convince our end-users that MT can be replaced (afterall, it’s just a secretarial/clerical role).

OK, the question here is not whether or not we’re going to be marginalized and automated - the question is whether we can turn back the clock. We’ve already been marginalized and we’re on the way to being automated.

I’m going to argue that medical transcription has always been marginalized, not only because of the low entry requirements, lack of standards and lack of credentialing - but because any sector where the work is performed primarily by women is almost always marginalized. Will credentialing change that? In my opinion, it will only change it if the large employers stop talking and start walking in support of the credential, both with the work force and with the client base. As long as they continue to contribute to the marginalization with business practices that do nothing to “move the profession forward,” it’s going to continue down the same road it’s on.

Is there a case FOR credentialing?

Absolutely I think a case can be made as to why credentialing is a good idea - I just take issue with the approach and the reasons given for it.

Like I’ve stated over and over above - the big employers, the hospitals, JCAHO all need to show a commitment to credentialing because it simply isn’t going to be supported at the individual MT level otherwise. All of this will be just more blather if employers SAY one thing and don’t back it up with action. (If I was actually being paid to blog, I’d probably do a flow chart on all this and it might make more sense.)

As fas as the RMT, it would serve the purpose of raising entry requirements into medical transcription. Employers would have to be on board with saying that any MT graduating after a specific date must get an RMT within XX months. This doesn’t alleviate the issue of getting experience and I don’t think there will be many (or any) employers who are going to be willing to commit to hire RMTs with no experience, based on my discussions with employers on this issue. However, it does raise the bar, even a little bit. It also sets the expectation from the very beginning that this is something necessary if you want to be a medical transcriptionist.

The CMT is probably most similar to the CCS credential offered by AHIMA, which has no education requirement (beyond high school diploma) and requires 3 years’ experience. Most coding employers require a credential. It isn’t mandatory, but applicants who don’t have one are not likely to be hired or the hiring will be conditional, pending passing the credentialing exam. As long as MTs can get a job without needing a credential and as long as they can continue working without a credential, there isn’t going to be an incentive for them to get one. And I’m sorry - I agree with my husband and AHIMA on the reality that it is IS about the money - and I think most MTs would agree with me.

Related blog entries:

• Answering some reader questions
• McScription
• Lowering the bar: Making once and done look good

Related screen shots:

I sometimes wish journalists valued responsible reporting as much as I do. I’m not getting paid, and I try to either verify what I’m saying is actual fact or I make sure I present it as my opinion or personal experience. It would please me mightily if the people who get paid and publish magazines would be as careful.

The April 2009 Vol. 19 No. 5 issue of Advance has an article on mandatory certification of MTs (”One Way or Another”). I’d link it but you have to subscribe to see the online issue.

Just the facts, ma’am

Here’s the statement that got me fired up:

Woodrow [Dave Woodrow, Vice President of Business Development with DSG, a Jacksonville, FL-based medical transcription service, formerly with SPI and Precyse] noted he sees about half of MTs in favor of mandatory credentialing.

Why would a journalist pass this along in an industry publication without getting or giving more information? The big question pertaining to that statement by Dave Woodrow is: Half of what group of MTs? How was this information gathered?

What’s irresponsible about this is that this “fact” will now start floating through the medical transcription community and industry. Shoot, it was published in a well-recognized industry magazine, so it must be correct! Nevermind that we have no information as to how Woodrow obtained this number, so we have no idea whether it’s even close to accurate.

Now about that credential…

The mandatory certification being floated is the RMT (Registered Medical Transcriptionist) credential. Of course - because AHDI wants us to think the CMT requires more experience. In truth, the CMT does not require two years of experience - it is suggested. But how would it look if new graduates could pass that CMT test? And you can’t require certification and then say only people with 2 or more years of experience can be certified, can you?

How much does anyone think it would add to the profession if the entry-level certification was required of all MTs? Let’s get real here - the CMT has been a tough sell and most people will tell you it doesn’t add any value for either the MT or the employer. But - this isn’t even a CMT we’re talking about! This is the RMT, an entry-level certification. All I can say is - I’m less than excited about this and more than a little cynical about the value it adds to the industry as a whole.

AHDI envisions mandatory certification on a state-by-state basis. Pennsylvania has already shot down licensing of MTs, although I’m having a difficult time telling if they were talking about licensing or certification or if a credential would be required to get the license. (You can read the Advance article here.)

