Last week, I attended the Healthcare Documentation Specialist Curriculum Development Seminar, sponsored by Mira Costa College, in San Diego. This was attended by educators from local community colleges with transcription and HIM programs, employers, some MTSOs and some transcriptionists. Kim Buchanan, AHDI-F and Director of Credentialing and Education with AHDI, and Peter Preziosi, CEO AHDI/MTIA, were also present.
Please don’t get distracted by AHDI here – I’ll comment in another blog post about AHDI and some discussions I had with those present that were pertinent to AHDI.
Already, you’re noticing something different – the job title, right? Everyone in the room agreed that the scope of medical transcription is changing. I think there are few business owners and working MTs who would disagree with that. More and more clinics and hospitals are moving to electronic medical records (EMRs) and either discontinuing dictation altogether or attempting to integrate transcription with the software. They’re also demanding that outsourced medical transcription services utilize technology to decrease costs and turnaround times, with speech recognition (although it seems the newest term for this is speech understanding), turning medical transcriptionists into editors.
The medical transcription industry is struggling with these changes. These changes don’t affect only transcriptionists; they affect the entire chain, from the physicians and the facilities where they must document healthcare to the outsourced service owners to the information technology services and support. Right now, nobody is quite sure where we will all end up – we’re all just pretty sure the demand for someone who wants to just sit and transcribe from voice will go down and some sort of blended job will emerge.
Probably the best thing that could happen in this blended job would be for technology to tie the actual documentation process in with the coding and billing process (the revenue cycle). This would place the documentation process itself (rather than the document) into the revenue cycle – that “missing link” that MT has always struggled with in order to find value for itself. It’s very possible that as the EMR technology advances, the MT (a term I’m going to use just because it’s easier and I don’t want anyone to get confused) may be looking at coding a document at the same time it’s produced; it’s also possible there won’t be any audio dictation, or very little audio dictation, or that the record will be transcribed by SR and sent to the MT for editing and coding verification. In spite of the fact that many in the industry believe that it will be necessary to include dictation to get more physicians to adapt to the technology – and because, quite frankly, it’s usually faster than alternatives – this still doesn’t address the demand for point-of-care documentation. Dictated records for handling by another person (i.e., the MT) will never provide point-of-care documentation. I’m not disagreeing that dictating is usually faster and a better use of physician time or that it will speed adoption of EMRs – I’m just pointing out that it won’t ever be a point-of-care documentation solution.
And no matter how many people with years and years of experience in the industry sit in a seminar and discuss these topics – it’s all theory at this point. Nobody knows any of this for sure. We do know what the current job is; we also know we need to prepare the people who are currently MTs and the people who want to be MTs for a future that may require a broader scope of job skills. Kathy Striebel, from Mira Costa College, said she has many more people now enrolling in the coding and medical billing courses than the medical transcription ones; part of the reason for the seminar was to discuss curriculum for preparing people for a blended job.
And frankly, I think it’s about time. We aren’t any of us making much money in the traditional medical transcription industry. Compensation is going down, costs are going up, and competitors continue to drive down pricing in crazy cutthroat competition (argh!) that doesn’t benefit anyone.
Skill Set
We had an interesting discussion about the skill set required by the knowledge-based worker in the emerging healthcare documentation environment. I’m interested in knowing how MTs feel about this.
- Hardware and software proficient
- Content and technology enabled medical editing
- interpersonal business skills targeted towards distributed virtual workforce (telecommuters)
– time management and discipline - Critical thinking/problem solving
- Knowledge of pathophysiology, anatomy, physiology and body systems, diagnostic procedures, laboratory data, pharmacology
- Critical and interpretive listening
- Digital and internet proficiency
- Knowledgable about privacy, security and ethics
- Knowledgable about healthcare compliance and risk management
- Awareness and knowledge of medical-legal issues
- Familiar with documentation workflow
- Coding skills
- Billing practices understanding
- American English language and regional syntax proficiency
Keep in mind that the curriculum being developed is for students who are just entering a college program that takes almost 2 years to complete.
One employer stated that when she had to outsource some of her transcription, she was unable to use the smaller service she would have preferred because they didn’t have the technology capability required to service the hospital. It isn’t just individual MTs who will need to be tech-enabled; the outsourced services need to be, as well.
Recently passed legislation now holds anyone handling PHI to the same standards and penalties as a covered entity. Whether or not you think the doctors and clinics you work for, or your clients, care or whether or not you think there will ever be a problem in your small corner of the world – there are a lot of mom-and-pop long-term care facilities that are now out of business because they never thought the Medicare auditors would come down on their heads.
Look at the list of skills and ask yourself – is there much in there that can’t be described as knowledge based? Can these skills take us to a job description that will place more value on what we know than how many widgets we can produce?
Job Title
Medical transcriptionist simply doesn’t adequately describe this evolving blended job. In addition to being more descriptive, I think that a new job title focuses more on the knowledge skills of the job and less on the current production-based commodity of medical transcription.
