The topic at AHDI Lounge is AHDI and MTs. Basically, it’s a highlight for the more in-depth AHDI “Let’s Talk About…” series and Barb Marques’ AHDI and MTs (PDF) talk-about. While Barb Marques’ piece is interesting, for me the most interesting part of this AHDI Lounge post was the comments (as is usually the case).

The first comment refers to the impact the VBC (visible black character) standard (explaining why this isn’t really a standard is another discussion entirely) has had on medical transcriptionist’s pay rates.  To which Laura Bryan responds:

AHDI is not responsible for issuing the “VBC”. This standard was issued by MTIA and AHIMA.

Now, just to be clear: Laura Bryan has no official position with AHDI. As far as I can tell, she never has (and I’m quite certain I don’t need to invite anyone to correct me if I’m wrong, but please let me know if I am). At the very least, however, she’s a very vocal supporter.

To which I asked – why wasn’t AHDI part of the task force on the visible black character?

And Laura responds:

@Julie, the standard was intended to address BILLING, not compensation. The MTSOs and AHIMA are most involved in billing negotiations.

When I noted that billing and compensation are related, Laura elaborates:

@Julie, I didn’t say they weren’t related. But it is common knowledge that billing is not necessarily calculated the same way as compensation. The standard was not intended to address methods of calculating line rates for the purpose of compensation.

The way I understand this statement, Laura believes AHDI wasn’t involved in this task force because it was about billing, not compensation. This is a direct contradiction to the following statement by Barb Marques in the referenced Let’s Talk About… article:

We have few weapons in the arsenal to “force” employers to alter their compensation practices. As I shared above, sometimes the only way to impact something you can’t get your hands on is to chip away at the walls around it in hopes of a breakthrough. For AHDI, that means identifying and addressing marketplace drivers that impact billing, whose inarguable bedfellow is compensation. (emphasis added)

I don’t know about anyone else, but I would certainly classify the VBC white paper as a market driver that impacts billing. And let’s not get confused as to the difference between recommending compensation rates and setting standards. When the organization was AAMT, it most certainly was involved in all kinds of standards setting, including billing.

One goal of the white paper was to provide a standard that would give the customer base the ability to compare apples to apples when evaluating proposals from outsourced medical transcription services. However, that was only one goal.

The goal was to implement a standard for content measurement that health information management (HIM) practitioners can use to evaluate in-house transcription staff and external transcription service suppliers.

And makes the recommendation:

The task force recommends that this definition be adopted by all organizations producing medical transcription, including those using in-house staff to transcribe dictation.

That’s pretty clear intent, wouldn’t you say? Anyone who thought it wouldn’t impact transcriptionists working for the outsourced services is either brain dead or sleeping at the wheel.

AHIMA subsequently issued a FAQ (frequently asked questions) about the white paper, where it states that the white paper does not call for MTSOs to change compensation methods for medical transcriptionists.

Though adoption of the VBC unit for compensation of medical transcriptionists was neither the intent nor recommendation of this paper, we recognize that some will choose to adopt it for compensation and strongly encourage those service owners to engage in the same research and analysis outlined in this paper, as well as dialogue with their transcriptionists, in transitioning to this new methodology.

I read this as AHIMA backing down from what was actually published in the white paper. I question why the white paper would recommend adoption by all organizations and specifically include in-house staff if the intent wasn’t to apply the VBC to calculating compensation.

Additionally, let me point out something maybe Laura has forgotten: not all medical transcriptionists – not all members of AHDI, even – work for a hospital or transcription service. I’m not quite sure how Laura could forget this, since she runs a medical transcription service and is obviously a member of AHDI. The suggestion that AHDI would decide to bow out of a task force attempting to set standards involving billing units because it didn’t involve compensation suggests that AHDI isn’t representing the interests of all its members.

Perhaps AHDI didn’t bow out; maybe it was never invited to the table. If that was the case, it demonstrates the weak position AHDI has in the healthcare documentation community.

In all fairness, Laura does make the point that the “standard” is being applied in a detrimental way that was most likely not intended and that AHDI did say it was not in favor of the VBC without adjusting equivalent pay. This is, in fact, stated in the white paper:

Financial analysis must be completed to establish the equivalent VBC pricing in comparison with the existing rate and unit of measure. The company must then ensure the counting and financial applications are properly configured to support the new method for consistency and verifiability. As mentioned previously, comparative modeling showing each method side-by-side on invoices will more than likely be required.

The same problem came into play when the 65-character standard was enacted. But that doesn’t excuse AHDI from taking a back seat in any attempt to set standards that impact the industry. The fact that there were problems associated with the 65-character line standard, which AAMT ultimately backed away from as a result of these issues, isn’t a reason to bow out of any further attempts to set standards that will impact transcriptionists, the industry and compensation. I would argue, in fact, that it was an opportunity (now lost) to take the lead to make sure billing standards that could impact compensation would not be used to the detriment of transcriptionists.

This is an interesting question now being frequently posed in the medical transcription community on Facebook, in the forums, and elsewhere. It’s one I am frequently asked, as well.

And my answer is no – it’s not a career choice I encourage. This position has been questioned by some, especially when I say it in forums like MT Chat, because I own several websites for medical transcription (and, obviously, I blog about the medical transcription industry). My response to that is that I spent over 20 years in the medical transcription industry. I know a lot of people in the industry and support them, regardless of how I feel about the career.

But – if you’re someone looking for career choices, I am going to tell you to really do your homework before plopping down thousands of dollars on a medical transcription education.