Pennsylvania denied the request on this basis:

The Department of State Sunrise Evaluation Team wrote that MTs didn’t show a “compelling state or public interest in that there are no identifiable benefits to the public,” and cited that physicians read over the documentation “to prevent misdiagnosis or medical errors and to protect the patient.”

I would certainly agree with that, but Carol Croft, the MT who brought the request to the state of Pennsylvania, disagrees with the findings.

As far as the patient not benefiting, as the state wrote, Croft found that untrue. The patient would benefit the most from having a credentialed MT transcribe the record, she explained, and mandatory credentials would bring a new level of professionalism to the field. “I think we will all benefit, but No. 1 would be the patient,” Croft said.

While that sounds good, Croft doesn’t really explain HOW this benefits the public or the patient. If a “new level of professionalism” is the best she could come up with, then I’m not surprised the state of Pennsylvania found as it did. There’s absolutely nothing to support any argument that an entry-level certification will add anything of value to patient care.

It seems that AHDI, in its efforts to instill value in the process of medical transcription, is willing to overlook the fact that the physician is the one who provides the care, the physician is the one who documents the record and the physician is the one who is responsible for what is contained in the record. I’ve noted many times in the past that trying to lay responsibility for accuracy of the record on the transcriptionist is a very slippery slope. If there’s a question as to whether or not MTs will support the cost of certification, the bigger question is whether or not MTs - and MTSOs - will support the cost of malpractice insurance.

And what happens if a state does buy into this nonsense and require mandatory certification? That’s where the confusion begins. Will it apply to MTs living in that state, or MTs in any state working on an account geographically located in that state? The article does bring this up. Regarding pending action in the state of Washington, Kim Buchanan, Director of Credentialing and Education at AHDI, is quoted as saying:

Buchanan said the best way to do it, if a state were to approve mandatory certification of MTs, would be to have all work for that state’s hospitals done by certified MTs, no matter where those MTs might be based.

“[If] you said any health care documents in the state of Washington have to be produced by certified individuals, I think outsourcing nationally could be called into question,” Buchanan said. “We may end up seeing Washington hospitals bring their dictation either back in house or at least more local because they would have more control over it.”

Some of the comments made by MTs in the online forums are directed towards the hope that mandatory certification would mean the end of overseas outsourcing. That would only be the case if the state requirement meant that all health care documentation done for practitioners and facilities in that state had to be performed by a certified individual.

The article then raises the question of how this would affect the work force shortage. Let me go on record as saying that the work force shortage in the US is primarily caused by the work conditions and pay rates in MT, which have been impacted by outsourcing offshore. It simply isn’t an attractive career for people with the education level and intelligence required to do it. IF the pay rates and work conditions improved, it’s my opinion that there wouldn’t be a work force shortage in the US

Woodrow explained that service organizations are already operating under tight budgets and having MTs pay for their own credentials also seems like a difficult choice, as maintaining the credential can be pricey.

OK, so why are budgets and operating margins so tight? Because nobody has the guts to just come out and say “we need to charge more for this service - you simply can’t get what you want at that price.” Instead, the ambiguous line game continues to play out and outsourcing companies engage in cutthroat competition, apparently willing to bleed right along with everyone else. Would healthcare facilities be willing to pay more? Ten years ago, when Diskriter was performing benchmarking of what it costs per line to maintain a medical transcriptionist as an employee, the cost per line was 30 cents. So why are MTSOs undercutting to less than half that? If it can be demonstrated that employees cost 30 cpl, then isn’t 20 or 22 cpl still less expensive? I simply don’t understand the business model that says undercutting has to be drastic in order to be successful - unless the outsourced MT business has also bought into the healthcare model of “we’re not making any money, but we’re making up for it in volume!” In addition to cutthroat pricing, the outsourced services have practically thrown the kitchen sink into the mix as “added value” to the actual transcription, all while charging less and less. And when an MTSO has to provide ever-increasing technology - or offers it to get a leg up on the competition - without actually charging more for the service, guess where the difference gets made up? It has to come from somewhere and as long as MTs are willing to continue working for less and less, that’s where it comes from. Is it any wonder that more and more experienced MTs are walking off the field? This shouldn’t come as a surprise to anyone.

