A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Eliminate the MTSO - Thoughts? - Had Enough!

Posted: Apr 09, 2015

For others who have had it with the miniscule wages, unreasonable expectations and unethical business practices, have you thought about working directly for the providers again? What would it take to be able to do this? Are all EMRs set up to receive dictation? Anyone know how we would integrate our services with the EMR and the approximate cost?

I would think that for providers who are fine with 24-hour turnaround, we could offer the same service they are receiving from an MTSO at a reduced cost.

Any thoughts or ideas?

I would love to do this. - Sign me up.

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I have no idea how to go about it though. I would love to hear other ideas as well.

EHRs do not record the dictation - Informacist

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EHRs don't record dictation. They are not dictation systems. Doctors do not dictate into them. They can use a front-end SR system along with an EHR, in which case there is nothing for anyone to transcribe or even edit. They can type their notes, and they can use templates notes, neither of which requires any transcription.

They can also dictate on little handheld tape or digital recorders, or they can dictate into a dictation system like your MTSO uses. Those reports can be uploaded into the EHR. Yes, you could do that, but you will need to be a business entity, not just some woman who types at home in her spare time, and you will have to PROVIDE THE DICTATION SYSTEM, THE PHONE LINES, THE 24hr TECH SUPPORT, THE SOFTWARE AND LICENSES, THE TRAINERS, THE UPLOADERS, THE QA, THE OFFICE STAFF, THE PEOPLE WHO COLLECT THE FORMATS AND SPECIFICATIONS, THE BILLING AND ACCOUNTING, THE LAWYERS, THE CONTRACT WRITERS, AND EVERYTHING ELSE. Which will cost a fortune and which will become defunct the minute that facility goes to FESR. Or to a big MTSO that is offering to convert them to FESR. Which won't be long. Good luck getting a businessman for a dead field, too. Or to get deadbeat doctors and bankrupt facilities to pay you.

There is a reason MTs get paid so little ... the cost of the MTSO is outrageous.

I am not an MTSO nor do I work for one, but I know about EHRs and the cost of doing business.

Something else ... - Informacist

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Doctors do not do the contracting at facilities. The facility does it.

I'm aware of that. - Had Enough

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.

Informacist - I'm glad you posted (sm) - Had Enough

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I'm talking about one person doing transcription for one clinic or hospital. Most of the costs you mention are only necessary on a large scale with multiple employees. As an IC x 20 years I took care of all templates, formats, specs and billing. No lawyer was needed as a standard transcription contract was personalized and used. The legal text remained. So what it would come down to is simply a secure network to transfer data that integrates with the EHR system. Is such a system affordable for one MT? We already have access to call in dictation systems and a free/low cost transcription program.

I wonder if the creators of EHR systems simply wrote us entirely out of the process without knowing whether VR would work, which makes absolutely no sense to me.

To Had Enough - Think about it

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You must be one amazing MT to be able to provide 24 hour turnaround, stat coverage and weekend and holiday coverage alone. Unless you live in a very rural setting, you are looking at a provider list of at least 50, maybe more. You need more than a secure network. Many facilities use Epic, and you need to have software compatible with those systems to receive and send information and those licenses are expensive. You need to have encryption software in place as well. Many facilities are already using speech recognition with only a few providers using straight dictation. My facility has a goal of having everyone on Dragon by 2017. We currently use an outside vendor for transcription and an onsite QA staff and if for some odd reason we needed to hire an MT we would pull in someone who worked for us in the past and was laid off. MTs are no longer in demand and people now wait in line for jobs. All of that being said, I don't know how you plan to convince a facility to change vendors and sign with you. Your pricing has to be better than what you propose, and you have to prove that you can provide the staffing to do the work. You might be able to find 1 or 2 small offices in your town who need an MT or maybe if someone new comes to town, but otherwise I don't know how your plan will work.

