MT Exchange Medical transcription exchange

There’s been a lot of criticism over the years about the hobby MT, someone who just needs to make a little money to pay for a few extras. This is as opposed to the professional MT, someone who takes their career, the industry and the business of MT seriously.

When it comes to the business side of MT, many MTs lose all sense of  perspective. Although there is a general derision for hobby MTs, the flip side is that the same (or more) level of derision is applied to the corporate aspects of the business. It sends a message that small business is okay, big business is not and that my small business is better than your small business because I run a serious business, dammit! There’s an aura of superiority put off by those who look down on the hobby MT because s/he doesn’t treat MT like the business it is and make business-like decisions. They undercut prices, they aren’t adequately trained – golly, sometimes they aren’t even real MTs! However, while the attitude is that we should be business-like, there is a fair amount of derision heaped upon being too business-like. All that business rah-rah goes down the drain when it comes to the large MT businesses and even the not-so-small MT businesses. Men are suits and women who are too business-oriented are bitches.

What got me writing is a thread at MT Chat about the sale of M-TEC and changes taking place at that school.

I am not thrilled with the corporatization of MT or the fact that what used to be an industry of primarily women has been taken over by men in suits. Men don’t think the way women do and they don’t do business the way women do. That’s not necessarily a bad thing, but sometimes it’s difficult for women to deal with, much like the toilet seat that’s left up. Unfortunately, any business dominated by women is going to look a lot like medical transcription; i.e., marginalized and commoditized and that has little to do with “the suits” and the corporations. I’ve been stiffed and mistreated just as often by the small local MTSO run by a woman as I have been by a large corporation run primarily by men. I’d rather work for a corporation run responsibly and by the book than a poorly-run small outfit and I don’t care whether a man or a woman is at the helm of either. Suits ≠ bad bad bad.

There is an attitude in the MT community that a transcription service owning/operating a transcription school is automatically A Bad Thing. Let’s apply some intelligence to this. First of all, M-TEC was originally owned and operated by owners of a transcription service. Maybe everyone has forgotten that in the intervening years. I don’t know how long Kathy and Susan ran a transcription business along with the school, but I know they ran a transcription service simultaneously with the school at some point. Second of all, the origins of this objection were based on small services with local clinic accounts that charged exorbitant sums of money to “school” people in MT. The curriculum (and I use the term loosely) was geared towards that service’s specific needs and was not even close to adequate for educating a well-rounded MT. The MTs who completed these “programs” were only employable by the service that ran the “school” they attended. This worked fine for both parties as long as the transcription service actually had work for the MTs completing the “school.” The problems arose when those people, thinking I R A MT, lost or left that job and represented themselves in the wider MT community as a trained medical transcriptionist with experience. Which – by every definition – they were! However, because their education, training and experience were so narrowly confined to that one service, they found they were simply unemployable elsewhere – and had to start all over again. That is not the case with M-TEC, whether we’re talking about past or present owners. WebMedX, in fact, would be able to provide an excellent training ground for MTs because they have contracts with a wide variety of facilities. If they intend to employ many of the MTs who attend M-TEC, then it’s a win/win situation for MTs and for WebMedX. On top of that, M-TEC gets a real boost to its placement numbers. Any MT who has completed the M-TEC program and worked for a year or two for WebMedX would most likely have no more trouble finding another job than any Andrews School graduate. So – get a grip, people! Transcription Service + Transcription School ≠ Bad bad bad, either.

The next big criticism was the shortened time allowed to complete the program before additional fees are assessed. I think what many of the participants in that discussion are not realizing is that there are many, many community colleges offering medical transcription certificate programs and that’s really the competition. I don’t have numbers, but based on my discussions with a lot of educators at those programs, the college programs are a bigger competitor than other online schools. Most of these colleges have 9-month programs and many of the requirements are regulated by the community or state education system. I was at a meeting of educators earlier this year and the college educators said that if they made the MT certificate program a 2-year program, they wouldn’t get any students. Several months ago, I did a spreadsheet of what the schools charge and some of the community colleges were the most expensive (depending on location), especially for out-of-state students. The number of credits required to complete the certificate program and the cost per credit jumped some of these well over the $5K range for tuition. While the prior owners ran a good business, the new owners have an investment (i.e., the purchase price) that the prior owners didn’t have and they need to see return on that investment. Therefore, their focus is going to be a little different and more aggressive than the prior owners’.

And while higher fees may push some people to the less expensive schools, I don’t think it’s going to make that much of a difference. Someone who price shops their education doesn’t even get as far as M-TEC or Andrews – they think Career Step is too expensive and they’re agonizing over that or one of the $900 programs.