I’m not saying it would be easy to find quality MTs here in the US if the pay rates were better or that it would be easy to find outsourced companies doing a better job just because they charge a higher rate than anyone else. Sometimes, all you get is more expensive incompetence. However, the probability of getting better service would be greater and over time, as MTSOs and facilities demanded better performance from MTs in exchange for better pay, there would be more attraction of better candidates overall. In the current environment, there simply is no incentive for US MTs to do a better job than they’re doing. By the same token, there isn’t any incentive for MTs to get an entry-level credential that presents additional costs to them with no subsequent reward.

There’s a cautionary tale inside the hype of medical transcription as a career and that is that there are a lot of scams. There are scam schools and there are scam jobs.

Let’s focus on another shady area of transcription: the “certified medical transcriptionist.” I’m going out on a limb and expressing my opinion that any organization, other than AHDI, that claims it awards a “certified medical transcriptionist” or “CMT” designation or “credential” that is recognized in the industry is a scam. And I find this practice so reprehensible that I’m going to name names.

This is a real-life story about how these scams and substandard programs affect individuals. I’ve also used her real information, with her permission - she’s made no effort to hide who she is online and a search will bring up several of the complaints she’s filed in the online media.

Disclaimer on my research

It’s difficult (but obviously not impossible) to find out what a web site used to look like. I’ve included what I feel are pertinent screen shots of the old web sites for the companies I’m discussing, but there are gaps and I can only piece things together based on the information I’m able to obtain in the internet archives. I’m not going to claim that I have all the information - but I think I have enough of it to support the conclusions.

TechSkills owns the three top domain name extensions for their site: dot-org, dot-edu and dot-com. All the sites are identical, both currently and in the archives, and versions in the internet archives have the same logo and contact information

If you’re having trouble seeing the screen shots, click on them for the full-size version.

Like everything else on my blog, these are my opinions unless otherwise stated and referenced.

The School: TechSkills

Cathy thought she did her homework. She investigated medical transcription and medical transcription education. She chose TechSkills, a vocational school with multiple programs and locations in multiple states.

The state in which Cathy resides lists TechSkills as an approved school offering medical transcription education. There are only 4 schools on their list: Kaplan University, At-Home Professions, Rasmussen College and TechSkills. For those of us who’ve been in the industry for awhile, that list says about all there needs to be said about the value of the state approval. It should also provide a precaution for those beginning their search: state approval of a program can be pretty meaningless. In this particular instance, all it means is the school is approved to operate in the state. The state site makes it clear that approval and accreditation are two different things, and what they do is provide approval. TechSkills is an approved school, not an accredited school. Approved schools undergo the following process:

…staff evaluates program and teaching location applications, advertising, enrollment and school catalog documents, refund policies and financial statements. Approval is granted after a school has submitted all required information and forms and the school is in compliance with state law.

The state establishes a standard and makes every effort to ensure that a school meets the standard. They respond to complaints. They are also supposed to monitor a school’s success rate; i.e., whether students are graduating and getting jobs. This all kind of begs the question: who is watching the watchers?

Cathy also checked out the TechSkills web site and information provided there. In January of 2005, this is what the TechSkills web site said about their medical transcription program (ignore the “Careerstep” on this site - it’s what they call one of their programs and has nothing to do with the transcription school by the same name):

The program also prepares our Students for the Certified Medical Transcriptionist exam, which enables them to earn a widely recognized industry certification.

They don’t say who performs this certification, but as Cathy found out - it wasn’t AHDI. I’m going to put that part of the story on hold for a minute, however, so we can finish up with TechSkills and move on to the organization that was administering the referenced certification.

The reference to the certification appeared some between January 2004, when the site looked like the screen shot below, and January 2005 (screen shot above).

You note there’s no reference to a certification of any kind; however, one difference I am noticing is this one:

…with access to a professionally-certified instructor in person, via telephone or electronically.

I can’t find any information at the current TechSkills site about their instructors, including what professional certifications they might have. In fact, Cathy tells me that the instructor at the time she took the course was a recent graduate with no medical transcription experience. Am I being too cynical if I wonder why they aren’t terribly forthcoming with this information?

