MT Exchange Medical transcription exchange

AHDI-West wants to show you how to use the AHDI Book of Style 3rd Ed.

Am I the only one who thinks that if AHDI had done a good job in layout and design, we wouldn’t need lessons on how to use the book?

I was doing some research for updates to the MT Reference Style Guide this last week and discovered why people may need lessons on how to use the book.

There are confusing discrepancies and contradictions between the text and the samples.

I’m interested to see how they address that in a webinar.

If you have the book, look at section 10.3.9 Money (pp. 246-248).

For numbers less than one dollar, use numerals; spell out and lowercase cents. Do not use the decimal form. Do not use the dollar sign ($). Do not use the cent sign (¢) except in tables.

EXAMPLE:
8 cents not $.08 or 8¢

20 cents not 20¢ or $.20

It then notes an exception for tables and moves on to:

For amounts over one dollar, use the dollar sign ($) preceding the dollar amount, and separate dollars and cents by a decimal point. Do not use a decimal following the dollar amount if cents are not included.

EXAMPLE:
$1.08
$1.20

$40 not $40.00 (unless listed in a column with other amounts that include cents)

Are you with me so far? Stay with me while we cover ranges in money values (bottom of page 247).

For ranges, repeat the dollar sign or cent sign, but do not repeat the word forms. Use to instead of a hyphen with a dollar-sign or cent-sign forms.

EXAMPLE:
$4 to $5 not $4-$5.

10¢ to 15¢ not 10¢-15¢

I had to read this about 20 times to figure out that NOW there’s an exception to the “do not use the cent sign except in tables” instruction at the bottom of page 246. Because apparently, it should read: “do not use the cent sign except in tables and ranges.”

I’m starting to understand why a webinar might be necessary.

Moving on to the top of page 248:

Use to with word forms.

EXAMPLE:
4 to 5 dollars not $4-5 dollars.

10 to 15 cents not 10-15 cents.

Wait a minute. Back on page 247, it says we use the dollar or cent sign in ranges. Why are we spelling it out now?

I hope they cover that in the webinar.

More confusion on page 248:

Do not use the possessive form with compound adjectives.

EXAMPLE:
a 2-dollar bill.

Again – why are we spelling out the word dollar? According to the instructions on page 247, amounts over a dollar use a dollar sign ($).

I’m confused and this is only 3 pages. I’m beginning to wonder if 2 hours is enough time to explain everything.

In contrast, I refer to section 4 of the Gregg Reference Manual, which clearly states:

An isolated, nonemphatic reference to money may be spelled out.

two hundred dollars
nearly a thousand dollars
a twenty-dollar bill
like a million dollars

That might provide some clarity to the examples used – if there was an explanation in the AHDI BOS. But there isn’t. And why should you have to refer to both books to get some clarity?

Of course, this could be just a sales pitch for the book. Attendees are advised that they should have a copy before they attend the webinar. I wonder if AHDI-West gets an affiliate percentage of the books sold as a result of this webinar.

The bottom line is that because the book is in print and not electronic format, it can’t be changed. The solution – give a webinar and charge people $45 to learn how to use the print version of the book after they’ve paid $50 (members) or $70 (nonmembers) for it. I hope you don’t mind making notes in the margins – you’re going to need them. Alternatively, you can pay $30 a year to get the electronic (searchable) version. I’m also wondering if they’re going to do a webinar on the electronic version or if there are plans to update it to clear up any errors or confusing text and examples.

I’m thinking I need to spend more time on the MT Reference Style Guide so MTs have a free, searchable, updated style guide that is comprehensive and complete. Shameless plug: Feel free to participate in the style guide creation. Your comments and feedback on the content is welcome and appreciated.

As usual, I’m a little behind on what has become the Annual Review of the Advance annual salary survey. Two years in a row counts as annual, right? (Last year’s review here.)

This year, the study split out full time and part time, which gives a more accurate picture of what full-time MTs are making. However, the study continues to lump together production MTs, editors, quality assurance and supervisors and I just don’t understand why. In all the other job categories (coders, HIM director, cancer registry), MT is the ONLY one that just throws every job description having to do with medical transcription into one group. In my opinion, that would be like throwing HIM team leads or supervisors into the HIM director category. It makes the results very difficult to interpret.

Having said that, let’s take a look at the drill down.

The percent change in reported MT salary from 2007 to 2008 is +4%. Kim Buchanan, AHDI-F, director of education and credentialing at AHDI, is quoted in the article:

“You hear complaints that wages are going down, but overall the data shows otherwise,” Buchanan said. “This stat is showing we’re slowly increasing.”