Andrews can’t – and won’t – take everyone who applies. As I’ve said in prior posts about transcription schools, the stance that it’s “M-TEC or Andrews” (and now if you take M-TEC out of the equation, it’s just Andrews) is just unrealistic. If your dream is to see every other transcription school shut down, consider the consequences – a mass shrinkage in the labor force. We can’t even say that’s a good thing, since the MT industry has been defying the usual influences of supply and demand for years now. I’m not sure what anyone thinks would be the positive consequences of this, or what MTs who believe in “M-TEC or Andrews” think would happen to the quality of education at those schools if they started expanding to take more candidates. (Hint: There’s a reason Harvard and Yale are so expensive and have higher admission standards. They don’t take just anyone, either.)

Can an MT program be completed in 9 months? Of course it can. Just because an MT who took longer “can’t imagine” completing the program in less time doesn’t mean it isn’t possible. Someone who is truly desperate to get into the job market can complete a self-study course in much less time than that, even. It takes focus and hard work – but I know more than one MT who eschewed Andrews in favor of a self-study course they could get through quickly so they could get a job faster. Take your pick – be broke for 2 years because you’re working part time and going to school part time, be really broke for 2 years because your school won’t let you complete faster and there aren’t any local jobs available or you live in a rural area – or be really broke for 9 months or less because you’re going all out to complete a program so you can get a full-time job and stop being broke. There’s a reason community colleges can’t “sell” a 2-year program. For one thing, the pay rates don’t justify it and for another, most people wanting to enter MT need to get into the job market faster than that.

It costs money for a school to carry people who are poking along in the program. What WebMedX is doing is requiring people to make a real commitment to their education. Having to expend considerable money and a significant amount of time speaks to motivation and commitment.

I’m going to share with you one of my first experiences about learning the value of money and commitment. I joined a martial arts class at the university in the town where I lived. The instructors were volunteers and the university let the group work out in a room in the physical education building. Although the stated fee was $5 per month, it was like it was voluntary – nobody really made an effort to collect it and most students didn’t pay it. When I had gained some seniority, I told the senior instructor I was taking over the treasury – then I started aggressively collecting the fee. Oh, the whining! Even the instructor whined, telling me these were poor college students who couldn’t afford $5 a month for martial arts. I looked him in the eye and told him “they spend more than that on beer every Friday night.” Then I looked them in the eye and told them “you spend more than that on beer every Friday night.” Did we lose students? No, we didn’t. In fact, we had a resurgence of participation. Paying $5 per month was enough to motivate these students to make a real commitment to studying martial arts and working out. People who had previously come to class only when they felt like it now attended every class. For $5 a month, they didn’t try to find time for class – they made time for class. People who had worked out with a modicum of effort either dropped out altogether or started working harder. The club finally had money to buy equipment and have social events (read: parties) at the end of the quarter after belt testing.

Someone who is having financial difficulty will either decide they simply can’t complete the program in 9 months and they’ll go elsewhere – or they’ll knuckle down and work twice as hard to finish the program before having to pay more money to extend the education – 0r pay more money to extend the education. The MT benefits by getting into the job market faster. WebMedX benefits by getting more potential candidates faster. And if WebMedX considers itself the #1 employer of its graduates – do you really think they’re going to do anything that results in their getting less qualified graduates? If employers won’t hire their graduates, if they find their own graduates aren’t adequately trained to work for them – they’ll suffer the consequences of their own decision and make adjustments.

WebMedX made (presumably) a huge investment in M-TEC. From a business standpoint, it’s in their best interest to do what is most profitable and will get them the best return on their investment. Whether or not they feel preserving the reputation of the school is a necessary part of that investment remains to be seen, but they could’ve bought any of a dozen lesser schools if they didn’t care about name recognition and reputation.

I’ve said it many times over the years when a group of MTs criticizes the decisions of a business – if you don’t like the way a business is run, feel free to start your own. You can run it any way you like, including making decisions that eat into your profit so you can please the masses of faceless MTs criticizing you in the forums.

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I search the internet occasionally for interesting news about medical transcription and it seems all I find are these crappy sites. I ran into one this morning that really got me going, so I thought I’d share. Have you ever wondered why there are so many crappy articles and web sites devoted to medical transcription careers – usually promoting some of the more questionable schools?

I live and breathe to enlighten you.

What follows is a cautionary tale to those who search the internet for information on how to work at home as a medical transcriptionist. The rest of us – you know, the choir – can only look on in horror.