Fast forward to December 2007. Somewhere in this time frame, TechSkills changed their web site. In November 2006, AAMT (now AHDI) sent a letter to TechSkills, notifying them of the misuse of “certified medical transcriptionist” and “CMT” and requesting that they stop using the terms, as the use implies that individuals have actually received the industry-recognized credential and it’s confusing. In addition, Cathy responded to the schools’ feedback form for graduates, and indicated that she had contacted over 50 employers and 48 of them had never heard of the organization issuing the “certification.” She was told by prospective employers not only is the NHA certified not widely recognized; it is, in fact, not worth the paper it’s printed on.

As you can see, the site now specifies that the Certified Medical Transcriptionist (CMT) exam is through AHDI.

But wait - there’s more! As those of us in the industry know, new graduates are not eligible to sit for the CMT exam. Just this year, AHDI sent TechSkills correspondence and informed them that this is misleading, as students and post-grads are not eligible to sit for the exam.

Finally, TechSkills changed the site, indicating:

You’ll also prepare for the Registered Medical Transcriptionist (RMT) exam, enabling you to earn a widely recognized industry certification from the Association for Healthcare Documentation Integrity (AHDI).

Going way, way back in time, it appears that TechSkills started out as a computer technology school and then branched out into other vocations some time in the early 2000s.

In the interest of disclosure, Cathy did get her money back from TechSkills after she filed complaints about their program, claims and “credential.”

So what about that”certified medical transcriptionist” or CMT?

The elusive “CMT”

The organization providing the testing and credentialing of “certified medical transcriptionist” or CMT to new graduates of TechSkills is/was National Healthcareer Association, “the benchmark in Allied Healthcare Certification.”

How can you be a “benchmark” when nobody has heard of you? I called a couple HIMS managers I know, at large hospitals (including a couple University medical centers) and none of them have even heard of this organization or its certification. I called several clinics, with the same results.

I like the broad ambiguity of this statement. It doesn’t say these organizations require the National Healthcareer certification - but since NHA has “national certifications,” it is implied, in my opinion. Even if we ignore that, the statement is patently false. Let’s look at the administrative healthcare certifications offered through NHA.

• Medical transcriptionist - no brainer. We all know there’s no certification required; most of the time, it isn’t even preferred.
• Billing and coding specialist - hospital coders are usually required to have the AHIMA credential. Medical billers aren’t required to have a certification of any kind.
• Certified medical administrative assistant - not required in any office I’ve ever been in, in any state.

What does NHA do when Cathy forwards them the letter from AAMT? A response from Jon Brandt (whose function is unclear - it’s not on his e-mail signature and their web site doesn’t have ANY information about principals) first claims they had never received the letter from AAMT. He then states that the term “certified medical transcriptionist” and the initials “CMT” are not trademarked by AAMT - which is is true. However, these have been in use by AAMT since the late 1970s. NHA claims to have used it since 1986. But the best part of the e-mail sent Cathy, in my opinion, is this:

nor have we ever had an organization not accept the NHA certifications…

I’m not going to call Mr. Brandt at NHA a liar because he was - I would guess purposefully - vague about which organizations and which certification. If there’s a lie in that statement, it would be that this has never happened. I would, however, like to see if he could make the same statement with specific reference to the NHA “CMT” and still keep a straight face. He then goes on to speculate that this is an effort by a competitor to discredit a company that’s clearly ahead in the game. (Where are my eyeballs? They rolled right out of my head!)

The matter could be resolved in court, but that costs money and AHDi doesn’t have any spare cash. So - it appears that the folks over at NHA will continue to cash in the bucks by offering a credential that is worthless in THIS industry.

What do we learn from this?

I called TechSkills today and said I wanted information about their program and fees. Apparently, they’ve learned some things, but not as much as we might think.

The individual I spoke to actually had to rustle around in papers to provide me with information. I guess this gets confusing when you offer so many different programs at so many different locations. He even had to look up how much the medical transcription program costs.

Are you sitting down? $7400. Yep, you read that right. I have been researching MT school tuition for another article I’m working on and the only AHDI-approved schools charging anything close to that are the universities and colleges - and that’s the out-of-state tuition.

Although their site refers to the RMT by AHDI, the representative told me I could get a credential from either NHA or “the other.” He said (and this is word-for word):

The other is offered by a little network in the industry, so it’s preferred.

He also told me that both are valid and both are well known. Well, I’ve been in the industry for over 20 years and this is the first time I’ve ever even heard of NHA.

