MT Exchange Medical transcription exchange

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An interesting subject came up on one of the MT boards this week. (I’m not going to give them a link back, because they don’t allow links to other MT sites on their site.)

The MT posting the topic said she’s an independent contractor for an MT service company and was recently notified that if the hospital account she works on goes out of TAT, there is a 15% penalty – so the MTSO is passing that penalty onto the MT contractors.

Huh??

Whether you’re working as an employee or an independent contractor, I have news for you, so MTs – sit up and take notice.

The contractual agreements between an MTSO and client, including penalties for failing to meet turnaround, aren’t your problem, whether you’re an employee or an independent contractor. Unless, of course, you’re the employee responsible for staffing, scheduling and making sure the account stays in turnaround. If you’re an MT (employee or IC) who is just putting in your lines – not your problem.

And MTSOs – here’s a news flash. If you agree to a TAT penalty, it’s your responsibility to meet it – not the MTs who are doing the work. It simply isn’t the responsibility of your contractors or employees to make sure you are meeting the contractual obligations agreed upon between your business and your client.

In my opinion, it’s just shameful for a business to attempt to pass contractual penalties along to the MTs doing the work.

Let’s understand something – being an independent contractor isn’t the same as being a chump. Your IC business may accept TAT penalties from your clients, but they’re agreed upon in advance and you would only agree to them if you have full responsibility – and control – for the entire account. If you’re one of five MTs contracting with a client (because maybe they don’t want to work with a unified service), you would never agree to a contractual penalty for TAT because you have no control over what the other four MTs working on the account are doing. Working on an account for an MTSO as an IC is no different – you have no control over their staffing, their management, their operations management, their workflow process or the other MTs. Why in the world would you accept a penalty because they’re not meeting their contractual TAT?

The post I’m referring to also makes a reference that this is how you treat employees, not ICs. Another news flash – you don’t treat employees like this, either. Would you, as an employee, agree to a policy that makes YOU responsible for the overall TAT of the account? It’s the same story – whether you’re a contractor or an employee, you don’t control the management of the entire account.

Here’s a clue: the people who control the management of the account are the ones responsible. And they should take that responsibility, not pass the buck on to the people who don’t control the process. And it doesn’t matter whether those people are employees or independent contractors.

My advice to this MT is to write a letter to management, pointing out that contractual obligations are being met by the independent contractor and that any attempt to reduce payments will result in suspension or termination of services. Then start looking for another contract.

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I recently received an e-mail from a transcriptionist who described a situation that I think will surprise most medical transcriptionists. It’s an issue I found especially interesting in light of a post by Nae at MT Chat, and the responses it got: Yep, my ESP is working real well today doc …

I hadn’t even discussed this with Nae, so when she posted that thread, she was not aware of this MT’s e-mail to me.

Let me preface this by saying there are usually 2 sides to a story and I only have one, so my conclusions are going to be based on that. I’m not going to name names, but if any MTSOs have had a similar experience from their side, or if you’re in management and you think this is your company, I’d like to hear the “other” side.

In a nutshell, an MT who was being paid a premium line rate because of her experience and skills on multiple accounts, was demoted due to “potential reportable events” (PREs) involving privacy and security breaches.

The reason? Selecting the wrong doctor as attending, and sending a copy to the wrong physician. In the first case, the error was noted by the MT, but too late – the report had already been sent in, at which point it was immediately distributed. Even though the MT sent an e-mail, noting the error, this error was counted in the disciplinary action that was taken against her. In the second instance, the name dictated sounded almost exactly like another name – and the MT selected the incorrect name.

As amusing as it is to say “we can’t read your mind, doc,” I’m wondering if some of the people responding to that post at MT Chat want to rethink their answer. Although Nae’s example is “send a copy to Dr. Patel,” in a case where there are multiple doctors with that name, it could have easily been “send a copy to Dr. Smith,” where there are not only multiple Dr. Smiths on a list, but Dr. Smyth, Smythe and etc. All it takes is one large university hospital or VA account to realize there are many, many ways to spell names we all thought had a common spelling, for both patients and physicians. With no training and no physician list, it would be obvious to an MT that picking the correct one among a number of Dr. Patels is impossible and needs to be flagged to QA – but what about Dr. Carter v. Karter? If someone says “send a copy to John Carter” and you find a John Carter on the roster – would you look any further to see if there was also a John Karter and therefore flag the report to someone up the food chain?

In my opinion, there were a couple of errors that occurred prior to the MT making the error.

1. It was a new account and no training was given.
2. No physician list was provided, including a list of attendings and their fellows or residents.
3. The MT company has no written policy regarding PREs and how they will be handled.
4. The MT company has no written policy regarding disciplinary action to be taken in the case of MT errors of this kind.
5. No software safeguards are in place.
6. As is usually the case, training for dictators at the facility also appears to be substandard – GIGO.