Follow the money

For several years, my impression that medical transcription pay rates are going south has been anecdotal. Then, my friend Kathy Nicholls (who is much more data oriented than I am) did an excellent analysis of numbers, which you can read at MT Tools Online: A Salary Perspective Over 11 Years.

It doesn’t take a rocket scientist to read that information and see the writing on the wall for the working MT. Medical transcription pay rates haven’t kept up with even cost-of-living increases over the last 11 years. I don’t see that this trend is going to change. There are increasing reports from medical transcriptionists that pay rates continue a downward slide, with speech recognition editing paying half or less, while not delivering a breakeven proposition with increased productivity.

The line count pay rate isn’t the only factor affecting how much a medical transcriptionist can make. There are more and more MTs telling me that they fight a daily battle to eke out their daily line count minimum when there isn’t enough work in their employer’s system. These employees are expected to not only be available to work their scheduled hours, but to sit around and wait for work to be available on the system – without any compensation if there isn’t.

Whiners and winners

My decision to write on this topic came out of a Facebook discussion. Fortunately, you don’t have to be on Facebook because Kathy also wrote a blog post at her MT Tools site – Medical Transcription on Facebook: A Case Study. In my opinion, the most interesting response to the question posed came from Ava Maria George, the president-elect of AHDI.

In order to assure that pay is commensurate with our talents, we have to get out there and educate ourselves (yes, I mean bachelor’s degrees) and advocate for our profession. One cannot simply sit back and say, “Please Mister, give me more” and expect that will happen. Obviously, not advocating or speaking out has literally made us obsolete. So, what are we willing to do about it? Get out there or leave. Simply, those are your choices.

Call me crazy, but if someone told me I needed a bachelor’s degree to do medical transcription, I’d be laughing so hard, I’d be speechless. I mean really – if you had the time and money to get a 4-year degree, would you get one so you could be a medical transcriptionist?? I wouldn’t even do it if I had to get a two-year degree.

Now, the case might be made that even Starbucks pays more if you have a college degree and therefore we may draw the conclusion that medical transcription would pay more if practitioners had a college degree. However, it is not the degree itself that is driving higher pay rates – it’s the employers. Starbucks simply states that employees who have a college education are paid more than those who do not. It does not give preferential hiring to degreed applicants, but it does reward them for having a degree. (And it’s kind of a sad statement on the economy and the value of a college education when people with college degrees are working as baristas.) And employers in the medical transcription industry have not supported either higher education or credentialing.

Get out there or leave – seems to me that’s a predictive statement, especially when it comes to AHDI membership. Oh sure – they can point to growth, due to the KB membership, but their practitioner level membership numbers are shockingly low, just over 3000 members at the end of 2010. When I left the organization, the practitioner membership was over 7000 members. Apparently the answer to not finding your sweet spot in serving actual people is to come up with a product you can sell and tie it to a non-voting membership category so you can tell the people you used to represent that you’re tired of their whining and they can just go away.

Which brings me to the next statement made by Ava…

I’m not talking about staying traditionally an MT…we’re evolving. We will be looking at changing not only what we do, but hopefully in the process elevating our profession to one that is compensated at a professional rate. Think about it. Coders were in our position years ago. They decided to educate up, credential, and their salaries followed (higher). Now, they are at the same crossroads that we currently find ourselves…we either grow or go. It can be scary or it can be exciting. I’m betting on exciting….

I have a couple observations to make about this. First of all, I don’t know where Ava Maria George gets the impression that coders educated up. The requirement is, and always has been, a high school diploma or equivalent education.

And I’m going to argue with the interpretation of history here… coders did not, by themselves educate up and credential. AHIMA was successful in getting employers of coders to recognize the value of the credential and start demanding that coders be credentialed. The recognition of the coding credential was not a grassroots movement by the coders, but a top-level-down marketing campaign by AHIMA.

The same is true at HFMA. In the Southern states, more employers require their finance people to have an HFMA credential; therefore, there are more credentialed HFMA members in the Southern states. In the Western states, fewer employers require the credential and therefore there are fewer HFMA members in the Western states who are credentialed.

My daughter is a personal trainer. To get hired at a reputable gym, she must have a credential. No credential, no job. In addition, at the gym where she works currently, she must participate in additional inservice training in order to advance in pay. If she doesn’t participate or participates and doesn’t pass, she loses her job at that gym. Her reward for participating and doing well is not only higher pay, but continued employment.

I have a friend who works in the HIMS department of a major university hospital. She was given a drop-dead date for finishing her AA degree and passing the RHIA exam. If she did not, she was out of a job. She took the test on the Saturday and fortunately passed because after many years of working at this hospital, she would have been terminated on Monday if she hadn’t passed. And – she didn’t get a raise or a promotion, she just got to keep her job.

What AHDI seems to be missing in the entire credentialing discussion is that successful credentialing takes place from the top down, not the bottom up. The problem in the medical transcription industry is NOT that transcriptionists haven’t supported credentialing and education – it’s that employers haven’t supported it. How long do you suppose MedQuist would last if they terminated all MTs who didn’t get a credential by a certain date? The plain truth is that the transcription industry doesn’t have the guts to place such a stringent requirement on its workers, even if it had a financial incentive for doing so. And let’s face it – there’s no financial incentive. For the Record recently did an article on The MT Credentialing Debate, and this statement is indicative of why credentialing for medical transcriptionists has never gotten off the ground:

Dale Kivi, MBA, business development manager at FutureNet Technologies Corporation and a member of the board of directors for the Clinical Documentation Industry Association (CDIA), says he understands and appreciates the efforts of industry organizations that promote credentialing. However, he says organizations that purchase transcription services don’t seem to care whether the labor force is credentialed. Their interest lies in stipulating quality expectations and holding vendors to those levels, regardless of whether the staff are credentialed.