How Google ads work

It helps to have some knowledge of how Google ads work. You see them everywhere you go; maybe you’ve wondered how they work (maybe you haven’t!). There are two sides to Google ads: advertisers, who want to place ads (Adwords) and publishers, who run the ads on their sites (Adsense). When an advertiser runs an ad campaign in Adwords, they pay Google. When a publisher places Google Adsense ads on their site, they get paid by Google when someone clicks on a link in the ad. High-volume publishers get enough people to the site to also be paid per 1000 impressions, or the number of times the ads are displayed to users. Low-volume publishers don’t get enough page impressions to make much money this way – they rely on the ad clicks to make money. Google, of course, takes a cut in the middle. The entire system is based on keywords, keyword phrases – the perceived value of the keywords (i.e., the number of people searching that keyword) and the traffic of a publishing site.  Advertisers can select keywords relevant to their product (in this case, medical transcription) and they can target specific web sites that get a lot of traffic. The more advertisers there are competing for a keyword phrase, the higher the cost goes because it’s a bidding process. Likewise, the more traffic a site gets and the more advertisers competing to be seen on it, the more it’s going to cost the advertiser.

I could spend days on this, but I’ll try and keep it simple because that’s not the focus of this topic.

Let’s say I want to place ads for my MT jobs site on a bunch of MT-related web sites that run Google ads, using the keyword phrase medical transcription. And let’s say that specifically, I want my ads to display at MT Chat. I start an ad campaign in my Google Adwords account and specify the keyword phrase medical transcription, then I select the option to target specific web sites. Google will retrieve a list of sites for me, but I don’t need them to – I know I want my ads to run at MT Chat. I then bid on how much I want to pay per click and what my daily budget is for the campaign. Now, I can bid whatever I like – I can say I’ll pay $0.25 per click. And Adwords will let me do that – but they’ll also pop up a message saying that my ad has a slim-to-none chance of ever showing up on MT Chat. Why? Because medical transcription is a high-value keyword phrase and MT Chat is a high-volume site, so there are a lot of advertisers targeting not only the keyword phrase, but the web site, as well. The more you’re willing to pay, the better chance you have of your ads showing up on the specified web site. Adwords lets me know that other advertisers are paying more for that phrase and makes a suggestion as to how much I might have to pay to have my ad show up there. The more I’m willing to pay, the better my chances are of having my ad seen. There are keywords that are paying advertisers a handsome amount (mesothelioma was a popular one for quite awhile and paid upwards of $30 per click!). If I choose not to target a specific site, it’s cheaper – my ads will show up on any page where the term medical transcription is found, which is why you see ads related to the topic in a discussion forum.

How this translates to medical transcription and matchbook schools

There is a thriving business on the internet known as internet marketing. Some people are very good at it, some are very bad at it, but what is pertinent to the readers here at MT Exchange is this: medical transcription careers is a very lucrative niche for internet marketers.

If you search the term medical transcription in Google, what you get in return is a mixed bag of sites about medical transcription services, medical transcription training and medical transcription courses. In the Google search results world, medical transcription is a very competitive term. People who want to work at home seem to be one of America’s greatest renewable resources; and as we all know, medical transcription has been an attractive work-at-home career for a very long time. There are approximately 18,000 searches a day for the term medical transcription.  That’s a lot of searches. To give you an idea of how competitive this term is, there are over 1.8 million web pages that contain the term and over 800,000 pages that contain the term in the title.

The web site that gets to the #1 spot in the Google search engine results (SER) is the big winner, capturing a huge portion of the traffic. Currently in that spot is Gatline Education Services. Gatline is not an AHDI-approved school and some of you probably haven’t even ever heard of it. So what do they get for being in the #1 spot? They will get 45% more clicks than the #2 site, which is currently the Department of Labor site. All I can say is Gatline must have some awesome people working on their search engine optimization because Google weighs government sites ahead of commercial sites in their results. The farther down the list a site is, the less likely it will be seen – the drop in clicks between the #1 and the #2 spot is bad, worse for #3 and progressively worse down the list, so that if a site isn’t in the top 5 results, it has a very small chance of being seen. While Gatline doesn’t run Google ads, being in the #1 spot means that anyone searching for medical transcription is more likely to click on their site than any other – which means they get more traffic.

In the internet marketing world, it would be foolish to try and compete for the #1 (or even #2-5) spot for this keyword phrase. The advice is – pick something that has fewer searches but also less competition. Sure, the ad revenue will be less, but your chances of getting to the #1 spot are much better – and something is better than nothing.