I think Had Enough meant as an employee - Bobmark

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not an IC. I always worked as an employee for hospitals or clinics in the HIM department. The last hospital I worked for was owned by a large hospital administration company. Once they had to go to EHR, they moved all the HIM departments were moved into a shared services division. Turned out the purpose of all that was to cut personnel to the bare bones. They went to a centralized transcription system and then sent all the MTs to work for an MTSO. At that point, I was part of the management team and got to keep my job a year longer until they eliminated mine. There aren't many hospitals or clinics any longer that outsource. If you want to work as an IC, there are probably some smaller doctor's offices that will do that. I've also done that in the past. The problem I ran into with that is that when I needed to take off, I didn't have a backup so this created a problem for the doctor unless they were also taking off. The only time in my 25+ year career that I worked for an MTSO was for about a month once and I couldn't stand it and went back to my previous job at a clinic. But 20 years ago there were many more options for MTs. Now it's pretty limited.

Here's the main issue... - MT

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Transcriptionists are not in demand. Our work is changing and being phased out. As I said in other post, become a scribe if you want to work for private practice MDs. They are tired of charting. They want someone who can sit in the exam room and manually type into the EHR, navigate PACS, etc. Also, part of meaningful use has been providing a clinical summary at the end of the visit. This can only be accomplished by a scribe who is working live. Those who don't want scribes are using speech recognition. If you can walk into an office, hand them your resume, and tell them that you can work live, eliminating at least 1 hour after hours that the MD has to chart (increase his profits), and help them meet critical documentation demands, you will be much more in demand than someone offering transcription, which is outdated and is being offered with better technology and lower prices than you can offer elsewhere.

reason - anon

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Awesome that you know so much about EHRs and the cost of doing business. Seriously, that's terrific. However...

There IS a reason MTs get paid so little but it is not the overly simplistic reason you've indicated here. The REAL reason is spelled g-r-e-e-d.

Reason - Think about it

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I don't know if you were addressing me. Perhaps we are talking about greed but there are so many reasons why things are the way they are in the transcription world. Facilities need to cut costs and save money and they look for ways to do that. Transcription was one area where this was possible and unfortunately the MTSOs are very competitive and undercut each other all the time. That may be greed, that may be survival in this day and age of VR and cut and paste documentation. I don't like it any more than anyone else, but it is what it is. No facility is going to cancel their transcription contract and hire someone else for more money just because when the service they currently use works well for them. I don't know anyone who willingly pays more for goods and services when there are other choices. I didn't say anything about MTs getting paid very little and I was hardly being overly simplistic, just realistic.

Reason - anon

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My apologies to you, Think about it. My response was actually to Informacist.

about that FESR - question

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Okay, I've seen it, and at least where I work, it doesn't work near as well as you say it does. You have said on this forum that the SR works well with FESR and that the doctors don't mind making their corrections, but that doesn't seem to be the case at our facility. We are using Dragon, and the reports produced are garbage. As bad as any SR reports I've ever dealt with, and now we have to correct them WITHOUT BEING ABLE TO LISTEN TO THEM. Please explain to me again what is so great about FESR.

We use it, but do not have the issues you describe. - sm

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Our doctors choose to use it. We offered it about ten years ago, some picked up on it, more turned to it as time went on.

It hasn't been a big deal.

It was gradual and voluntary. We didn't ram it down their throats.

We did not present it as a cost-cutting inconvenience. They choose it because they prefer the instant results.

We also do not overfunction by having people run around after them making changes. First of all, we can't change anything once the report is signed, which they do on the spot. Second, our SR must work better than yours because the results aren't that bad. Third, we would never have someone screwing around with a report they hadn't heard, so the only thing they could "correct" would be spelling and punctuation, which doesn't matter.

Not sure what you are doing, but whatever it is, we don't find it worthwhile or necessary.

Informatics the - You are wrong - Just a lowly Ex-MT

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You are wrong about spelling and punctuation not mattering; that is spoken by someone who either has never done transcription or can't spell. My experience with FESR is different than yours. My providers don't like it, about 30% refuse to use it and the facility is trying to shove it down their throats. It was meant to save time and money but now it takes additional IT staff and transcription QA staff to fix the mistakes.

No, I am NOT WRONG. - Please read my post accurately.