It seems all the blame doesn’t go to AHDI, but I’m tired of them point a finger at medical transcriptionists for not supporting the credential. A better use of their time and energy would be to use their partnership with CDIA (the organization formerly known as MTIA) more effectively.

Winners never quit

You know that saying: Winners never quit and quitters never win.

If you examine successful business people, you’ll find the above statement is erroneous. More than anyone else, winners know when to quit.

What really sets winners apart from quitters is the ability to escape dead ends quickly, while staying focused and motivated when it really counts. They don’t waste time and energy on a dead end. Winners do not keep chasing unprofitable ventures.

The biggest difference between quitters and winners is that when quitters quit, it’s an emotional decision. When winners quit, it’s a rational decision, based on objective data and analysis. Seth Godin has some interesting things to say about quitting and winning in his book: The Dip: A Little Book That Teaches You When to Quit (and When to Stick). Guy Kawasaki interviewed Seth about the book and asks:

Question: Other than hindsight, how does someone know when it’s time to quit?

Answer: It’s time to quit when you secretly realize you’ve been settling for mediocrity all along. It’s time to quit when the things you’re measuring aren’t improving, and you can’t find anything better to measure.

Smart quitters understand the idea of opportunity cost. The work you’re doing on project X right now is keeping you from pushing through the Dip on project Y. If you fire your worst clients, if you quit your deadest tactics, if you stop working with the people who return the least, then you free up an astounding number of resources. Direct those resources at a Dip worth conquering and your odds of success go way up.

What’s the worst time to quit? When the pain is the greatest. Decisions made during great pain are rarely good decisions.

Research and make your choice

Basically, medical transcription has been the one reliable (or, lately, semi-reliable) legitimate work-at-home opportunity. It works for people who don’t have other choices; they must work at home or they must have a more flexible schedule than a traditional office job allows; or they live where there aren’t many work opportunities. For those reasons, medical transcription will remain a career choice for some, while those with more and better options will choose something else. Blaming medical transcriptionists by telling them they’re a bunch of whining losers won’t make medical transcription a higher-paid career. Not only is that a lousy marketing tactic, it’s just putting lipstick on a pig and trying to convince everyone the pig is a something desirable.

This is my surprise face

The discussion at the AHDI Lounge has taken on a life of its own. As usual, the more AHDI representatives talk, the more questions get raised.

Over the past couple of days, the conversation has raised some questions in my mind about why AAMT changed its name to AHDI. While telling medical transcriptionists they need to be forward-looking, prepare for change… blah blah blah… it becomes clear in some of the comments here that AHDI itself isn’t doing the same.

First, Lea Sims (remember, the Director of Professional Programs), states:

I think the challenge is that as an association, we don’t know enough about the scribe role to conclude that a 6-month training program is either too long or too short for this position.

Clearly, as pointed out in comments made by Kathy Nicholls, using medical scribes to facilitate physician use of an EMR isn’t a new concept. And also clearly, this occupation falls squarely within the mission statement of the organization. So why is it, at this point, AHDI doesn’t seem to know very much about medical scribing and it’s place in healthcare documentation integrity? Forget how it relates to medical transcription. The purported reason for the name change was to adapt to changes in how healthcare documentation is accomplished, and to lead those changes. But it seems that AHDI is as stuck in the medical transcription mindset  as the people it purports to lead and instead of taking a leadership role, it’s continuing to grope in the dark for relevance within the narrow definition of “as medical transcriptionists, where are we going?”

Lea goes on to say:

We certainly COULD represent the scribe occupation and most of us agree that this new role falls well within our mission, goals and objectives as an organization, but I think you’re missing the fact that we can’t just walk over to an independent workforce group that formed on its own, stamp an AHDI logo on their heads and say, “Shazam, scribes. We own you.” LOL

Here’s my question: Why not? They seem to have no qualms about claiming to represent the entire medical transcription industry. Taking a leadership role would entail identifying potential careers in healthcare documentation integrity and taking a lead in developing the job description, education and training requirements and credentialing for those careers. In fact, I was under the impression when AAMT changed its name to AHDI that doing this was the whole point. Whether or not medical scribing is a career that medical transcriptionists can transition to isn’t really the point; the point is, it falls within the mission, goals and objectives of the organization and therefore the organization should be leading the way in setting the standards. If it was leading the way, there wouldn’t be a need to tell medical scribes we own you; medical scribes or people looking into medical scribing careers would be coming to the organization, looking for information and direction.

In a press release (PDF) dated August 10, 2006, the following was given as the reason for the name change:

The House of Delegates voted on August 2, 2006, to change the name of the association to Association for Integrity of Healthcare Documentation and open the membership up to a broader sector of healthcare professionals involved in clinical documentation and data capture.

Sounds good on paper, doesn’t it? And in reading this, one would certainly conclude that the organization intended to take an active role in the broader sector of clinical documentation, not limited to medical transcription or what medical transcription might become. It was, in essence, saying “we own you” to the entire healthcare documentation sector. In spite of its own mission statement, the organization still seems mired down in the medical transcription of it all. One would think the leaders behind the name change had a plan in mind that extended beyond a different name for medical transcription.

In terms of leading the way, AHDI gets a big fail on the medical scribe issue. Medical scribing is nothing new. In July 2008, the AMA News published an article about medical scribes (One answer to EMR data entry: Hire a scribe to do it).