Here’s an example: if you were an Adsense publisher in the #1 spot for the keyword phrase medical transcription, the anticipated revenue you’d receive from having Google ads on your site would be (drumroll please) – nearly $27,000 per day. That number is based on the number of searches and the statistics for searchers not only clicking through to view that #1 site, but also clicking on the ads (and believe me – Google is all about statistics and therefore so is anyone with a serious web-based business).

On the flip side of that, medical transcription schools is searched only approximately 250 times a day and the site holding down the #1 position could expect Adsense revenue of approximately $1,000 per day. While nothing close to the $27,000 per day for medical transcription, it’s still nothing to sneeze at, and there’s less competition. There are only approximately 30,000 sites mentioning the phrase and only 16,000 sites using the phrase in the page title. That’s why, if you search the specific term “medical transcription schools,” you get a lot of crappy sites dedicated to nothing more than providing Google ads and affiliate sales for one of the schools that offers a high affiliate payout. (Google isn’t the only way to make money on the internet.) Currently sitting in the #1 spot is an affiliate site for Allied – which is also not an AHDI-approved school.

The obvious benefit to someone like Gatline Education – which doesn’t run Google ads – is capturing a huge share of the search market and selling to them directly. They’re capturing people who are already interested in what they’re selling and they are getting more of them than any of the other sites selling similar products/services.

Apparently, the more credible schools don’t feel the need to improve their search engine rankings – or they just don’t know how all this works. If there were more of them showing up in the top 5 spots for the search engines, there’d be fewer hopefuls shunting off to the questionable schools.

The site that got me started

No, I’m not going to give them the pleasure of a link. But it was an awful/funny exercise in targeted keywords by an affiliate marketer. The site is owned by someone in India. I could’ve guessed that, even without checking the domain name registry. It’s targeting medical transcription keyword phrases (the low-lying fruit ones). They’re giving away an “Easy Cash Blueprint” e-book – but you have to provide an e-mail address to get it, which means that address will be spammed from a mailing list in the hopes of selling you products. At the very least, they’re hoping visitors will click on the Google ads at the site.

There’s the really awful content (I’ve italicized the obvious keyword phrase being targeted by this marketer):

I am sure your quest for Medical Transcription Book has come to an end as you read this article. Yes, gone are those days when we have to search endlessly for Medical Transcription Book information or other such information like protein protein comparison, free voice to text software, transcription desk or even group transcription services. Even without articles such as this, with the Internet all you have to do is log on and use any of the search engines to find the Medical Transcription Book information you need.

If this article still doesn’t answer your specific Medical Transcription Book quest, then don’t forget that you can conduct more search on any of the major search engines like Search.Yahoo.com to get specific Medical Transcription Book information.

A career in medical transcription has a lot been going for it. Here we are facing an economic downturn and this field is only likely to thrive in these times. The medical transcription industry is set to steadily grow as the population ages.

All that useful information crap was packed into one article! First of all – would you read that garbage and then buy something? Better yet – would you want someone who read it and then paid for it to be working next to you?

Just as a note, medical transcription book gets a little over 100 searches a day. If this bozo captures the #1 spot in the search results for that term, there’s a good chance of making about $100/day from the Google ads. Heck, there are MTs who don’t make that much! Unfortunately for this hapless marketer, this site doesn’t even turn up in the top 10 of the results (although it is on the first page). With a little more work, it might make it there!

Here’s another one:

Title: Free Medical Transcription Helpful Information

As you devour this article, remember that the rest of it contains valuable information related to Free Medical Transcription and in some way related to home based medical transcription jobs, transcription from home, medical transcription position or global medical transcription for your reading pleasure.

(skip to the end) It might interest you to know that lots of folks searching for Free Medical Transcription also got information related to other medical billing, sirna delivery, and even transcription services bangalore here with ease.

Again, the obvious keyword stuffing that tells you nothing and frequently doesn’t even make sense. In one article at this site, the keywords were actually preceded by the word keyword. (where’s my rolling eyes icon?) I don’t even know what sirna delivery is – but I know it makes no sense in this article.

And my personal favorite wins the award for complete nonsense. This is the first paragraph:

If your major interest is information related to Learn Medical Transcription or any other such as medical transcription job opportunities, transcription systems, allegiant transcription services or dictation services, this article can prove useful.