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Sorry, but I can't be wrong when I am describing MY FACILITY'S experience.

As I said, WE DID NOT FORCE IT on them. We let them choose it. There was no pressure.

Not only that, but we rationed it at first. Only a few doctors got to use it because we only licensed a few copies of the software. Budget constraints wouldn't allow more. Hence, only the ones who tried it and liked it got it installed. They were interested in working with it to learn. They had a positive attitude toward it. They taught colleagues how to use it.

We also have it integrated with our EHR, which allows them to develop templates that do a lot of the work for them. They only have to dictate parts of reports.

They also are not trying to adapt to an EHR that sucks at the same time. Our EHR is very good and it existed long before we started SR.

The difference between our success and your experience is probably a matter of approach and timing. You forced it on them -- we did not. Forcing something ... anything ... on people is just about guaranteed to result in them hating it.

We also don't focus a lot of attention on nit-picking spelling and punctuation errors. When you had paper records, you didn't chase after them to correct their handwritten notes, did you? So why do you feel you need to chase after them now???

Spelling and punctuation is important to YOU because it is the basis of the job they gave you. It is what keeps you employed. If, instead, they had given you a job in informatics working with, say, templates, you would feel differently. You also would not resent the jobs in IT that are required by the EHR, because you would have one of them.

Incidentally, I was an MT and I can spell. Please do not resort to personal attacks to justify your arguments.

Not a personal attack, but correct assessment... - Had Enough

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Critical errors can come from misspelling and incorrect punctuation. It is a necessity to correct such errors and it is not an obsession or nitpicking, at least on our part. I will not speak for the MTSO's, as QA does have to justify their position by nitpicking much of the time and most errors are not incorrect, but just not per the MTSO's preference, i.e. the Oxford comma or inserting "the" in front of "patient." The day that "HER-2/neu" has a standard way to document will be a time saver. The MTSOs QA even differ on the same client!

Back in the days when physicians really did have the choice to use or not use VR, when Dragon Dictate first tried to sell to the medical community, 80% of the programs purchased by doctors were returned. The other 20% mostly just sat unused, with the exception of techy doctors. The ones I knew who used Dragon Dictate used it for templates and normals, but never for a new patient consultation. They recognized it's limitations and dangers, which are the same today as they were 20 years ago. The software just does not improve. Being trained thousands of times on the words "Texas" or "FOLFOX" and the software still not getting it means it does not work accurately.

The choice doctors were given is to use SR and edit your own reports, wasting valuable patient time on data entry, or hire a transcriptionist or editor AND a data entry person to sit at your EHR, get the report signed, then move it into the patient's permanent medical records, which is not cost effective. We would have told them that SR requires a brain to use, as the software can't always tell the difference between "uh regular" and "irregular", "hyper" and "hypo", "he" and "she" so they still need a brain to create an accurate medical record. Without it there will be errors.

You admit that some EHR "sucks." As long as this is what we are dealing with, then it is not safe to use.

It really isn't correct... - MT

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Doctors aren't concerned, in general, with grammar, punctuation, etc. If you work side by side with them daily, you will come to understand this. You will realize that as an MT we are getting screwed over by the MTSOs who nitpick, which lowers our wages. The doctors simply do not care, and majority never read their notes. I know, I've worked as a scribe and an MT. The administrators care about meeting coding/billing requirements. The narrative is no longer what is wanted or needed, and that is what dictation and MTs were for.

Also, regarding EHRs... - MT

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"sucking" and that making them unsafe, that also isn't correct. The fact that many of them are not user friendly has nothing to do with safety. It simply means doctors are tired of charting in EHR. That is why they are hiring scribes. That doesn't mean they are going to begin using dictation more again.

I agree with you. - Had Enough

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Doctor's don't care about grammar and sentence structure unless it creates a critical error, which can happen. MTSOs micromanage far beyond what the doctor's want. They are also paying the services what they used to pay us so where is the savings? Only in those few doctors who can use SR correctly.