In addition, TechSkills has an NHA testing center in their facility, with a monthly testing schedule, and graduates can arrange to take the NHA test there. In my opinion, that’s still an endorsement of NHA certifications, in spite of the fact that it wouldn’t be difficult to prove to them that the NHA “CMT” is worthless to aspiring transcriptionists.

What I would like medical transcription hopefuls to learn from this is that there is only one organization offering any credentials that are recognized in the medical transcription industry, and that is AHDI.

Class Action

Cathy is trying to find other graduates from TechSkills, as well as others who have received the NHA “CMT” so she can start a class action lawsuit. The clock for her is ticking - the statute of limitations on her claim runs in a month.

These sort of practices affect both individuals and the industry. I’m helping Cathy spread the word and get her class action together because she lost a lot of time and money in this process.

Interested parties should Contact Cathy directly. (Her e-mail is included with her permission.) If you have any questions, please comment.

Other links:

Cathy’s Rip Off report

A couple days ago, I linked to an article, Career Step is not a Scam, at at Undress4Success, a site focusing on at-home jobs. I give them kudos for trying to provide accurate information on at-home work and potential scams. However, like most sites that cater to the ever-popular WAH topic, I get frustrated with information disseminated by people who aren’t experts in the industry. To their credit, they’ve asked if I’ll review the medical transcription section of their WAH guide, which I’ve indicated I’d love to do.

They get a lot right in this article. To their credit, they clear up the myth that medical transcription is an easy job and they make it clear that it requires knowledge and skills - and education.

The biggest mistake made in this article is suggesting that criticism of Career Step is based on jealousy, intramural competitiveness - or even possibly paid shills.

Oh, gulp.

Career Step has an aggressive marketing campaign, including affiliates who are paid for everyone they get to sign up. Many of these affiliates run their own web sites and blogs, promoting the Career Step program with a great deal of bias. Affiliates and advertising publishers aren’t the same as “paid shills” who are “encouraged to bad mouth Career Step,” but there’s a thin line between positive shilling and negative shilling. And anyone who knows the principles at Andrews and M-TEC know that they stand on their reputation - they don’t need shills. Some of the competitive programs actually use the Career Step curriculum - hopefully with corrections and all with actual live teachers - I doubt they’re going to be bashing the Career Step program. If people actually listen to the advice of others in the industry and go to only AHDI-approved schools, they have some fairly decent choices, Career Step among them, and can avoid the really awful programs that aren’t worth the tuition, regardless of what it is.

The second biggest mistake is this comment:

Both schools [Andrews and M-TEC] —and others—offer fine training, but not necessarily better than Career Step.

I’ve said here before: Career Step serves a purpose. In my opinion, it is not, as stated in this article, on par with Andrews or M-TEC. For one thing, both Andrews and M-TEC have entry screening exams. If transcription isn’t the best career choice for you, based on your skills and knowledge, you won’t pass the test and they won’t take your money. That seems pretty honest to me, however unpopular many hopefuls wish it to be otherwise. And anyone who wants to ignore the danger signs can go to Career Step. Unfortunately, what this means is that Career Step takes a lot more people who are doomed from the beginning but don’t seem to mind plunking down nearly $2,000 to have the lesson hammered home. The second big difference is that Andrews and M-TEC have actual live instructors. It absolutely boggles my mind that a school wouldn’t have instructors, but there you have it - Career Step lets its students and graduates instruct each other in their forum. Therefore, we have the blind and the clueless instructing the blind and the clueless. Taking up the article’s comparison to a carpenter blaming the tools - what would an apprentice carpenter hope to learn from another apprentice carpenter? The third big difference is the “placement program.” Please correct me if I’m wrong, but I’ve been told by Career Step graduates that they pay extra for the “placement program,” which consists of a list of transcription services that may or may not hire new graduates and may or may not have openings for anyone, experienced or otherwise.

What I see a lot in the various MT forums are comments from Career Step about-to-be-grads who state they feel their education is adequate. Well - how do they know? Until they graduate and actually get a job and start work, they aren’t really qualified to judge, are they? And there are plenty of Career Step graduates who are critical of the difficulty they had finding a job and the inadequacies in their education that became apparent once they actually did start work. These graduates aren’t shills for someone else and the only jealousy they have is for people who picked a program they felt would have served them better in starting a new career.

