Bringing Work Back To America - (sm) - Meerkat

Posted: Mar 05, 2012

Not long ago I was watching a news story about several manufacturing companies that had found, after shipping work overseas and seeing quality drop precipitously, a way to bring the work back to U.S. soil that actually LOWERED their overhead, INCREASED quality, and RAISED their profits. One company in particular made some sort of an appliance that was assembled with quite a few screws that are put in by hand.  They shipped the work to China, and quality suffered.  They also had to hire a lot more employees to put in a lot more screws. So they reworked the design on their product, so that the metal housing fit together more precisely, and required half the number of screws to fasten it in place.  They were then able to bring the work back onshore, hire fewer people to install fewer screws, and because there were fewer of them, doing a better job on a better product, they were able to pay them far more than they paid all those Chinese workers, and still make more profit than ever before.  And needless to say, because the quality of their work went up, and because they could now say it was "Made in the USA", their clientele continues to grow.  A win for the employer, and a win for the worker! This business model could be applied to medical transcription, as well.  I really don't know why MTSOs shoot themselves in the foot by making everything so complicated, and by hiring far more employees than they need.  If they SIMPLIFIED production of the medical record, instead of continually adding more people, more steps, more editing, etc., they would likely be able to do away with India and/or VR altogether, pay their U.S. MTs a fair wage, AND make more money/gain more clients at the same time. 1.  Eliminate The Fluff:  All those unnecessary steps the report must go through before it reaches the client is ABSURD. The report should be dictated, go to a trained, capable, EXPERIENCED American MT, and then, in most cases, go directly back to the client.  MTs who can produce this kind of work should be paid top dollar.  2. Ditch The Voice Recognition:  It may be of limited use for the private practitioner, or for a very diligent and computer-savvy M.D. working on his own manuscript, paper, etc.  But for the day-to-day production of mass volumes of work, it's a time-waster and a quality drain.  The mere fact that it cannot go directly to the client (and let's face it - never will!), means that it then has to go through an MT's eyes, and computer, before finally going back to the client.  The Indians don't have the skill set to edit this VR mess.  Nor does a still-wet-behind-the-ears newbie.  Editing VR is HARDER than regular transcription.  It INCREASES the chance that a mistake will be made, and missed. It's a waste of the MTSO's money, and the MT's time.  Use VR for writing your interoffice memos, but leave the word-processing and transcription to people who know their stuff.  You'll make more money in the long run, and have happier clients. 3.  Back Off On The T.A.T:   I realize TAT is a bargaining tool between provider and client, but I mean, REALLY!  It's become a ball-and-chain for both the MTSO and their employees.  MOST medical reports do NOT have to be back in the EMR within 2 hours.  Or even 2 days, for that matter!  How many days or weeks-old consults or discharge summaries do we do every single day?  When hospitals are up for accreditation, they have to catch up on their backlogs.  Suddenly everything but the kitchen sink is dictated as "STAT", because if it's not all in the patients' charts, they may lose their accreditation.  Well, you know what?  That's not the MTSO's problem!  It's the hospitals' problem!  If they didn't train their docs to keep up-to-date on their dictation, then if it has to be sent as a STAT report, they should have to pay a premium to have it transcribed with a quick TAT.  Maybe that extra cost should come out of the DICTATOR'S pocket. There should be 2 transcription lines - regular and STAT.  If the STAT lines cost twice what the regular lines cost to get transcribed, then I'd be willing to bet that the hospitals will come down hard on docs and PAs who dictate anything other than a true STAT on those lines.  4.  The MTSO and the MT should not be paying out of their pockets for lazy and/or ESL dictators.  A new dictator should go through an initial, experienced MT's ears, and get rated.  The higher the rating, the more will have to be paid to transcribe them, because they will need a more-experienced MT.  The lower the rating, the easier they are.  Currently my MTSO has different pay scales for different accounts, but it should go further than that.  It should be PER DICTATOR.  They take more time. They take more experience. They're higher-risk in terms of potential for mistakes.  Maybe the hospitals should consider intelligibility of speech to be a factor when considering new-hire MDs.  The mush-mouths should cost them more money.  After all, their amateur attemps at ventriloquism-while-dictating (i.e., without moving the lips) is a risk to patient care. 5.  Get Job Descriptions Under Control:  Although it may be slightly more complicated in terms of billing, when it comes to different price tiers for good or bad dictators, I think that would more than pay for itself in terms of getting the offenders to clean up their acts a bit.  That could be even further offset by scaling back on the currently PONDEROUS and RIDICULOUS custom-order job specifications set by not only every hospital, but by every frickin' doctor!  What the H__ IS all this?!  "Dr. X wants every report double-spaced.  Dr. Y wants paragraph headers bolded and underlined.  Dr. Z wants an Arial font (never mind that his hospital uses Times New Roman!).  Dr. W wants all dictation verbatim, and Dr. P wants the MT to clean up his sentence structure.  Dr. T wants a phone number inserted after every referring physician's name, wherever it is mentioned in the report.  Dr. B wants all drugs in Italics.  Dr. A wants indented paragraphs on Mondays, Wednesdays and Fridays, but on Tuesdays and Thursdays, he wants block form.  And on Saturdays and Sundays, he wants the first letter of every paragraph embellished in oversized Gothic script. Come ON, people!  How does this help accuracy, TAT, or patient care, when the MT has to not only refer to a 100-page "instruction manual" for every account, but then to a list of positively ridiculous and NEEDLESS personal style demands from each Prima Donna? (I mean, doctor.)  Tell the hospitals and the doctors to GET OVER THEMSELVES.  If they REALLY want all doctors to have their very own "style" of dictation format, maybe they should hire a few highly-paid MTs of their OWN to deal with all that fluff. The medical record really has only two purposes: For doctors to refer to in order to provide better patient care, and to serve as a medicolegal record.  That record should be neat, easy-to-read, and accurate.  6.  Have A Standard Format:  You're already charging them bargain-basement transcription rates. Why on God's green earth do you think giving them all that style-diversity is good for your bottom line?  Where do you even DRAW the line?  Come up with a simple, standard, businesslike company format that will be Word-compatible, and easily compatible with ALL client software.  That way, when it uploads from your platform to the client's, it won't take on a life of its own, format-wise.  It will STILL be simple, easy-to-read, and businesslike.  If the format is the same for all your clients, it will be easier for your MTs to jump from one hospital to the next during the working day.  Pay your MTs more for the time it takes to tackle those no-speakie-English doctors.  That way they can slow down a little, and take the time to fill in more of those blanks.  And, if you charge more for them, maybe in the future there will be fewer of them to deal with, because the hospitals will realize that clear speakers mean a lower bottom line for them, as well.