Critical errors... - MT

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The MDs are responsible for their notes, not the MTs. If there is a critical error, it is their responsibility to catch it prior to signing the note. They rarely read their notes, and their staff oftentimes sign for the MDs. We are not expected to have the same knowledge level that MDs do. We have been trained to believe that our job is more important than it is by the likes of AHDI and MTSOs. It isn't about narration and English language rules, it's about billing and created structured data for other issues.

It is illegal for staff to sign for MDs - Be careful

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No message

Yes, and they still do it... - MT

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The point is exactly what was stated: Critical errors are the responsibility of the MD, not the transcriptionists. MDs are supposed to review their notes and then sign off on them. Tell the MDs to be careful. They should care more about their notes. It isn't the transcriptionists' responsibility when they dictate terribly and never review their notes. It's ridiculous that our wages are low because we are nitpicked about quality, yet the person who the note belongs to doesn't give a flying flip about the quality.

Staff should not be able to sign for others with an EHR - sm

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Except for certain circumstances, no one using an EHR should be able to sign for another.

EHRs also track users, date and time entries, and prevent alterations and removal of entries. It is no longer possible to rip pages out and rewrite them to cover up medical errors or to claim that one's failure to document is due to nurses and ward clerks.

That is one of the main reasons some doctors dislike EHRs so much ... too much control. They shed too much light.

Sharing passwords - No message

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nm

I know how they do it, but it is still wrong. - nm

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nm

Really? No kidding. That's the point. - No Message

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nm

To informaticist - To clarify

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I don't want to get into an argument over this, but spelling and grammar matter. There is a huge difference between hyperglycemia and hypoglycemia or BMP and BNP. Meds that are heard incorrectly by VR and transcribed as something else are a huge deal. Some QA editors become over zealous in their corrections but if those things didn't matter to someone, no one would use QA staff; I was "given" the job because my facility feels the need for accurate reports. If I worked in IT creating templates I would probably feel the same way; the feedback in regard to transcription errors comes to me from practitioners, clinical staff and yes, even IT. I don't resent what anyone in IT does. I work closely with our IT and informatics department, but they also recognize the importance of what I do. Our EHR does not suck; in fact, it's probably the same system your facility uses. My experience with paper records was that the physicians proofread their dictated reports and wouldn't sign off on anything that contained errors, it came back for transcription to correct. The coders and analysts caught errors and requested corrections as well. I don't chase after anyone but I have caught a number of critical errors and I am not talking about spelling and punctuation. When I find those, we do request that the provider create an amended report. You will probably continue to say that transcription errors don't matter until your facility gets sued or your personal medical records are subpoenaed in a lawsuit. From the people I have spoken with and from the personal experiences shared on this board, I think that your facility's experience is probably unique, and you are fortunate that it works so well for you. No one likes to be told that what they do does not matter, so perhaps you need to choose your words a little more carefully.

Not giving doctors a choice is forcing it on them. - Had Enough

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We have always been able to provide immediate turnaround, given the option to send and receive via Internet, rather than pick up and delivery. You mention templates as if they were a new tool. Weused them 40 years ago on a typewriter called the "Auto Typist."

You claim the doctors are free to choose SR over transcription. What options are they given? Expensive MTSOs? They no longer have the option to hire a transcriptionist, as the creators of the EHR platforms have written us out of the equation. It is no longer affordable to work directly for the doctors, nor is it affordable to support yourself on one fourth the salary you made 20 years ago unless you have another source of income. Why do you think there are so few American doctors today? They are fed up with the increased workload put on them by ignorant bean counters trying unsuccessfully to save money. Had they asked the ones who create the medical records, they would have discovered that SR cannot succeed with dictators who haven't the foggiest idea how to dictate. How it costs us production and money every minute we have to sit and wait for the next word to be uttered while they review the chart. How many doctors would welcome the chance to have their little tape recorders in their pocket to dictate whenever they have time, retaining the option to "go back to the family history and add..." or "scratch that" and having free risk management in addition to transcription or editing services? As an IC I had errors on a daily basis that could have resulted in a lawsuit. How many doctors would choose having to watch the text populate the screen, proof read and edit before signing or just leaving the mess in the permanent medical record? Who knows better than MTs and editors the dangers of using SR? You can look at the report, or even proof it, and not recognize the errors. If you read "pupils are equal and reactive to light and accommodation" you have no idea that the doctor never even said that! He simply said "per" but you will never know that without listening to the audio and how does that save money?? The worst dictation I edited stated that a woman had an affair outside marriage and listed her diagnosis as an STD. It also stated she was gay, all of which were untrue. It will take time for the errors that are initially unrecognized to surface. I still predict many lawsuits. Doctors who mumble through the boring portions get back a perfect report and are under the false believe that they must be great dictators if the software can recognize their humming through a review of systems or physical exam. Thus, they have no reason to change their dictation style and the errors will continue.