Scribe companies, which previously had concentrated on hospitals, say they are finding demand for their services from individual practices.

Obviously, Scribe America not the first medical scribe company. I don’t know how long they’ve been in business, but their domain name was registered in 2004. Abbott Northwestern Hospital launched a physician scribe program in 2006.

So where is this change leadership we keep hearing about? You can’t say on the one hand that you’re leading change, then turn around and say you “don’t know enough about the scribe role,” a healthcare documentation career that’s been around for over four years. What other healthcare documentation careers has the organization not identified, not taken the lead on, not informed its members about? Four years is certainly enough time to evaluate the broader sector of healthcare professionals involved in clinical documentation, but maybe they’ve been too busy trying to decide whether or not to keep the House of Delegates and otherwise restructuring the organization of the organization.

Unfortunately, I don’t have the original draft I had submitted, which got sent back to me for some editing because the PTB at AAMT didn’t feel I was being positive enough about the future outlook for medical transcription. That draft would have more accurately pinpointed my predictions for the industry and how I felt about the future of medical transcription. With that caveat…

Although many transcriptionists work through the internet, they may be unaware of the scope of technological changes and the jockeying for position currently taking place. Many see a threat from offshore labor, when they should be looking at the technology that resides on their own desktop. The very tools we use to enhance productivity are also available to the computer-literate physician, especially if packaged nicely and marketed aggressively by a far-sighted company. The advertising claims that physicians can replace their transcriptionists are not far-fetched. Some physicians have, in fact, done just that and are perfectly satisfied with the results. The number will increase exponentially over time, in much the same way the technology has advanced. Transcriptionists need to prepare themselves to work within the new model of  business that will be created by the available technology and the changing environment of business brought about by the internet.

I’m pretty sure that last sentence was part of the edit. Notice that I don’t say HOW MTs need to adapt. Quite frankly, if memory serves, I couldn’t think of a way they could that would keep them in this picture. After all, I just predicted that technology would give physicians more tools to facilitate reducing or completely eliminating medical transcription.

At the time the article was written, the AMA reported that 59% of physicians weren’t even using computers. I wasn’t able to find a recent study, which suggests to me that there’s an assumption that medical practices and healthcare facilities are using computers, including mobile devices.

My updated prediction is that this trend will continue and we’ll see an even bigger spike as more computer-literate physicians enter practice. They will not only be less resistant to entering data into the computer directly, they’ll be more proficient at it than their predecessors.

I also predict that as more computer-literate patients enter the system, and as technology advances, we’ll see patients entering their history directly into an EMR, either at the doctor’s office or online. Or, if interoperability issues are resolved, retrieved from a PHR. I predict updates will take place the same way, so you can review the history the physician or facility has for you and enter any updates or changes. As EMRs evolve and improve, the information you give the doctor will be available to any other facilities or offices in the system. There are already systems that share information with providers across the system. As always, the technology will only improve over time. Young adults who have used computers most or all of their life won’t wonder why they’re being asked to type in this information themselves – they’ll wonder why it isn’t available, or why they have to enter the same information multiple times in multiple places. I think there will even come a point when speech-to-text is so accurate that this data entry will take place in the form of speech, combined with touch screen and keyboarding.

A new tool becoming available to the individual transcriptionst and smaller business owners is the application service provider (ASP)… The purpose is to provide an “enterprise” solution for physicians (in plain English – one-stop shopping). By giving physicians access to something everyone knows they utilize, the portals hope to entice them to take advantage of other services and/or goods being sold through the portal. The advantage an ASP can give transcriptionists as a by-product is more equal footing with the large services. Access to both physicians and other transcriptionists becomes a possibility, at a price that is not beyond reach. It will no longer be necessary to take a deep breath, hyperventilage, then sign a five-year lease agreement for $60,000 worth of digital dictation equipment that will be obsolete before the lease is up. ASP networking will allow transcriptionists to work with each other to coordinate coverage for peak periods and time off… The ASP model provides state-of-the-art networking and upgrades inclusive with the other services offered.

I’m not sure the ASP model has been of great benefit to the independent MT, working solo or in small groups to provide service to select physicians. I think it has been of benefit to small transcription services looking for growth opportunities. In the past ten years, a model used by some ASPs is to do the marketing and sales, then contract with various independent MTs and small MTSOs to perform the work. In this scenario, the ASP sets the price to the client, not the MT or the MTSO. Like everything else, the ASP market has continued to evolve, with multiple acquisitions, change of ownership, mergers, and some winners and losers. Very few of them partnered with portals; instead, they became transcription platforms, with interfacing on the client end for compatibility with whatever technology the client used. Companies like InterFix made it easier to interface the ASPs with the multiple hospital IT systems and recently, in partnership with AHDI, created the Benchmark KB, a desktop application for transcriptionists that interfaces with various transcription platforms. The value of the Benchmark KB is that it reduces training and learning curve for transcriptionists working for a company that uses more than one platform.

Although currently many physicians remain blissfully ignorant of templates, macros and normals, that will change as doctors become more computer literate and money gets tighter. I predict more transcriptionists will be requested to discount or not charge for templates or normals.

I think I got this one right. What I missed completely was that anyone would not count spaces! I also missed that there would be transcription services (in my experience, predominantly overseas services) that would use this as a selling point, not only discounting the characters contained in templates, macros and normals, but also undercutting prices at the same time, further eroding the rates charged by US-only companies and the earning ability of medical transcriptionists here in the US.

