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May 2018

Transcription Trends: Get to Know the MTC
By Keith Loria
For The Record
Vol. 30 No. 5 P. 5

In December 2017, Darlene Pfister founded the Medical Transcription Coalition (MTC) with the goal of promoting ethical outsourcing, organizing workers, collaborating with stakeholders, and generating and implementing strategies for improving conditions and pay within medical transcription service organizations (MTSOs).

"I have worked as […] a supervisor, manager, and worker in medical transcription," Pfister says. "The situation in many MTSOs is mismanagement and worker exploitation. One physician signing a petition went so far as to call it abuse. Some call the uniformity of low wages, pricing, and similarity in working conditions to be industry collusion."

She believes medical transcriptionists/editors (MT/Es) have been largely ignored by industry organizations that have failed to sufficiently advocate, pressure, boycott, or collaborate for improvement, a stance that validates the situation and permits it to continue.

"Many MT/Es, including myself, have been waiting for somebody else to come along and remedy the situation, and we are realizing that in order to effect change, we need to organize and work better together," Pfister says. "The MTC provides an opportunity for MT/Es to articulate the conditions and pay that they want in their MTSOs, both present and future, and to work together to identify strategies to implement them."

The Beginning Stages
Being a newcomer in the industry network, the MTC is working on spreading the word about its mission, building trust, and gaining a track record for responsiveness.

"Some have questioned if the organization has a financial motive, and we respond that there is no membership fee and that it is a nonprofit, volunteer organization," Pfister says. "We found that many MT/Es are skeptical and jaded about the potential for achieving any change in conditions or pay given previous unsuccessful individual attempts. Some have given up on the industry, believing it to be dying due to technology and offshoring."

Other MT/Es, she continues, believe that the only way to achieve change is to not accept positions under the existing pay rates and conditions. She contends many have essentially been priced out of the industry, forcing them to resort to public aid and obtain second or replacement jobs.

"We are working to reassure that the industry is not dead, that our services will still be needed for quite some time, and that, responsibly working together and utilizing modern networking technology and activism strategies, we can identify and implement effective means of activism to improve conditions and pay," Pfister says.

In the current labor law environment where employee and management collaboration can be somewhat restricted, Pfister believes the MTC offers an alternative, industrywide approach to communicating workers' needs.

"It is similar to some industries developing a bill of rights," she says. "In some ways, it is also a free consultation on managing the work processes and human resources in an MTSO from those that know the processes and resources the best—the MT/E."

The MTC also invites expertise from others in business, organized labor, health care, law, government, and IT to help identify alternative business models such as worker cooperatives, alternative organizing and activism strategies, and legal and legislative solutions that can help improve industry conditions.

Although there are other transcription organizations and networks, Pfister believes the MTC is different in that the others provide a wider range of information on industry trends, educational opportunities, professional advancement, industry standards development, information exchange, and job leads.

"The MTC is more of a working group for the focused purpose of improving pay and conditions within MTSOs," Pfister says. "It is not intended to be a substitute for other organizations or networks, and we often contact those networks and organizations to ask for input and to update them on activism opportunities and progress."

While the Association for Healthcare Documentation Integrity advocates for the medical transcription profession overall, it does not consider itself a labor organization and believes it can't get involved in employer issues, Pfister says.

"We provide a focused and organized place to go in order to effect change in the MTSO industry for better pay and conditions, similar to their equivalent peers in health care facilities," she says, adding that the MTC does not accept special interest advertising, donations, or leadership.

State of the Industry
With the advent of speech recognition and EHRs, Pfister understands that many perceive medical transcription as a dying industry, noting that the general public is often surprised that it still exists. However, she notes, it is a little like the long-forecasted paperless environment that has yet to become the norm.

"We have found that technology has improved productivity but not as much as people were promised or expected, either for care providers, who are still overworked and pressed for time with patients, or for MT/Es," Pfister says. "This is particularly true in many MTSOs due to the way they manage work flows and the many variables affecting their productivity."

Variables include rotating hospital account assignments, shifting efficiencies in multiple software platforms and processes, and unweighted work difficulty.

"Traditional health care facilities with in-house MT/Es working on only their health care account are not contending with the same conditions," Pfister says. "They have less variability, have more positive environments, and utilize hourly vs per-line pay, commensurate with the required knowledge and skills. They are not differentiating pay between speech recognition vs traditional methodology—other than increasing production requirements—for the same end product. With this working environment and resultant living wage, they are better able to achieve higher productivity and quality standards with improved employee retention."