If you have not worked recently as an MT or editor for a service, you have no idea the crap we have to deal with on audio. If only the public could hear this their would be an uproar.

I know there are doctors who are excellent dictators who work well with SR. However, what we have been editing, after years of training SR, will never make it unless there is some SR training. It is a tool for the MT and will not save time for most providers. As it is today, on office visits, providers waste over 50% of the time on data entry. Really makes sense to pay $70 an hour for typing, doesn't it?

That is a complete misunderstanding. - sm

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This discussion was not about the SR that YOU use. You do not understand that what YOU experience and see is NOT what front-end delivers.

MTs do not provide "immediate turnaround." Hours is not immediate. Operative reports need to be signed a x on the record before the patient leaves the OR. That is a Joint Commission standard. When MTs take even an hour to return work, the surgeon has to type a short op note himself. Discharge summaries have to be on the record before a transfer. Again, the doc has to type it himself. Same with admission H&Ps. You can't provide them fast enough. Nobody can afford to rely on you.

In light of the fact that they have to type it anyway, they don't consider dictating to FESR much of a problem.

Apparently, many MTs have not understood how all this worked, hmm? They think they provide super services? Well, SURPRISE! they don't.

The BIG GIANT TIME LAG has always been a problem.

Second, the templates I am talking about are not the canned text you used 40 years ago or even yesterday. I am talking about templates that have the ability to import demographics, vital signs, labs, imaging, medication, orders, PEs and other information into the report, including graphing and charts of it.

You aren't getting it. Doctors no longer have to dictate every word. They only need to do short portions of it. Why use you and have to dictate for 5 minutes when they can do only what is necessary in 30 seconds?

Most MTs also don't seem to be aware that many of their colleagues produce junk. Yup, half of what we get back is missing entire sections of dictation, contains text errors everywhere else, and that doesn't include the spelling and punctuation errors.

And, yes, a whole bunch of you here work for that very MTSO. YOU are the option they have.

Undoubtedly, the SR YOU have is rot. We can see it when you ... oops! ... forget to edit a report. (And charge full price for anyway.) But, that is not the same thing we provide our doctors. What they have is individually trained for them. It works much better.

Dictation services are expensive, poorly performing nuisances. Even our doctors think so.

no, not spelling and grammar - big mistakes

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Medicines spelled wrong. Apgar scores that make no sense. Underpants where it was supposed to be pets. In some cases all we can do is flag it and say it's an error but we don't know what it is supposed to be.

Sometimes you miss them entirely - sm

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If MTs are supposed to be correcting all those "critical errors," why didn't the MT change -- or at least flag -- an incorrect bone in a dictation? That seems pretty critical to me, but the MT just blundered right through it. I listened to it after a coder pointed it out. Given what the surgeon was doing, he could not have cut the bone he dictated. Anyone with a knowledge of basic anatomy who was paying attention to what was being described should have caught it. It should have been corrected or flagged.

There was also a period cutting off a sentence before the last word, with the last word typed as the beginning of the next. That changed the meaning of the first sentence and then the second didn't make sense.

Not to be picky, but there was also an incorrect verb where an article should have been.

You may think you provide a superb service, and maybe YOU do, but most do not. They never did.

"some woman" - some woman I be

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"not just some woman who types at home in her spare time." You have as little respect for MTs as the MTSOs do.