The next level for speech recognition will be speaker-independent recognition. Translated for the technophobe, the technology will be able to understand the dictator who is your worst nightmare, with very little user training.

This prediction was accurate, in fact. Not that no training at all is required, but companies providing server-based (also known as back end) speech recognition do train the speech recognition engine, but they do it using a library of digital dictation files obtained from the system. Physicians are not required to sit and train the engine. Most of them are told they don’t need to change their dictation habits, which is more for the purpose of getting them to adapt to the system than anything else because there certainly would be a benefit to the accuracy of the documents if the physicians were willing to make some changes.

The question for transcriptionists is: will it matter if recognition accuracy is 100% when grammar, punctuation, syntax and language usage are not (how shall I say this?) – exactly representative of a strong foundation in English? My prediction is that it won’t. I believe as long as the document says what the dictator means it to say in a relatively clear (i.e., defensible) fashion, it will be accepted… While we may wring our hands that the quality of patient care is being compromised, who is actually compromising it – the physician, the transcriptionist, or the software used to create the transcript? Ultimately, the responsibility belongs to the physician. The more we try to take ownership of this responsibility, the more liability we expose ourselves to – a questionable tactic for assuring job security.

Well, I feel my crystal ball was working really well on this one and I probably don’t need to add anything to this.

If you don’t know the difference between DOS and Windows programs, it’s a reasonable conclusion that brushing up on your tech knowledge is necessary. I predict a future where computer literacy will be tested along with English literacy, and not just in the MT profession.

I found the following excerpts in current job listings for medical transcriptionists:

Cerner experience preferred. No satellite.

Meditech Client experience.

Are you reasonably computer literate? (This may be tested.)

Familiarity with transcription platforms (M*Modal, eScription, DocQScribe, and Spantel) a plus.

We are looking for editors who have had experience with the M*Modal platform.

You must have the necessary software (EditScript MT) and equipment (IN-DB9 or IN-USB pedal) in place with Microsoft word and a current electronic medical spell check loaded, ready to work.

Computer that is no older than 3 years. High-speed cable or DSL connection. Air card and satellite will NOT be supported. Internet service with AOL is not supported. RAM (memory) – 512 MB minimum. Hard Drive – 40 GB minimum. External computer speakers with volume control knob and headset plug-in. Good quality headset. USB port foot pedal. CD-ROM drive.

You MUST know how to use a FTP program to download and upload work. … Please DO NOT APPLY if you do not hve the required equipment or know how to use a FTP program.

I think it’s pretty obvious that computer literacy has become an essential part of the job, and we’re way past having to differentiate between DOS and Windows! What’s also become important is having a computer that has up-to-date software and current software. It would be difficult to find a job listing that doesn’t include software and hardware requirements, as well as internet connection requirements.

The article also completely neglected any mention of how technology would impact US medical transcription by facilitating overseas competition. Because digital technology and file transfer was available in 2000, I know overseas competition was a big concern for US MTs at that time. I’m not sure why I left out any mention of it – whether I was asked not to, or whether it was based on my opinion that there’s nothing you could say about overseas medical transcription that you couldn’t also say about onshore medical transcription, or whether I felt it had no place in a discussion that was about technology – I’m not sure. My memory isn’t what it used to be.

My crystal ball says that medical transcription as we know it will continue to deteriorate in both value and pay, and that advances in technology and a burgeoning population of computer literate physicians will contribute to that. We keep hearing that medical transcriptionists need to change their skill set and adapt in order to survive, and I agree with that. However, I see it evolving to an increasingly clerical position, with pay rates comparable to a clerical position. What MTs need to decide is whether or not they want to continue to work in the evolved position, at the evolved pay rates.

Hopefully, I’ll be around in another 10 years to see if the predictions I’m making here will take place.

Granted, AHDI is being technically accurate when it represents itself as the largest organization for medical transcriptionists. What does that make the thousands of MTs who aren’t members? The largest disorganization for medical transcriptionists?

AHDI now counts among its membership over 10,000 members as a result of requiring KB users to be associate members of the organization.

Associate members are those individuals who have qualified for membership under a third-party vendor contract and have received this membership offering through the purchase of a contracted product or service, such as Benchmark KB. Only users/purchasers of those products and services qualify for this membership category.

Unfortunately, AHDI doesn’t go into detail about what associate members get with their membership, but it’s my understanding they cannot vote and they cannot hold office. In effect, therefore, there are only roughly 5,452 members in other categories. According to MT Tools Online, reportedly 30% of the total membership number is in the student category (also unable to vote or hold office), but that number is mixed with students who receive the KB as well. Subtract an unknown number of corporate, institutional and educational members and who knows how many that leaves in the individual professional category – those who can vote and hold office. Certainly, less than 5,000 and probably closer to 4,000. That’s down significantly from the 7000 individual professional members reported several years ago; and it is certainly a smaller and smaller pool of people who are eligible to hold office, much less vote.

Wow.

Actions this week at ACE that make it look like AHDI leadership has been taking their cues straight out of the Tricky Dicky book of Dirty Tricks. The House of Delegates’ (HOD) vote to retain the present members of the HOD for another year gives me flashbacks to an illegal secret Board meeting held in California years ago and reinforces the screw the membership mentality. If you don’t think your delegate is adequately representing your region – too bad. Like it or not, members will not get to hold an election of new delegates for next year.

Regardless of the reasons for this action, it’s illegal and a violation of AHDI’s own By-Laws, and possibly California law, where AHDI is incorporated. Niggling little things like that never seemed to stop this sort of thing in the past, so I guess nobody should be surprised that the dirty tricks continue. It should be frightening to realize that this is the same group that gives leadership seminars.