For the record, I run a variety of web sites related to transcription and I accept advertising at them. If Career Step wants to advertise, I’ll let them. But I won’t softpedal my opinions about where they stand in the transcription school rankings and why they won’t ever be the best unless they make some significant changes - like real instructors.

Last week, I attended the Healthcare Documentation Specialist Curriculum Development Seminar, sponsored by Mira Costa College, in San Diego. This was attended by educators from local community colleges with transcription and HIM programs, employers, some MTSOs and some transcriptionists. Kim Buchanan, AHDI-F and Director of Credentialing and Education with AHDI, and Peter Preziosi, CEO AHDI/MTIA, were also present.

Please don’t get distracted by AHDI here - I’ll comment in another blog post about AHDI and some discussions I had with those present that were pertinent to AHDI.

Already, you’re noticing something different - the job title, right? Everyone in the room agreed that the scope of medical transcription is changing. I think there are few business owners and working MTs who would disagree with that. More and more clinics and hospitals are moving to electronic medical records (EMRs) and either discontinuing dictation altogether or attempting to integrate transcription with the software. They’re also demanding that outsourced medical transcription services utilize technology to decrease costs and turnaround times, with speech recognition (although it seems the newest term for this is speech understanding), turning medical transcriptionists into editors.

The medical transcription industry is struggling with these changes. These changes don’t affect only transcriptionists; they affect the entire chain, from the physicians and the facilities where they must document healthcare to the outsourced service owners to the information technology services and support. Right now, nobody is quite sure where we will all end up - we’re all just pretty sure the demand for someone who wants to just sit and transcribe from voice will go down and some sort of blended job will emerge.

Probably the best thing that could happen in this blended job would be for technology to tie the actual documentation process in with the coding and billing process (the revenue cycle). This would place the documentation process itself (rather than the document) into the revenue cycle - that “missing link” that MT has always struggled with in order to find value for itself. It’s very possible that as the EMR technology advances, the MT (a term I’m going to use just because it’s easier and I don’t want anyone to get confused) may be looking at coding a document at the same time it’s produced; it’s also possible there won’t be any audio dictation, or very little audio dictation, or that the record will be transcribed by SR and sent to the MT for editing and coding verification. In spite of the fact that many in the industry believe that it will be necessary to include dictation to get more physicians to adapt to the technology - and because, quite frankly, it’s usually faster than alternatives - this still doesn’t address the demand for point-of-care documentation. Dictated records for handling by another person (i.e., the MT) will never provide point-of-care documentation. I’m not disagreeing that dictating is usually faster and a better use of physician time or that it will speed adoption of EMRs - I’m just pointing out that it won’t ever be a point-of-care documentation solution.

And no matter how many people with years and years of experience in the industry sit in a seminar and discuss these topics - it’s all theory at this point. Nobody knows any of this for sure. We do know what the current job is; we also know we need to prepare the people who are currently MTs and the people who want to be MTs for a future that may require a broader scope of job skills. Kathy Striebel, from Mira Costa College, said she has many more people now enrolling in the coding and medical billing courses than the medical transcription ones; part of the reason for the seminar was to discuss curriculum for preparing people for a blended job.

And frankly, I think it’s about time. We aren’t any of us making much money in the traditional medical transcription industry. Compensation is going down, costs are going up, and competitors continue to drive down pricing in crazy cutthroat competition (argh!) that doesn’t benefit anyone.

Skill Set

We had an interesting discussion about the skill set required by the knowledge-based worker in the emerging healthcare documentation environment. I’m interested in knowing how MTs feel about this.

• Hardware and software proficient
• Content and technology enabled medical editing
• interpersonal business skills targeted towards distributed virtual workforce (telecommuters)
  - time management and discipline
• Critical thinking/problem solving
• Knowledge of pathophysiology, anatomy, physiology and body systems, diagnostic procedures, laboratory data, pharmacology
• Critical and interpretive listening
• Digital and internet proficiency
• Knowledgable about privacy, security and ethics
• Knowledgable about healthcare compliance and risk management
• Awareness and knowledge of medical-legal issues
• Familiar with documentation workflow
• Coding skills
• Billing practices understanding
• American English language and regional syntax proficiency

Keep in mind that the curriculum being developed is for students who are just entering a college program that takes almost 2 years to complete.