Informacist has some deep seated - resentment for MTs

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that I simply don't understand. I also don't understand why this person continually comes here to degrade us and espouse the virtues of EHR.

One must wonder why Informacist spends so much of their spare time on a website made specifically for something they hold such clear distain for.

What is lacking in their life? Must be a very lonely person.

Too expensive - Think about it

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You couldn't afford to purchase the software and licenses required to access the facility's EMR. How many providers are you talking about? You would need to hire staff to help you with the workload. In essence, you would become the MTSO. I'm assuming you would want more money and decent benefits. You would have to convince the providers why you are worth it. They are outsourcing to save money, I would suggest that you try and find an onsite MT job that pays hourly. You are never going to offer the same service as your current MTSO at a reduced cost unless you plan to work for free; how do you plan to undercut Nuance? I don't think you thought this through very carefully.

Become a scribe... - MT

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That is how you begin working directly for providers. The physicians that work in/for hospitals do not hire transcriptionists for their hospital dictation; that is decided by the facility. Believe it or not, physicians don't have a whole lot of say in what goes on. Sure, you can work for an MD at his private practice, and you'll follow him around to see *every single* patient and work your tail off, make copies of the note immediately for the patient because they feel it *should* be completed at the end of their 10-minute visit (even if you have questions for the doctor), etc. You can do all of this for a starting wage of $8-12 per hour. If you prove yourself in the first year, you might get bumped up to $14. That is the new trend. Sorry, I know it sucks, but healthcare is changing at a rapid pace.

Scribes in my rural area are also MAs - Had Enough

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I know in hospitals and large facilities the MDs have little say in how transcription is done. My clientele was MDs in private practice or small clinics, where they made their own decisions.

I was told that EPIC had the option of sending dictation for transcription, but that is probably an elaborate expensive system that individuals could not afford.

You could contact Epic and - Ask them

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I suggest you just ask them how it would work. Asking us here requires me to ask Epic for you or to do online research for you.

If you can't do your own business research, how are you going to be able to run your own business?

You could ask a consultant, too, but you would have to pay them. Why should I do your work for free?

Re: Delusion of grandiosity... - Had Enough

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Oh please, get over yourself.

THANK YOU!!!! - Anti-Informacist

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I have been telling this person the same thing for years! I don't understand why they keep coming here when they really have nothing at all to offer this board besides condescension and animosity. They evidently have no other hobbies to occupy their time or friends to talk with. With the attitude they display here, is it any wonder?

Regarding MAs, some are... - MT

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and some aren't. As transcriptionists, we are going to have to further our education in one way or another in order to keep up with the changes. That is part of the problem in general with MTs (I'm one myself); wanting to work from home,making decent money, and not wanting to put ourselves out there and furthering our education. I was in the same boat until I realized that I'd have to find another job sometime soon if I wanted to survive. I'm studying for my bachelor's degree in health administration and will graduate next year. I hope to be in a position one day that actually has a say in what happens at the facility I work for.

Regarding dictation, there are EHRs that allow input of text (transcribed) with insert codes typed into the report. It's a complicated process (HL7) that would require IT help, as these features are generally add-ons to basic EHR.

Good for you! (sm) - Had Enough

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I love hearing of those who are escaping this business and kudos to you for getting your BA in heath administration!

Thanks for the info on HL7.

That is what I did to get out, too. - Informacist

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Nm

But you're not really out at all - Anti-Informacist

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You come here every day and spend who knows how long commenting on things no one asked you about. Your observations don't serve any purpose other than to make yourself feel superior to the rest of us. You haven't moved forward at all in your life. You are mentally still here! If you're so above it all, why keep coming back to a place filled with people you look down upon? What is wrong in your life that you can't move away from this place?

You must be a really sad lonely person.

Scribes in my medium-sized city are - expected to be MAs

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or LPNs. They also only pay them $10 an hour. F that!

Sounds great - we should all contact local hospitals - Depressed

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and see if they would be willing to hire MTs to do their dictation at home. I do know of one hospital in my area that pays MTs to do their reports on their EMR system.