Frankly, I found Miriam Wilmoth’s comments on emergent resolutions before the HOD to be… well, enlightening.

… It is unfortunate, too, that any efforts to speak for members who are still confused, torn, or outright opposed to the way current issues before the House have been handled are met with accusations of dishonesty, that any dissenting opinion is met with an association-sponsored blitz of ad hominem attacks like none we have ever seen in this association – from the CEO, to selected (not all) board members, and even the Speaker of the House.

I’m having déja vú all over again.

I’m sure the response of the AHDI faithful will be – if you don’t like it, join and change it. OK, first of all – with no new delegates being voted in for next year, how much change can there be? I rather suspect the real purpose behind that move is to make sure the only changes made are the ones Dirty Tricks club wants made. And my personal response to that would be – been there/done that, got the T-shirt and what I experienced was eerily similar to what’s currently going on – burn the By-Laws, damn the torpedos and to hell with what the membership wants (what do they know, anyway?).

If we encourage our members to talk to us, to tell us what they think, to become engaged in the purposes of the association – yet when they open their mouths to speak effectively they find their integrity called into question – do we really think they will continue to speak?

And after reading this comment – again made by Miriam Wilmoth – is there any question that you would plop down your $135 annual membership fee only to be told screw you very much? Because that’s what’s already happened to current members.

I’ve already seen a slew of long-time members – members who were active in leadership positions – drop their membership and leave AHDI. And yet the insanity continues. Obviously, the number of core members – those in the individual membership category – has dropped drastically over the last couple of years. And instead of addressing the issues and concerns of members and former members and asking what they could possibly be doing wrong – many of those who remain at AHDI write off criticism as sour grapes or negativity and then drop their heads back into the sand. Because as long as you can write off the people who bring up the issues, you don’t have to actually take responsibility and address the issues. And I’m not even going to get into how AHDI has ignored the fact that nonmembers could be potential members. (More on that in another post, where I’ll talk about a publication by an AHDI staff member that makes it clear what the attitude is about us.)

In my opinion, this organization has been on a course that is detrimental to practitioner medical transcriptionists since they changed the name of the organization and got into bed with MTIA. They say they want to get online and into social networks. Great. I say the largest disorganization of medical transcriptionists in the world use the same social media to let the world know that this organization does NOT represent us.

Is the medical transcription profession doomed?

Just reading the title, I thought maybe AHDI was finally going to take off the rosie-colored glasses they wear in public. During the whole decline of the industry, they’ve insisted that there’s a place for medical transcriptionists in whatever new world health information documentation evolves to. (The other blog post there, Doctors weigh in on the use of scribes, is another worthy of its own separate rant.) So I eagerly went to read the entry, thinking maybe maybe AHDI is going to come out of the closet about the future of medical transcription.

Boy, was I disappointed when I read the blog entry. And surprised not only at the apparent cluelessness at what practitioner MTs (their base membership) go through on a daily basis, but the direction AHDI seems to be willing to take with the tone of this blog entry.

First of all, is it really standard practice for MT recruiters to not respond to those who are applying for jobs? Even if the applicant bombed the test, common courtesy would be to at least thank them for the effort, wouldn’t you think?

Is it really standard practice for the World’s largest professional association representing and advocating for healthcare documentation professionals (MTs, editors, and QA coordinators) (that’s what their Twitter profile says) not to know that yes, indeed, this is standard practice in the industry? That every day, recruiters receive hundreds of applications, solicited and not, and can’t possibly respond to all of them? That MTs take tests all the time – and never hear back a peep from the testing company? That common courtesy isn’t so common? That sometimes recruiters not only don’t know what they’re talking about, but they lie, don’t give direct answers to questions, set up phone calls they blow off, and are even downright rude?

Not that I think that’s a huge factor in what is happening to “doom” the medical transcription industry.

But here’s the part that blew me away:

It’s a tad ironic for someone so concerned about communication skills to criticize someone for not being “atriculate” and having poor “dictation.” And as anyone knows who has participated in online MT forums for any length of time, this scenario is all too common.

Let’s put aside for a moment that anyone who has participated in online MT forums for any length of time should know that the common response to this: I’m not at work so spelling, grammar and punctuation aren’t a priority. (And since I’m putting it aside for a moment, that’s all I’m going to say about it.)

How professional is it for the world’s largest professional association to slam a medical transcriptionist for spelling and grammar errors in an online forum? And a forum that isn’t even theirs?

AAMT/AHDI has never seemed to understand that nonmembers are still potential members and that’s demonstrated again in this blog post. It’s probably not a good idea to alienate your prospective membership base if you expect to recruit and grow – unless, of course, AHDI is happy with the number of members it currently has. However, by claiming to be the world’s largest professional association representing and advocating for healthcare documentation professionals (MT’s, editors and QA coordinators) it’s painting the MT world with a very large brush. I guess it wouldn’t sound so great to be the world’s largest professional association representing and advocating for a very small percentage of healthcare documentation specialists – but it would be a more accurate representation.

It’s one thing for a blogger with no affiliations to blow off steam about whatever they want. Heck, I do it all the time! But I don’t represent the professional association. Matter of fact, I don’t represent anybody but me. Call me old-fashioned, but the official blog of the professional association should be – well, professional! And in my opinion, being professional means you don’t slam MTs posting in forums for their spelling and grammar, even if they are anonymous.

AHDI had an opportunity to focus on something that’s wrong in the industry and actually advocate for the practioner MT – and they blew it by losing focus and attacking the messenger.