Nonsensical use of keyword phrases is a sign of a novice who found the keyword phrases with low competition, but didn’t use half a brain cell in applying them to the article. I’d rather think that than think this person’s English is so awful this actually makes sense to them.  In addition, this bright marketer apparently researched the keyword phrases that were low competition and discovered that Allegiant transcription services fit the bill – and so it was included in this garbled paragraph!

The next time someone online asks you about a matchbook school, ask them where they learned about it. Chances are, it was through the internet version of  a matchbook.

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Ask me if I am at all surprised to hear there are some issues – and lots of questions and disagreements – with the visible black character “standard” that was concocted by a joint task force a couple years back. In addition to my first post about this at the old MT Exchange site, I posted a followup earlier this year: Visible black character, revisited. In addition, I put a web site dedicated to an explanation of the various methods of billing, including the visible black character.

As I had predicted – there’s no method that can’t be manipulated.

Whether the issues arise from manipulation or from the fact that the “Joint Task Force on Standards Development” issued a white paper, not a standard, and failed to use actual standard-setting methodology, is debatable. But – I was catching up on my reading and came across For the Record’s article: “Buyer be Aware.” I’m sending a great big thank you to them for putting this online so everyone can read it.

My first bone of contention in this article is some of the quotes attributed to Dale Kivi, director of business development at FutureNet Technologies.

While many companies such as SPi say they prefer that providers adopt the VBC method, Kivi suggests that a good deal of the resistance has come from transcriptionists themselves. “Whereas HIM directors have been coming up to speed on adopting VBC, the understanding and acceptance at the MT [medical transcriptionist] level has not progressed as rapidly,” he says. “Some transcriptionists are wary of changing because there have already been so many changes to their compensation. They see any change as something that could reduce their pay for the same volume of work. And because the VBC method eliminates payment for spaces, they worry it will eliminate something from their salary as well, which of course it does not.”

Dale, obviously you don’t work in the trenches. Let’s count the number of MTs who comment on this and tell me that they were asked to convert to the VBC and either (a) didn’t get an increase in line rate to compensate for the lost characters, (b) weren’t advised that a change to the VBC without a compensatory increase in the rate paid per line would result in reduced pay for more work and/or (c) weren’t even advised that their company’s line counting software was being changed to the VBC.

And here we have a promotion of the biggest lie perpetuated by those promoting the VBC:

One of the most important benefits of converting to the VBC method is that it allows documents to be easily verifiable. With previous methods, there was room for improper billing practices to take place.

I have to keep beating this drum:

• There are no methods that can’t be manipulated
• Unless someone is counting – manually – all the visible black characters (note the importance of the word in bold), this method is no more accurate than any other method that uses software to count the billable units.

The assertion made by Kivi and others is that the VBC is much easier to audit because “what you see is what you pay for.” I would like to know from the industry leaders how many companies are auditing by actually counting the visible characters with no software. Because the bottom line is – the VBC is only more accurate if you actually sit and count each visible character on the document you are auditing and only easier if you were using an abacus to verify your invoices prior to going to the VBC.

Oh – but wait! Read on in the article and you see where the cracks are starting to show in the stressed-out “standard.”

Of course, nothing is ever 100% foolproof, and there are some bones of contention even when using VBCs.

Do tell!

“Headers and footers are one issue,” says Cohen [president of SPi Healthcare]. “Some clients are OK with counting headers and footers across all pages, since they are visual characters, while others may insist on counting the first page only.”

What a surprise – some people want to have their cake and eat it, too! Look, folks – either you pay for all the characters you see on each and every page – or this “standard” starts on that slippery slope to join the calculated line. It seems the demographics are joining the headers and footers on that slippery slope. It doesn’t at all surprise me that this issue has come up. There were reasons why the calculated line was abused and those reasons still exist in the industry. Those reasons didn’t go anywhere just because a joint committee got together and came up with a new way of counting billable units. At fault are both parties involved in the transaction (you know who you are).

Now here’s what I find to be the real kicker in the whole article:

Kivi agrees that it’s important for both parties to be clear about these types of details to avoid the perception that the transcription service is attempting to sneak something under the radar. In that regard, he considers communication to be a key to better billing.

No s***, Sherlock. And if this was the case across the board, there wouldn’t be a need for the VBC.

Back to my bottom line: you can use any method of calculating a billable unit as long as it is transparent and verifiable.

Oh yeah – and I’m just never going to understand how any of these people can claim the VBC is easier to verify. I’m begging Kivi or anyone else to explain it to me.

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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:

Medquist web site: Careers

Focus Infomatics web site: Careers

Webmedx web site - Careers

Spheris web site: Careers

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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.

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