Well, not exactly. Let’s look at the 2006 number from the Advance survey, which was $25,400/year. The increase from 2006 to 2007 (which was $27,800/year) was 9.5%. In terms of growth, MT pay rates slowed to less than half, so the 4% number isn’t exactly encouraging. So while we are slowly increasing from 2007 to 2008, we have decreased the rate of growth overall.

In my opinion, the issue of multiple job descriptions being lumped together makes it very difficult to take this survey at face value. I’m reading it and applying a huge measure of salt. I applaud Advance for making some changes that improve the data, but I don’t know why they chose to dump all medical transcription jobs into one category, as if they (a) are all equal jobs and/or (b) don’t have significantly different pay scales.

What I’d like to see in next year’s survey is a survey only of production medical transcription jobs. Not editing. Not quality assurance. Not supervisory. Just medical transcriptionists who spend all their time transcribing.

Let’s look also at the number for credentials (CMT). Again, because the survey lumps together all medical transcription job descriptions, it’s impossible to tell if there are more credentialed MTs who work in supervisory, quality assurance or management positions that pay higher than production MT work. Therefore, it would be erroneous to make any conclusions about higher pay for credentials.

In addition, let’s look what happened since the 2007 survey – the difference between what a credentialed MT makes and what a non-credentialed MT makes is less than it was. The 2007 survey had a $10K difference in pay. Since the 2008 survey eliminates part-time MTs from the equation, we should see the difference increase in 2008, not decrease; the difference in the 2008 study for the CMT is $7K.

My comments from last year still apply.

…there’s a huge pay differential for MTs with credentials, but in my experience most credentialed MTs are working in management or QA positions, not as production MT. It’s possible there were no more appropriate (and accurate) options and so the respondent took the one that best fit (MT). When the pay differential for a credential is usually less than 1 cpl (at the few companies that offer it), I have difficulty believing that adds up to an average $10,000/year difference in pay. At 200 lph, a full-time MT would only make approximately an additional $4,000 per year at 1 cpl pay differential for a credential. Factor in that very few companies offer any differential at all and it adds up even less. Every respondent would have to be working for a company that paid over 2 cpl differential for the credential AND be producing at least 200 lph. The $10K difference just doesn’t add up for someone who is doing production MT.

Also pertinent from last year’s review is that even if we believe the average full-time MT is making $33,500 per year (and I don’t believe that most production MTs make that much), it would be interesting to get an adjusted dollars comparison between what MTs were making 10 years ago and what they’re making today.

I’ll tell you why I question the number. Almost every MTSO I talk to tells me the average full-time MT at their company makes $28K a year. That’s $5K/year less than this salary survey reports. It would seem to me that getting MTSOs to report their averages would be a more accurate way of getting a large sampling, if we’re really interested in what MTs are making. Companies like MedQuist and Spheris have thousands of MTs working for them. If we took the average annual pay for production MTs at just those 2 companies, it would be a significantly higher sampling than the 516 full-time respondents to the Advance survey and we’d have a better picture. These companies could also give more accurate figures for each of the job classifications in MT.

I see Advance now has a fan page on Facebook so I’m hoping they get an even larger sampling next year. In addition to breaking out MT jobs more thoroughly, I’d like to see them poll the MTSOs for information.

I’m very interested in hearing from MTs here. I’m going to address other issues affecting pay in another post but I’d like to know: do you feel the survey results accurately reflect your own experience?

I had the opportunity recently to do a presentation at the TEPR meeting in Palm Springs on verifying your outsourced transcription, met some new people and had a couple interesting debates about the VBC.

After reviewing my initial blog about the visible black character and having these discussions, something occurred to me and of course I’m going to share it.

The VBC is touted as the most accurate, most verifiable method of counting.

Let me point out the two fallacies of that assertion:

1. It assumes that the verification is done by actually viewing and verifying the characters with the naked eye.
2. IF that is the way it is verified, it is no more accurate than verification for characters that include spaces.

The argument made by those who support the white paper is that spaces can be manipulated because they cannot be seen. That argument becomes completely invalid if the verification is being done by physically counting the characters as they appear! We can all see a valid space – can’t we? So if we’re verifying by viewing a document, what doesn’t appear isn’t counted.

Let’s take a look at the sample I gave in the presentation:

Let’s look at the points where there might be extra characters inserted and convert those to visible characters:

I don’t know about the rest of the people in the medical transcription industry, but if I’m counting these characters by printing it out and counting what I can see, I’m not going to count all those spaces now displayed as slashes. I am going to count all the spaces that are appropriate – the ones not converted to a slash mark.

I’m going to make two assertions of my own:

1. Nobody is going to sit and verify a line count by printing out a document and counting the characters they see, especially in a high-volume environment that doesn’t even verify electronically.
2. There is no method that can’t be manipulated electronically and if the accuracy of the verification depends on #1 above, then the VBC is the most difficult method of counting/verifying. And as noted, no more accurate and verifiable than characters including spaces.