Healthcare documentation technician: This describes the most basic level of the job, probably comparable on skill level to what the Hay Group study describes as a level 1 transcriptionist.
Healthcare documentation specialist: This is probably where many in the industry are currently at, or what the Hay Group study describes as a level 2 transcriptionist.
Healthcare documentation analyst: This job title excites me. Just the term “analyst” makes a strong statement about the knowledge level of the person with this education and experience. This is level 3 and beyond, encompassing all the skill sets.
Credentialing
Someone asked me in another discussion why AHIMA has been so successful in getting its credential accepted, where AAMT/AHDI has not. I don’t know the answer to that, but I’ve made myself a note to ask someone in AHIMA leadership. Whenever you see a job advertised for HIM, the employer usually specifies that a credential is required. This “requirement” is internal – there is no external requirement that these positions be credentialed. However, there are enough people who value the credential that when a job is posted with this requirement, there will be more credentialed applicants than noncredentialed applicants.
The problem in MT is that the opposite is true. Even if employers specified “credential preferred” in their ads – and they don’t – there are so few credentialed MTs that everyone knows it’s not really going to make a difference. If 9 people with 10 years’ experience and 1 person with 2 years’ experience and a credential apply for the job, do any of us really believe the person with the credential will be given “preferential” hiring? (No.)
I’ll save the deep discussion on credentialing for another blog, so start thinking about it. I think it’s something MTs really need to consider if they’re going to make any progress – whether it’s the CMT from AHDI or the RHIT from AHIMA.
Getting Experience
Continuing on the subject of credentialing (kind of)…
The reason I went to this seminar was to talk with people in education about what can be done to help MTs get into the job market post graduation and if there’s a way I can help employers and new graduates by offering something through MT Registry and what that might be. This isn’t an area of transcription I’ve really kept up on, especially in terms of what AHDI is doing in this regard, but I knew this has always been an issue and that it’s one AAMT/AHDI has tried to address.
Which brings us to the apprenticeship program. After years of hard work, AAMT/AHDI was finally able to get the Department of Labor to recognize MT as an apprenticeable job. Unfortunately, this has been a huge failure, for a variety of reasons. However, I’m told by employers that nobody can afford to pay a new graduate an hourly rate for 2 years, which makes employers reluctant to take on an apprentice.
Then, there are internships. An internship is an unpaid position and my guess is that this wouldn’t be terribly successful either, as most people can’t afford to work for 90 days without making any money. On the flip side of that, the employer can’t afford to put someone on the books for 90 days at at least minimum wage so they can train them, either.
Mira Costa College is going to add 10 hours of dictation to their curriculum, which a student must complete before completing the program. Still – that’s not a lot of dictation. In reality, if you convert lines to minutes at 10 lines/minute and realize that a company requires an MT to produce 1000 lines/day as an employee, that’s only 6 days of work. It’s going to be a start, but that’s all it is.
In my opinion, the ideal would be for schools offering medical transcription programs to add a module to do transcription on dead files for 3 months, with the requirement that productivity and quality guidelines be met prior to program completion. And anyone who can’t meet those guidelines within the 3 months wouldn’t graduate.
So where does that leave us?
Unresolved, I’m afraid! I’m going to save further comments for another post – I wanted to keep this one focused on the actual seminar I attended and I think there’s enough here to keep readers thinking for a week or so.
Transcription School Wars Part 2
My school had 600 minutes of transcription (no idea how many lines), but no grading, just a key for comparison that you couldn’t see until you submitted your answer, and then it would do the comparison for you. Worked okay, but the lack of human interaction had some drawbacks when it came time for finals, which were graded by a human.
I felt that the reports chosen were adequate preparation for beginning.
I also did an externship for 2 months. This was as an independent contractor. The not getting paid stunk, (actually they paid me by the line, which is almost like not getting paid for how fast I was going and I was limited on how much I could work because of the labor intensive 100% QA) but it was good for starting. I probably would have stayed on had there been work at the times I was scheduled. Additionally, I didn’t really want to work as an IC, although being my own boss kind of appeals now.
I have a little trouble with the inclusion of coding and billing into what looks like a melded job description that seeks to be “all things to all people” in the documentation value chain and who would, in my opinion, never be compensated at a level commensurate with the range of skills implied here.
Coding and billing, in particular, are subspecialties of their own that can literally take years to master, and moreover would demand additional time to perform for each record (how would this not delay documentation?). I don’t think that we need to be producing people who are “jacks of all trades and masters of none”.
And what are the implications for the value chain itself? To properly utilize (which means, to avoid underutilizing) such individuals, it seems to me that much of the documentation value chain itself would have to be restructured, possibly involving enormous cost. You couldn’t just insert these people into existing structures without suffering underutilization. Meanwhile, it would take quite awhile for a sufficient number of these new workers to come “on line” in order to justify the cost of restructuring, so there’s a bit of a Catch-22 here.
I applaud efforts to rethink the role of the MT, but I think we should be cautious about overreaching. Perhaps a more orderly, stepwise approach would be better advised.