So if we’re looking at factors that doom the medical transcription profession, I have to say – AHDI, look at the mote in your own eye.

Let’s focus on another shady area of transcription: the “certified medical transcriptionist.” I’m going out on a limb and expressing my opinion that any organization, other than AHDI, that claims it awards a “certified medical transcriptionist” or “CMT” designation or “credential” that is recognized in the industry is a scam. And I find this practice so reprehensible that I’m going to name names.

This is a real-life story about how these scams and substandard programs affect individuals. I’ve also used her real information, with her permission – she’s made no effort to hide who she is online and a search will bring up several of the complaints she’s filed in the online media.

Disclaimer on my research

It’s difficult (but obviously not impossible) to find out what a web site used to look like. I’ve included what I feel are pertinent screen shots of the old web sites for the companies I’m discussing, but there are gaps and I can only piece things together based on the information I’m able to obtain in the internet archives. I’m not going to claim that I have all the information – but I think I have enough of it to support the conclusions.

TechSkills owns the three top domain name extensions for their site: dot-org, dot-edu and dot-com. All the sites are identical, both currently and in the archives, and versions in the internet archives have the same logo and contact information

If you’re having trouble seeing the screen shots, click on them for the full-size version.

Like everything else on my blog, these are my opinions unless otherwise stated and referenced.

The School: TechSkills

Cathy thought she did her homework. She investigated medical transcription and medical transcription education. She chose TechSkills, a vocational school with multiple programs and locations in multiple states.

The state in which Cathy resides lists TechSkills as an approved school offering medical transcription education. There are only 4 schools on their list: Kaplan University, At-Home Professions, Rasmussen College and TechSkills. For those of us who’ve been in the industry for awhile, that list says about all there needs to be said about the value of the state approval. It should also provide a precaution for those beginning their search: state approval of a program can be pretty meaningless. In this particular instance, all it means is the school is approved to operate in the state. The state site makes it clear that approval and accreditation are two different things, and what they do is provide approval. TechSkills is an approved school, not an accredited school. Approved schools undergo the following process:

…staff evaluates program and teaching location applications, advertising, enrollment and school catalog documents, refund policies and financial statements. Approval is granted after a school has submitted all required information and forms and the school is in compliance with state law.

The state establishes a standard and makes every effort to ensure that a school meets the standard. They respond to complaints. They are also supposed to monitor a school’s success rate; i.e., whether students are graduating and getting jobs. This all kind of begs the question: who is watching the watchers?

Cathy also checked out the TechSkills web site and information provided there. In January of 2005, this is what the TechSkills web site said about their medical transcription program (ignore the “Careerstep” on this site – it’s what they call one of their programs and has nothing to do with the transcription school by the same name):

The program also prepares our Students for the Certified Medical Transcriptionist exam, which enables them to earn a widely recognized industry certification.

They don’t say who performs this certification, but as Cathy found out – it wasn’t AHDI. I’m going to put that part of the story on hold for a minute, however, so we can finish up with TechSkills and move on to the organization that was administering the referenced certification.

The reference to the certification appeared some between January 2004, when the site looked like the screen shot below, and January 2005 (screen shot above).

You note there’s no reference to a certification of any kind; however, one difference I am noticing is this one:

…with access to a professionally-certified instructor in person, via telephone or electronically.

I can’t find any information at the current TechSkills site about their instructors, including what professional certifications they might have. In fact, Cathy tells me that the instructor at the time she took the course was a recent graduate with no medical transcription experience. Am I being too cynical if I wonder why they aren’t terribly forthcoming with this information?

Fast forward to December 2007. Somewhere in this time frame, TechSkills changed their web site. In November 2006, AAMT (now AHDI) sent a letter to TechSkills, notifying them of the misuse of “certified medical transcriptionist” and “CMT” and requesting that they stop using the terms, as the use implies that individuals have actually received the industry-recognized credential and it’s confusing. In addition, Cathy responded to the schools’ feedback form for graduates, and indicated that she had contacted over 50 employers and 48 of them had never heard of the organization issuing the “certification.” She was told by prospective employers not only is the NHA certified not widely recognized; it is, in fact, not worth the paper it’s printed on.

As you can see, the site now specifies that the Certified Medical Transcriptionist (CMT) exam is through AHDI.

But wait – there’s more! As those of us in the industry know, new graduates are not eligible to sit for the CMT exam. Just this year, AHDI sent TechSkills correspondence and informed them that this is misleading, as students and post-grads are not eligible to sit for the exam.

Finally, TechSkills changed the site, indicating:

You’ll also prepare for the Registered Medical Transcriptionist (RMT) exam, enabling you to earn a widely recognized industry certification from the Association for Healthcare Documentation Integrity (AHDI).

Going way, way back in time, it appears that TechSkills started out as a computer technology school and then branched out into other vocations some time in the early 2000s.

In the interest of disclosure, Cathy did get her money back from TechSkills after she filed complaints about their program, claims and “credential.”

So what about that”certified medical transcriptionist” or CMT?

The elusive “CMT”

The organization providing the testing and credentialing of “certified medical transcriptionist” or CMT to new graduates of TechSkills is/was National Healthcareer Association, “the benchmark in Allied Healthcare Certification.”

How can you be a “benchmark” when nobody has heard of you? I called a couple HIMS managers I know, at large hospitals (including a couple University medical centers) and none of them have even heard of this organization or its certification. I called several clinics, with the same results.