Some of these seem like no-brainers, don’t they? I don’t know how anyone can be expected to perform with minimal errors on a new account without any direction or instructions, regardless of how experienced they are. An experienced MT may be able to pick up and transcribe any dictator at any facility – but years of experience is going to give an MT the ability to somehow instinctively grasp account specifics.

This is not a small company, this MT is not an independent contractor. The disciplinary action taken cut the MT’s pay by 20% to 25% yet there’s no written policy in place. No inservice on HIPAA, no training on the account, no written disciplinary policy – but with no warning, the company takes action that cuts pay 25%.

Hello, MT employees – have you asked your employer what the written policy is for your company? What happens when a mistake like this happens? What are your responsibilities? What disciplinary action may be taken against you? What recourse do you have?

Technology being what it is, why doesn’t the EMR software – that same software that immediately routes the transcript to all interested parties upon completion by the MT unless it’s flagged – have some safeguards built in? I realize that EMR technology is evolving, but is anyone doing anything to ensure that copies don’t go to Dr. Carter if he’s not involved in the patient’s care and Dr. Karter is? If not, why not? You’d think that while everyone is out spending money on streamlining the process and reducing labor costs, they’d also be doing something to ensure security is more automated. Even a delay of a certain number of minutes would be helpful (something like the 7-second delay on newscasts), so if errors are caught shortly after the report is completed, there’s some hope of rerouting it before it’s gone out for distribution.

Are MTs paid enough to take on this kind of responsibility? Are YOU paid enough to take on this kind of responsibility? What I see happening is that more and more MTs will send every questionable physician name to QA or to the hospital staff to deal with. Then, someone will get mad – probably at the MTs. Because it seems nobody is willing to hold the dictators responsible. So here’s a tip for all you working MTs out there – unless you’re 100% certain, flag that report. The sooner these questions start piling up on the desks of people who are actually paid enough to deal with PREs, the sooner the problem will be resolved.

This situation was a FAIL of epic proportions, primarily on the part of the transcription service for not having policies in place, by not having in-service sessions for employees to train in HIPAA compliance and on account specifics. Well, shame on management for taking its shortcomings out on the transcriptionist.

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You know you’ve really made the big time when your blog starts getting spammed by spammers who are actually on topic. That means your blog is ranking well for targeted search terms; in my case, that would be medical transcription.

I’d like to thank all the spammers out there who have tried everything imaginable to get their spammy medical transcription links on my blog pages. Now – cut it out.

Thank you. Have a nice holiday.

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This year is flying by us. Before we know it, it’s going to be 2010 – and that means significant changes in privacy and security measures for service providers to the healthcare industry. One of the more important changes for the medical transcription industry is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which becomes effective in February 2010. Just when you thought the government couldn’t make anything more convoluted and difficult than HIPAA – they came up with HITECH. Never underestimate the ability of bureaucracy to confuse the public!

In an effort to help doctors make sense of this mess, The AMA News collaterally helps out business associates, so it’s a good idea to follow along if you are interested in what the doctors are being told and how it applies to medical transcription services. Attorney Steven Harris, reporting in the AMA News, writes:

Those agreements you signed to comply with the Health Insurance Portability and Accountability Act probably need to be torn up, rewritten and re-signed.

One of the most significant changes that HITECH makes to HIPAA is that the relationship becomes bilateral. Under HIPAA, medical transcription service providers were not covered entities. Under HITECH, they are. Under HIPAA, the physician was responsible for monitoring business associates for breaches. Under HITECH, the business associate must also monitor the physician’s compliance.

In another article, Stimulus package alters HIPAA rules for business associates, Mr. Harris goes into some informative detail about what business associates are supposed to be protecting:

A business associate is someone who, on behalf of a covered entity, performs an activity involving the use of disclosure of individuals’ health care information.

…Under the stimulus bill, several HIPAA security provisions now apply to business associates in the same manner that those provisions apply to covered entities. That means business associates of covered entities will now have an affirmative duty to protect the confidentiality of electronic protected health information created, received, maintained or transmitted in performing services for or on behalf of covered entities.

Even if you are only providing services 1:1 to a physician, read the article by Mr. Harris and take steps to protect yourself. He suggests that a contract should outline what steps the physician will take if there is a suspected breach, so that both parties know what to expect and for reporting purposes.

At this point, other than to say it’s probably time to start looking at the contractual relationship you have with your clients, regardless of how little you think you are and/or whether or not you believe HITECH will impact you in any significant way. I’m not going to go into detail about what MTs may or may not be required to do as a result of this legislation; I will suggest that you follow Mr. Harris’ articles at the AMA News. They’re written for doctors, but MTs and MTSOs will be able to apply much of what he writes about.

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