The Problem With Pay
Dwindling MT/E pay rates are a huge industry concern, a situation Pfister believes requires cooperation from all stakeholders, including providers, MTSOs, and MT/Es themselves, to resolve.

"Health care administrators and providers need real data on productivity from the people who know, the people doing the work, and not rely on vendor promises with inflated expectations," she says. "They need to be honest and admit when technology falls short and remedy the situation. Administrators also need to be informed about the real costs of transcription and editing, which includes adequately paid labor and administration and regularly adjusting for cost of living. Outsourcing can alleviate staffing and administration headaches of health care providers, but real costs remain. Rather than automatically turning to outsourcing, they can capitalize on productivity gains by looking around for other areas in the organization where these workers could cross-train into such as medical scribes, secretaries or assistants, data quality reviewers, abstractors, coders, or registrars."

Pfister says MTSOs can work more efficiently, humanely, and effectively in order to pay higher wages, suggesting they spend less time monitoring and micromanaging employees—which can negatively affect performance—and more time streamlining and improving processes.

"They need to understand that higher quality rates require more time and adjustment to productivity rates, which should be calculated using analytical measurement methods for the individual MTSO work processes and then used as a guide and a goal, averaged over longer periods for variability adjustments rather than a rigidly applied number expected every day all the time," she says. "They are not robots assembling a single, identical widget. Variable conditions, often beyond an MT/E's control, affect production and pay.

"Compensation systems need reevaluation, with a preference given for hourly pay to better compensate for variabilities and currently noncompensated, nonkeyboarding work tasks. Speech recognition pay rates were priced too low when set a decade ago in anticipation of higher productivity yields than were realized—100% vs 25% to 30% in many MTSOs—and never readjusted. This, along with the need to adjust transcription rates for a decade's cost of living, is a big factor in the current low-pay environment in MTSOs, compared to health care facilities."

The MTC can help by involving MT/Es in defining working conditions and performance measurement and compensation systems, encouraging additional job responsibilities for the productivity gains realized, and organizing them to open the avenues of collaboration and collective bargaining.

"It is a shame that there is even a need for this effort, as the situation is obviously unjust, and could easily be remedied by MTSOs and health care providers," Pfister says. "If MTSOs can universally agree to lower rates of price and pay, they can universally agree to higher rates, and health care organizations can be informed of the needs, costs, and benefits."

She says the issue of sending medical transcription offshore, while real, tends to be overplayed as a reason for lower MT/E salary rates, with MTSOs that do not send transcription overseas using it to justify noncompetitive pricing and pay rates.

"There are hundreds of other smaller MTSOs throughout the United States that do not offshore transcription at all and they promote that as a beneficial feature because many health care providers and consumers do not want their medical records offshored for a variety of reasons, including increased risks in security and privacy, quality, and support for US workers," Pfister says. "They say they need to price and pay as the larger offshoring companies do at lower rates in order to remain competitive for clients. However, many larger MTSOs that do offshore, do not offshore all of their work, only those health care accounts that authorize offshoring. Many of their clients also include those who require only the use of onshore workers. Those workers need to be paid living wages commensurate with the knowledge and skills required vs the now near-minimum wages by both larger MTSOs who offshore some of their work and smaller MTSOs who do not. Offshoring is an issue that should be addressed by all stakeholders but not overused as an excuse."

Looking Ahead
According to the Bureau of Labor Statistics, there is only a 3% decline predicted in the need for medical transcriptionists through 2026 due to technology advances and an increased demand for health care services. This provides hope for the MTC, which, as of early March, had approximately 200 members, some of whom were actively contributing while others sought updates on the organization's progress.

"Many MT/Es are still cautious about speaking up and prefer to submit their input via the contact form and e-mail rather than the website; teleconferencing is also on the horizon," Pfister says. "We want the website to be a safe place to speak up about needs and ideas without bullying or fear of repercussions, so we will add their input to the website forums and our activity, however they choose to submit it. The MTC wants to promote a cooperative and mutually prosperous effort between MT/Es, MTSOs, health care providers, and consumers in solving a problem that affects not only MT/Es but also the quality, timeliness, and cost of the transcription product to the client. It also affects health care provider workload, the accuracy of patient care, the privacy and security of patient information, and MTSO stability and solvency."

— Keith Loria is a freelance writer based in Oakton, Virginia.