One employer stated that when she had to outsource some of her transcription, she was unable to use the smaller service she would have preferred because they didn’t have the technology capability required to service the hospital. It isn’t just individual MTs who will need to be tech-enabled; the outsourced services need to be, as well.

Recently passed legislation now holds anyone handling PHI to the same standards and penalties as a covered entity. Whether or not you think the doctors and clinics you work for, or your clients, care or whether or not you think there will ever be a problem in your small corner of the world - there are a lot of mom-and-pop long-term care facilities that are now out of business because they never thought the Medicare auditors would come down on their heads.

Look at the list of skills and ask yourself - is there much in there that can’t be described as knowledge based? Can these skills take us to a job description that will place more value on what we know than how many widgets we can produce?

Job Title

Medical transcriptionist simply doesn’t adequately describe this evolving blended job. In addition to being more descriptive, I think that a new job title focuses more on the knowledge skills of the job and less on the current production-based commodity of medical transcription.

Healthcare documentation technician: This describes the most basic level of the job, probably comparable on skill level to what the Hay Group study describes as a level 1 transcriptionist.

Healthcare documentation specialist: This is probably where many in the industry are currently at, or what the Hay Group study describes as a level 2 transcriptionist.

Healthcare documentation analyst: This job title excites me. Just the term “analyst” makes a strong statement about the knowledge level of the person with this education and experience. This is level 3 and beyond, encompassing all the skill sets.

Credentialing

Someone asked me in another discussion why AHIMA has been so successful in getting its credential accepted, where AAMT/AHDI has not. I don’t know the answer to that, but I’ve made myself a note to ask someone in AHIMA leadership. Whenever you see a job advertised for HIM, the employer usually specifies that a credential is required. This “requirement” is internal - there is no external requirement that these positions be credentialed. However, there are enough people who value the credential that when a job is posted with this requirement, there will be more credentialed applicants than noncredentialed applicants.

The problem in MT is that the opposite is true. Even if employers specified “credential preferred” in their ads - and they don’t - there are so few credentialed MTs that everyone knows it’s not really going to make a difference. If 9 people with 10 years’ experience and 1 person with 2 years’ experience and a credential apply for the job, do any of us really believe the person with the credential will be given “preferential” hiring? (No.)

I’ll save the deep discussion on credentialing for another blog, so start thinking about it. I think it’s something MTs really need to consider if they’re going to make any progress - whether it’s the CMT from AHDI or the RHIT from AHIMA.

Getting Experience

Continuing on the subject of credentialing (kind of)…

The reason I went to this seminar was to talk with people in education about what can be done to help MTs get into the job market post graduation and if there’s a way I can help employers and new graduates by offering something through MT Registry and what that might be. This isn’t an area of transcription I’ve really kept up on, especially in terms of what AHDI is doing in this regard, but I knew this has always been an issue and that it’s one AAMT/AHDI has tried to address.

Which brings us to the apprenticeship program. After years of hard work, AAMT/AHDI was finally able to get the Department of Labor to recognize MT as an apprenticeable job. Unfortunately, this has been a huge failure, for a variety of reasons. However, I’m told by employers that nobody can afford to pay a new graduate an hourly rate for 2 years, which makes employers reluctant to take on an apprentice.

Then, there are internships. An internship is an unpaid position and my guess is that this wouldn’t be terribly successful either, as most people can’t afford to work for 90 days without making any money. On the flip side of that, the employer can’t afford to put someone on the books for 90 days at at least minimum wage so they can train them, either.

Mira Costa College is going to add 10 hours of dictation to their curriculum, which a student must complete before completing the program. Still - that’s not a lot of dictation. In reality, if you convert lines to minutes at 10 lines/minute and realize that a company requires an MT to produce 1000 lines/day as an employee, that’s only 6 days of work. It’s going to be a start, but that’s all it is.

In my opinion, the ideal would be for schools offering medical transcription programs to add a module to do transcription on dead files for 3 months, with the requirement that productivity and quality guidelines be met prior to program completion. And anyone who can’t meet those guidelines within the 3 months wouldn’t graduate.

So where does that leave us?

Unresolved, I’m afraid! I’m going to save further comments for another post - I wanted to keep this one focused on the actual seminar I attended and I think there’s enough here to keep readers thinking for a week or so.