I like the broad ambiguity of this statement. It doesn’t say these organizations require the National Healthcareer certification – but since NHA has “national certifications,” it is implied, in my opinion. Even if we ignore that, the statement is patently false. Let’s look at the administrative healthcare certifications offered through NHA.

• Medical transcriptionist – no brainer. We all know there’s no certification required; most of the time, it isn’t even preferred.
• Billing and coding specialist – hospital coders are usually required to have the AHIMA credential. Medical billers aren’t required to have a certification of any kind.
• Certified medical administrative assistant – not required in any office I’ve ever been in, in any state.

What does NHA do when Cathy forwards them the letter from AAMT? A response from Jon Brandt (whose function is unclear – it’s not on his e-mail signature and their web site doesn’t have ANY information about principals) first claims they had never received the letter from AAMT. He then states that the term “certified medical transcriptionist” and the initials “CMT” are not trademarked by AAMT – which is is true. However, these have been in use by AAMT since the late 1970s. NHA claims to have used it since 1986. But the best part of the e-mail sent Cathy, in my opinion, is this:

nor have we ever had an organization not accept the NHA certifications…

I’m not going to call Mr. Brandt at NHA a liar because he was – I would guess purposefully – vague about which organizations and which certification. If there’s a lie in that statement, it would be that this has never happened. I would, however, like to see if he could make the same statement with specific reference to the NHA “CMT” and still keep a straight face. He then goes on to speculate that this is an effort by a competitor to discredit a company that’s clearly ahead in the game. (Where are my eyeballs? They rolled right out of my head!)

The matter could be resolved in court, but that costs money and AHDi doesn’t have any spare cash. So – it appears that the folks over at NHA will continue to cash in the bucks by offering a credential that is worthless in THIS industry.

What do we learn from this?

I called TechSkills today and said I wanted information about their program and fees. Apparently, they’ve learned some things, but not as much as we might think.

The individual I spoke to actually had to rustle around in papers to provide me with information. I guess this gets confusing when you offer so many different programs at so many different locations. He even had to look up how much the medical transcription program costs.

Are you sitting down? $7400. Yep, you read that right. I have been researching MT school tuition for another article I’m working on and the only AHDI-approved schools charging anything close to that are the universities and colleges – and that’s the out-of-state tuition.

Although their site refers to the RMT by AHDI, the representative told me I could get a credential from either NHA or “the other.” He said (and this is word-for word):

The other is offered by a little network in the industry, so it’s preferred.

He also told me that both are valid and both are well known. Well, I’ve been in the industry for over 20 years and this is the first time I’ve ever even heard of NHA.

In addition, TechSkills has an NHA testing center in their facility, with a monthly testing schedule, and graduates can arrange to take the NHA test there. In my opinion, that’s still an endorsement of NHA certifications, in spite of the fact that it wouldn’t be difficult to prove to them that the NHA “CMT” is worthless to aspiring transcriptionists.

What I would like medical transcription hopefuls to learn from this is that there is only one organization offering any credentials that are recognized in the medical transcription industry, and that is AHDI.

Class Action

Cathy is trying to find other graduates from TechSkills, as well as others who have received the NHA “CMT” so she can start a class action lawsuit. The clock for her is ticking – the statute of limitations on her claim runs in a month.

These sort of practices affect both individuals and the industry. I’m helping Cathy spread the word and get her class action together because she lost a lot of time and money in this process.

Interested parties should Contact Cathy directly. (Her e-mail is included with her permission.) If you have any questions, please comment.

Other links:

Cathy’s Rip Off report

So what’s the first thing I see? The guest editorial by Brenda Hurley. Brenda, I lova ya – you know I do. And if we ever get a chance to Happy Hour again, I’m so there.

“Leaving a profession you love or staying bitter and angry – does that really work for you?”

As far as the former choice – why yes, I’d say that works really well for every MT I know who’s done it. In fact, many of them are happier and more prosperous. I’m scratching my head and trying to figure out why anyone would think it wouldn’t work.

There isn’t a shortage of jobs outside MT and let’s face it – since many of us got into MT so we could have more flexibility while our children were young, once the children are grown there’s isn’t a lot of incentive to continue sticking with the WAH options at all costs. And let me tell you – it can be costly. That MT is the digital equivalent of piecework sewing is the 300-pound elephant in the room that nobody talks about – and it’s probably one of the better WAH jobs, unless you have real entrepreneurial zeal.

“Does that really work for the greater good of our profession?”

If someone is leaving MT and moving on, why do they care about the greater good of the profession? So OK, I’ll agree that bitterness and complaining aren’t much good for anything, but I certainly wouldn’t encourage anyone to stay at a job that isn’t helping them meet their personal or financial goals just for the “greater good.”

“Just imagine the change we could impact if our membership was 30,000 or more instead of 7,000.”

I’m wondering how many MTs have to leave, how much of a crunch there has to be between supply and demand, before change CAN occur. Right now, the industry believes that technology is just around the corner that will make MT obsolete. What AHDI is telling you is that you will have a place in the New Order of Healthcare Documentation, it just won’t look a lot like what you currently do.

Well – what if you don’t like the New Order of Healthcare Documentation any more than you like the old one? Or even less? You will join the many MTs who have taken their skills to other jobs where, if they aren’t more appreciated they are at least paid hourly for showing up at work and spending the day there, and their skills are largely transferrable. And what if so many of us leave MT so fast that it leaves only those who are new, those with little experience, those who are just starting out because they want WAH jobs because they have children at home like we used to?

So – what do you think? If you had to make a choice between leaving MT entirely or staying and joining AHDI – which would it be?