I will be updating VerifiableBilling.com with these screen shots and information.

The slide presentation is available at my LinkedIn page.

I was reading Lynn Jusinski’s article in the latest issue of Advance on The Dark Side of Medical Transcription. The experiences related by Trudy Looney and some of her comments got me thinking about a state AHIMA meeting I attended years ago – probably 2002 or thereabouts.

Just a little bit about AHIMA. It’s a great organization in many ways and I’ve met a lot of people I really like. Now for the big HOWEVER… as a business in the transcription industry and a member of AHIMA, I felt like the red-headed stepchild of medical records and I know I’m not the only one. It was a recurring theme among the MTSOs and MTs I talked with who were also members of AHIMA. Ms. Looney’s feeling that MTs are undervalued in the medical records cycle is, in my opinion, validated by the way AHIMA – and its members – ignore transcription.

Case in point – back to that meeting I attended…

At that time, digitalization of records was advancing and there was talk of perhaps expanding the available pool of (very much in demand) coders by allowing telecommuting of jobs and how that might successfully take place. There then ensued a long discussion between particpants in the conference about the possible issues for coders telecommuting: isolation, child care, supervision, compensation. The conclusion? “We’ll have to study this and proceed very carefully.”

I wanted to stand up and wave my hands in the air and say, “Hey, over here! All you have to do is look at transcription!” At that point, MTs had been telecommuting for years. And yes, experienced all the problems associated with working remotely from home. And yet – not one person acted as though they had any idea that all they had to do was talk to the transcription industry, with its many years of experience!

Moving on – same meeting – I happened to be giving a presentation on speech recognition. During the presentation, I did a live demonstration of how speech recognition works for both live dictation and recorded (back end) recognition. I used a snippet of actual physician dictation for the demo. After the meeting, more than one person came up to me and said they’d never listened to a recorded dictation before! I was absolutely floored.

Is anyone still confused as to why MT is undervalued and misunderstood?

Flash forward to 2009 and I’m at another conference on electronic medical records, personal health records, Health 2.0 and health information technology in general and not much has changed except we’re more digitized. Still commoditized and marginalized, but digitally. I didn’t get the sense so much from people who asked questions in the transcription-related sessions that THEY felt this way – but everyone pretty much agreed that at most facilities, the general feeling is: (1) anyone can do transcription and (2) even if they believed it takes special skills to do transcription, those skills are no longer necessary when editing speech recognition. In fact, Nick van Terheyden showed, in his presentation, that the intrinsic value of a medical transcriptionist is that s/he isn’t the equivalent of a “dumb terminal,” but what we do is taken for granted because we do it so well. We make sense of the jumble, garble, frank dictation errors (well, most of us do) and turn it into a usable document which the doctor then looks at and says “Yes, that’s what I dictated!”

Wouldn’t they be surprised if we actually transcribed verbatim?

Part of the problem in the transcription industry is the upside-down supply/demand model. Even though demand is high, pay rates have gone down. (And yes, I do plan on getting around to commenting on the Advance salary survey one of these days.) Because demand remains high, even the worst MTs have no problem getting jobs as MTs, which doesn’t do a lot for the overall impression of the value of MTs. Top that off with the fact that the better MTs are better because they have higher levels of motivation, skill, intelligence – whatever constellation of assets you want to put together – which means they are also more employable in other sectors that utilize the same or similar skill sets. If someone who has been an MT for 20 years gets offered the same rate per line as someone fresh out of school, what is her incentive to remain in the transcription industry? And yes, I know I shouldn’t suppose that 20 years ipso facto makes one a better MT, but let’s just pretend it does. Why did she enter MT? Because she had children at home and wanted flexibility in her work. Twenty years later, those children are grown and she no longer needs the flexibility, which gives her more options when it comes to looking to take her skills to other jobs. The MT whose skills are marginal is more likely to remain in the industry, leaving behind the reluctant and unqualified, regardless of years of experience. In what other industry can someone be completely unable to do the job well and still remain employed at that job?

No wonder medical transcription gets no respect.

I’m not pointing the finger at any one group – there are plenty of factors that led medical transcription down this dark path. I do feel Ms. Loosey pretty much hit all the nails right on the head. I just hope those nails weren’t going into the lid of a coffin.

I had someone gush this week that I’m a guru.

Wanna know why?

I read the help file.

Yes, that’s all it took. Someone asked for help with something, I didn’t know the answer – so I read the application help file.

If that’s all it takes to be a guru – and there’s lots of money involved – count me in.

Folks, if you want to know how to use your computer and the applications on it – read the messages on the screen, read the help file and be willing to take some time to push a few buttons and see what happens. Don’t worry – I could be a professional button-pusher and I haven’t blown up my computer yet, so you should be pretty safe.