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March 16, 2009

MTSOs Can Ease Fiscal Pressures
By Linda M. Sullivan
For The Record
Vol. 21 No. 6 P. 8

These days, we keep hearing in the news that we are approaching the worst economic downturn since the Great Depression. (Funny that it was dubbed “great” when awful seems more fitting.) Recently, I’ve begun to hear the situation described as a “decession”—an economic slowdown that falls somewhere below a recession but not as bad as a depression.

Whatever the pundits decide to call it, we are all feeling its effects in many aspects of our everyday lives. Even those who are still able to pay the mortgage, put gas in the car, and have something left over beyond covering life’s necessities are uncomfortable spending whatever extra money they do have. We’ve finally—albeit at the worst time for the economy— become a nation of savers again.

In spite of this economic environment, there are companies that are still hiring, industries that are still financially healthy, and sectors experiencing growth. Out of failure, there are many opportunities for success, although it can often be difficult to see them.

While they enjoy the security of long-term contracts at set prices, medical transcription service organizations (MTSOs) can’t help but be wary and perhaps even nervous. Hospital and physician reimbursements through Medicaid have already been cut in many states, and more are being proposed. In this economic climate, where nearly all states are having a difficult time balancing their budgets, it seems likely that they, too, will cut Medicaid reimbursements.

This means it’s likely that clients, hospitals, and clinics have fewer dollars to spend on services, including medical transcription, which is often viewed as an item on the expense side that can be repeatedly revisited for cost savings. Despite these sobering circumstances, transcription companies that have implemented new and improved technologies have thrived, even while there has been ongoing cost cutting.

Because MTSOs have continued to excel in the use of technology—be it speech recognition or other productivity enhancements—shaving another penny off the line rate seems like a reasonable request. My sense is that cost cutting has started to plateau and that we’ve reached the current tipping point—the balance beyond which MTSOs cannot continue to cut their prices and maintain the integrity of patient documentation.
At the end of the day, that is the most important consideration of every healthcare facility. Price is always important, service is always important, but the accuracy of patient records is paramount. It cannot be sacrificed.

Having said that, today’s new economic reality can be game changing. While we all are wary of our futures—be it our jobs or, in the case of MTSOs, client contracts—there are opportunities amid the doom and gloom. The majority of today’s medical transcription is outsourced, as hospitals have been moving away from in-house transcription departments at a steady clip during the past 15 years. For the most part, small doctors’ offices that might have had an in-house secretary don’t even exist anymore.

But there are still some hospitals and large clinics that do a portion of their transcription in-house. The opportunity for MTSOs is to identify those facilities and make the case that outsourcing is a prudent, cost-cutting measure. If a facility isn’t currently outsourcing, there may not be a better time for MTSOs to persuade them to change their strategy.

No one likes the idea of laying off employees, but the reality in today’s world is that the rising cost of healthcare alone has sent the financial burden of annual compensation for employees spiraling upward. This is a difficult issue to face, as every facility that has already done so is well aware of. It’s fine to make a decision in a boardroom to outsource a function that previously was performed in-house, but it is another to sit face-to-face and tell individuals who have been on the job for many years that their position is being eliminated. Some facilities are able to find in-house positions for their medical transcriptionists and, in many cases, MTSOs will also offer them employment. As someone who has gone that route, I can say it has proven beneficial for everyone: the transcriptionist, the service, and the facility.

The outsourcing phenomenon is reflective of a sea change in many industries. It has been happening for a number of years in medical transcription, but this economy may force the elimination of the last of the in-house transcription departments. Here’s how. What is the goal of hospitals? All healthcare facilities have the stated goal, either explicitly or implicitly, of providing the highest quality patient care. It is a complex task for hospital administration to coordinate every facet in the delivery of patient care and all the people involved in those processes. We know that many of those processes can be done outside the hospital walls.

Who better to provide medical transcription than the experts—companies filled with experienced individuals who have learned and continue to learn about the latest technologies to enhance productivity, individuals who have learned how to edit transcription from automated speech recognition engines, and veteran MTSOs that have an intuitive understanding of the intersection between their companies’ strengths and their clients’ needs.

Why are medical transcription companies in a better position to provide lower cost, higher quality transcription? Because it’s all they do—they’re not part of an HIM department that must juggle many aspects of patient documentation. Medical transcription organizations are familiar with automated speech recognition and have invested millions of dollars in buying and developing platforms that will enable them to achieve maximum efficiency. These up-front investments are designed to achieve ongoing cost-saving efficiencies. At the same time, these platforms have become more sophisticated, adding such tools as automated quality assurance programs that allow users to review a document faster and have it delivered to clients in the required turnaround time. In addition, most platforms have successfully meshed with at least one of the automated speech recognition programs on the market.

The transcription process can be costly, not only in terms of hard dollars but also in how it drains people and time resources. By outsourcing medical transcription to dependable experts, hospitals and clinics can help remove some of that burden from overworked HIM departments.

— Linda M. Sullivan is president of New England Medical Transcription Inc and was the founding coordinator and first president of the Pine Tree Chapter of Maine, a chapter of the Association for Healthcare Documentation Integrity. She is also past president of The New England Association for Medical Transcription.