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.