Did they try an MTSO before hiring ICs to work at home? (sm) - Had Enough

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I use Indeed for job searches and have noticed some hospitals and facilities hiring at home MT/editors. Do you know any of MTs using the EMRs? I know one reported due to the very short dictations it was not worth it as so much time was required to open and close a dictation. When hospitals closed their transcription departments they really should have retained all their contractors and kept a work coordinator on site. It would have saved them a lot of money!

I hope using home ICs becomes the trend. The ONLY benefit to using an MTSO is turnaround when they receive unexpected large volumes.

Employed directly by hospital - Bear

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My local hospital ditched their service (one of the big ones) because the doctor's complained that there were so many blanks and errors. I am now working from home as an employee doing medical transcription. We are provided laptops, get paid by the hour with also bonus pay for higher production. We have benefits! No nights. Weekend rotation. I wish all hospitals would go back to this!

That is exactly what the hospitals should have done... - Had Enough

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Hospitals should have closed their transcription departments and offered their MTs IC position, cutting nearly all of their transcription overhead and paying the ICs less than they currently have to pay MTSOs who have to support their budget personnel to micromanage us, something IC's don't waste time on. It's such a simple thing to do, only having 2 MTs in-house to distribute the jobs and schedule the ICs for any changes in volume. I guess at the bottom this train wreck is the belief that SR will be the same as having transcriptionists. They just didn't think a brain was needed. I think as the malpractice suits start to pile up, there is a chance that they might figure this out, but I won't hold my breath.

What hospitals should have done - Maybe

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There are pros and cons to your idea, I suppose. Not everyone wants to work as an IC and have to pay their own health insurance and taxes. It actually takes more than 2 in-house MTs to distribute jobs and schedule ICs. It also takes QA staff and a manager. Then there are ICs who want to work when they want to work, so there is the issue of staffing and having people on call for stats, weekends, nights and holidays. I was an employee of a facility who supported an on site MT staff and had a number of people working at home. We were employees and all the equipment was furnished for us, they even gave us a monthly stipend toward our internet bill. That's all gone because the whole thing was outsourced and we all got laid off. We now have a combination of SR and transcription that is outsourced. I haven't seen any malpractice suits pile up, but the work is heavily QA'd and that requires a full-time person. The IC thing is a good idea, but depending on your line rates, they ultimately would have gone with the cheaper entity. As far as bringing the work back to where it belongs, we can always hope, but I doubt if it will ever happen.

You would have to - xx

[ In Reply To ..]
find sufficient people to complete the work in the agreed-upon turnaround time, organize them, make sure the work is assigned in a manner that ensures that it gets done on time, check the work for accuracy in accordance with the requirements of the client, ensure that the transcription system is functioning and everyone doing the transcription is trained in how to use it, etc., etc.

And now you've become an MTSO.

I've subconstracted and not interested in that (sm) - Had Enough

[ In Reply To ..]
My account were private practice (1-2) MDs and small clinics of about 4 MDs. There were some long hours but I was able to do it all myself. I did subcontract but with the training and proofing, it was easier to just do it all myself. It was impossible to take time off though. It would be nice to have other solo ICs to network with to cover overflow and possibly time off. I wasn't an MTSO though - I paid .10 cents per line.

10 cents per line not .10 cents per line - Pet peeve

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!

Pet peeve - Me too

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Watch out for the spell check police, you don't want to get banned.

Posting to EMR from home - Me

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I am doing this currently for a doctor's office on a small scale. Their IT person set me up with a virtual desktop so that I can access their office's server and EMR from my home. They load their sound files onto a folder on their system, I access them and download to my home, type in Word, copy and paste the completed work into the EMR. Easy peasy.

That's great to hear! (sm) - Had Enough

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What EMR does your client use? It would be nice if many in solo practice could do this.

Thanks for sharing!

Posting to EMR from home - Me

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They use Vitera Intergy (used to be Sage, I think). All solo practices can do this but the people selling them the EHR software also want to sell them the voice recognition software piece, too, so they never tell them that their transcriptionists are also able to use the EMR remotely.

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