Certification of medical transcription organizations

I think it's great that more print magazines are making articles available online so you can all go read for yourself the article I'm going to reference. "Uncertain about Certification," For the Record Vol. 19, No. 25.

I'm not certain in reading this article how certification of medical transcription service organizations (MTSOs) even became an "issue." Why are we talking about this? Nothing in this article clarifies that question.

The burning question in my mind is what does Dave Woodrow know that the rest of us don't?

Being proactive rather than waiting for government mandates to be handed down is something that the MTIA and the Association for Healthcare Documentation Integrity (AHDI) would certainly like to focus on, Woodrow says.

"As the industry is moving more into electronic patient records and as the skill sets for MTs [medical transcriptionists] are changing, and as the government is looking more and more to regulate information, it may very well [require] your company to be certified and that could be a huge issue," he says.

[Woodrow says] "one of the questions we need to look at is if we, as an industry, don't come together and get this done, will the government come in and do it? We hope not."

"The clock is ticking and this isn't something that can be thrown together in a couple of months," Woodrow says.

"Certification in our industry will let us be in control of our own destinies rather than having some legislative subcommittee that understands nothing of our business come and make decisions."

Apparently, Woodrow believes government involvement is somewhat imminent:

"As the industry is moving more into electronic patient records and as the skill sets for MTs [medical transcriptionists] are changing, and as the government is looking more and more to regulate information, it may very well [require] your company to be certified and that could be a huge issue," he says.

That’s a lot of maybes. Or may very wells. It also assumes a lot. At any rate, I’d really like an answer to the burning question.

Hello, Dave! If you're reading, a comment would be appreciated.

Woodrow makes another comment I find to be interesting: "Resistance to the certification idea could simply be a fear of the unknown."

Or... it could be a real healthy dose of skepticism. Or simply a rejection of how "industry leaders" are attempting to find some new value set for the industry. Apparently we've exhausted the old ones of quality, turnaround and price (another blog topic - let me mark that on my calendar).

MTIA and AHDI - now joined at the hip - seek to somehow increase the value of transcription by trying to place MT into the same category as those who provide direct patient care. One reason JCAHO accredits healthcare organizations is because they provide direct patient care and there has to be some oversight of that for consumer confidence. There is no direct patient care involved in medical transcription. I don't care how much AHDI and MTIA may want to believe that MT has some responsibility for accuracy of the patient record, it just isn't so and it isn't ever going to be so. Attempting to place MTs into this arena is a step squarely onto a very slippery slope.

Jay Cannon (now with WebMedx, formerly CEO of Spheris) pops in with this comment:

"In an industry where there is skepticism in the price vs. value ratio, business certification could go a long way in promoting the value of clinical documentation processing."

Or... and I know this is a really radical idea, but stick with me on this... MTSOs could start actually delivering what they promise the client. MTSOs could start being honest with clients about their ability to meet the client needs. MTSOs could start WALKING instead of TALKING. Do we really need yet another failed initiative? Think about it for a minute: the "AAMT line," which has recently been quite trashed by an industry giant, the "MTIA BMP," suffering the same fate at the same hands... need I go on? Yes, apparently I do!

In their search for relevance, AHDI and MTIA are (in my opinion) grasping at straws, latching onto any idea they believe will highlight "value" in medical transcription services. MTIA has the additional agenda of promoting its members and the services they offer. I understand that. However, like the VBC white paper, everyone needs to understand the underlying agenda. Remember that MTIA is the organization that promoted "Billing Method Principles" (BMP) at the same time its largest member (MedQuist) was engaging in billing practices not in keeping with the BMP.

"The review, conducted for the Board of Directors by Debevoise & Plimpton LLP and PricewaterhouseCoopers LLP, identified a number of issues regarding the company's billing practices. The review found that with respect to its contracts that called for billing based on the "AAMT line," the company used ratios and formulas to determine the number of "AAMT" transcription lines for which clients were billed rather than counting the number of relevant characters to determine a billable line as provided for in the contracts. With respect to these contracts, the company's use of ratios and formulas as a surrogate for counting was generally not disclosed to the clients."

I could get into a whole discussion about that alone, but in order to stay on track, I'll just note that the MTIA BMP was in effect during the time period the MedQuist "billing irregularities" took place. And since Woodrow states: "Some individuals in the industry are looking to MTIA as an option to supply the talent to put together criteria for certification," I'd like everyone to take note of how well MTIA members have performed in the past in complying with the standards they have set for themselves through the organization. Woodrow also states: "There is a short list of folks out there that might have a shot of putting this together."

I'd like to know who is on that short list, Dave.

The article talks quite a bit about ISO certification. This has me wondering why AAMT spent so much time and money on helping develop ASTM standards for the industry. I'm wondering if they failed to find the necessary relevance there and are now moving on to the next big thing.

In my opinion, there was one person interviewed for this article stood up for the rest of the industry against the "industry giants," and that is Beth McLaughlin, president of Adept Word Management, Inc.

"ISO certification is an enviable goal, but we are talking about an industry that is made up of a chain of people - from the clinician dictating the note to the transcriptionist transcribing it to the patient it affects," she says. "Bottom line, as a provider if you don't provide exemplary services and a great product, you don't get the work. Certification won't change that."

OK, I am going to disagree with McLaughlin that substandard services don't get or keep the work. They do. All the time. I could give a lot of examples. But will certification change that? I seriously doubt it, for two reasons. (1) Some healthcare organizations dig their own graves when it comes to how they handle selection and maintenance of a transcription service. Some of this is due to a complete lack of understanding of the industry and some of it is due to the willingness to put up with a substandard vendor as long as the price is right (ignoring all costs associated with having to deal with the consequences of a substandard vendor, but that’s another blog as well). (2) There are plenty of black eyes in the industry and unfortunately they keep popping up on the same very visible faces. Unless the certification process is set completely apart from the same people who have caused customers to lose confidence in the industry, certification won't change a thing and will only add a layer of cost to those who want nothing more than to provide the value their customers are paying for.