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May 2017

Transcription Trends: Small MTSOs Fight to Succeed
By Maura Keller
For The Record
Vol. 29 No. 5 P. 26

Until about five years ago, Lee Ann Wilmot's, CHDS, AHDI-F, CHTS-CP, transcription business was growing steadily. Since then, however, Wilmot Transcription Plus+ has abruptly lost several accounts for various reasons, including physicians selling their practices to large health systems and hospitals switching to an EHR.

Wilmot Transcription Plus+ is not alone. In what's become a trend, more and more small medical transcription service organizations (MTSOs) are struggling to survive in today's market.

A Changing Market
The medical transcription industry has changed significantly in the last 10 years, with the effects being felt by everyone from physicians and nurses to office staff. But perhaps no one has felt the effects more than transcription company owners.

"With all of the technological changes in the health care industry, we have had to adjust our way of doing business in order to survive," says Ben Walker, founder and CEO of Transcription Outsourcing. "We now transcribe directly into our clients' EHRs in some cases. We also edit voice recognition notes within EHRs for some of our clients."

Transcription Outsourcing's online platform is capable of interfacing with most EHRs, a feature that allows physicians to continue to dictate. Notes are populated in the EHR as needed with no effort on the medical practice's part.

As EHRs and speech recognition technology rose to prominence, Transcription Outsourcing lost several clients. However, the company is slowly starting to add a few more back into the fold.

"It took a few years to get things figured out on the physicians' side, and now that they have had a chance to see how the systems work and directly affect their workflow, we are starting to hear from more and more practices that they want our assistance getting them back to the levels they were experiencing before," Walker says. "The expansion and use of EHRs has strengthened our relationships with our clients and streamlined the path between our work and customers. This has eliminated the need to manually transfer transcribed reports between platforms and reduces the amount of clerical work for our clients."

Betsy Ertel, CEO of SpeedType, says some owners of small MTSOs have moved on to other options such as collaborating with larger companies and accepting backlog work and quality assurance jobs.

"When accounts are lost through buyouts, there is not much left to do but re-create your purpose," she says. "Some CEOs went back to school to teach while medical transcription instructors enhanced their skillsets learning the medical coding industry to teach to their students. This repurposed students with the medical record transcribing background to still seek demanding jobs within the health care documentation industry."

But, as Wilmot explains, there is a perception among decision makers that using an outside company for transcription and/or editing is cost-prohibitive. "A small hospital CEO has called me many times over the years to help them with their transcription needs because, on at least one occasion, they informed me their emergency department transcription was two months behind," she says. "There was no doubt that they needed help, and we were willing and able to provide it. Their EHR company was going to charge them many thousands of dollars to work with my company to set up an interface, for which I do not charge a dime."

Fortunately for Wilmot, there are existing and new clients that recognize the value her service brings to the table, including assurances that documentation is accurate. "They also depend on our assistance when they need to alter their workflow, forms, or formats when new guidelines call for it," she says. "They appreciate our ability to seamlessly interface their transcribed dictation directly into their EHR."

One of the biggest challenges small MTSOs face is EHR vendors that refuse to provide an interface between their technology and the transcription platform, either by outright saying it cannot be done or making it too expensive. "End users are often not included in the discussion prior to purchase, so this kind of issue comes when it's too late," Wilmot says.

Speech Recognition's Role
EHRs and speech recognition have cut down on the keystroking technique used to produce documentation. As Ertel explains, with speech recognition, a keystroke saver is still valuable to create strings of text manipulating the application to place a period, move forward two spaces, and start the next sentence or have an [@KEY Enter] command. A tab or a string of tab commands or multiple backspace commands with a three-character keyword is also relevant speech engine talk.

"When you have a universal Windows expander product, it just finds other expansion options to stay relevant," Ertel says.

While some clinicians continue to dictate using both front-end and back-end speech recognition technology, others are foregoing the step of having those draft documents reviewed for accuracy and terminating their contracts with MTSOs.

"Accuracy is of prime concern no matter how the record is created," Wilmot says. "Someone's time is required for that. One former client is actually having their nurse practitioner review the speech-created documents, which I know for sure is more costly than using my staff. In my opinion, the most cost-effective and reliable person for that job, rather than the much higher paid physicians and other clinicians, is the health care documentation specialist."

According to Wilmot, many physician practice decision makers and EHR vendors view the situation as being an "all-or-nothing" proposition. "This technology should be a huge boost to patient care, efficient documentation, and increased revenue by utilizing the best parts of all processes to create customized solutions for themselves and their clinicians," she says. "Instead, the clinicians I know are still struggling to try to fit themselves into an EHR system rather than it being a tool that works for them."

Necessary Adaptations
In an ever-evolving industry such as HIT, it pays for service companies to adapt. Many small MTSOs have done just that. For example, five years ago Wilmot Transcription Plus+ started using software featuring additional security, auditing tools, and the ability to interface with EHR systems. Wilmot herself expanded her skills and credentials through education sponsored by AHIMA and the Association for Healthcare Documentation Integrity (AHDI) while encouraging her staff to follow suit.

"I also offer services to practices to help them integrate their current workflow and needs with new technology, and even act as a liaison between the practice and the IT vendor," she says.

SpeedType, whose services now extend to the legal community, is poised to meet any transcription demands. "If you have a voice file that needs to be transcribed, then you need a text expansion system that helps cut down on those repetitive keystrokes," Ertel says. "If you are a seasoned transcriptionist, you can transcribe any voice file content by learning the definitive terminology. It is helpful to have those specific terminology dictionaries built with keywords to cut down on the production time. Segmentalizing keyword dictionaries based on workflow is powerful."

For its part, AHDI has done much to help small MTSOs stay relevant, including producing tool kits related to quality assurance best practices and clinician-created documentation. In addition, continuing education and professional development opportunities are available via face-to-face meetings and online webinars. These are lifelines for the owners of small service providers such as Wilmot.

To accommodate new and existing clientele, Transcription Outsourcing staff familiarize themselves with as many EHRs as possible. "This has made our business better able to work with practices that have expanded the use of EHRs," Walker says.

A Look Ahead
Is there a future for small medical transcription companies? "We expect to continue to hear from more and more practices asking us how we can help them improve their workflow by transcribing directly into their EHRs," Walker says. "That being said, I think the industry will continue to bounce back."

Ertel says there's still room in the market for small MTSOs. "From the business relationships built over the years through the SpeedType database, as I continue my own personal endeavor to connect the dots for those searching, small transcription owners still exist and are holding onto their accounts as we speak," she says. "It is all about the continual relationship of the MTSO and its clients. Some clients choose the dollar bottom line for final decision-making purposes while others choose quality and turnaround time as priority."

— Maura Keller is a Minneapolis-based writer and editor.