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

I don't know all the details as - Just wondering

Posted: Mar 04, 2010

I do not work for MQ, but why would a client want to outsource to a company who penalizes their transcriptionists for getting a second opinion on a questionable dictation BEFORE it reaches them? Isn't that what they pay the company for, finished quality reports, not having to fill in blanks themselves? What I see is a lot of people protecting their pay by sending blanks to the client that a fresh ear may be able to fill in or, worse yet, a lot of guessing going on. If I were a hospital or clinic looking for a company to outsouce my transcription to, I would not consider a company who penalizes for blanks sent to QA because I am paying for a finished product that has been QA'd and assured correct and that is what I should get, especially with the laws now going in affect concerning patient safety and accuracy of medical records.

Maybe I am way out of line here not knowing the specifics as I do not work for MQ, but from what I am reading on this forum I think it is very risky to affect transcriptionist's pay directly related to quality of reports in my opinion. Don't flame me, just curious as to the thought processes surrounding this new policy.

Please tell me you work in the administration of large - hospital system. Oh Please.

[ In Reply To ..]
That is exactly what I have been saying all along. Have you read some of the postings on here? Some MTs are already planning to just "guess."

Well, MT deserves to be dumped by a lot of clients when they catch on and find a ton of mistakes in their reports.

If you are a administrator, please feel free to email me. I will talk.

Me too! - Willing to talk. No message

[ In Reply To ..]
x

Ha, Ha - Just wondering

[ In Reply To ..]
No, not administration, just a grunt. I am an IC working for someone with a few small accounts and part time at a clinic. My cushy in-house hospital job was lost to a service (one of the big nationals) a few years ago. BUT, I was talking to the person I work for (could be considered administration as she owns her own company) about this and she could not believe that a company would actually penalize a person for trying to assure quality by getting a second opinion on dictation. The way she handles people who send too many "blanks" because they are too lazy (or just going for high line count) to look anything up is simply to fire them, not punish everyone for it...easy to pick these people out since she is the one who QAs our work.

In my opinion, you are more apt to get good quality and people to go that extra mile for you if you treat your employees with respect and pay a fair wage. Pay people according to their experience and knowledge and quality/productivity takes care of itself.

That is why everyone who is going for this is in for a rude - awakening.

[ In Reply To ..]
MQ will let everyone think it is okay to send blanks on to the hospital. It will go on for a matter of weeks. Then there will be another email and a bunch of mandatory meetings.

And they will tell everyone that the hospitals are complaining about the blanks, and we better straighten up and quit sending blanks. They will then start penalizing for blanks for EVERYONE who sends them to the hospital. QA will be long out of the equation by then.

I know what the MR departments go through when they get back reports that are full of empty lines. Not good. Not good at all.

That's why no one should get too happy. MQ got this whole plan down pat. They have to cut workforce big time. They don't want to just lay off everyone. They would rather do it in stages as they have been since the CBay takeover. Now that CBAy is just about up to snuff, they still need some transcriptionists to hang on until they get the EMR system they are working on in full swing.

They probably have the next 10 years planned to the minute. All the while they have to control the wages they are paying out which is a huge expense for them.

Also, when I started with MQ they had over 10,000 employees. They have 3,500 now. They have been cleaning house big time.

I am out. I am done. I am going back to work in the hospital. I have had enough of transcription, MQ and their tricks.

Clients are agreeing to take work with blanks directly - from MTs. They get lower costs, too.

[ In Reply To ..]
You all seem to forget (or probably just really have no idea since you haven't worked on that side---yes I have) that the clients are PUSHING and DEMANDING lower costs and FASTER TATs. They are willing to accept certain levels of work in exchange.

Don't shoot the messenger whether you like the message or not.

So, it is for company greed. - Who cares about the quality.

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Even though we are or which is it? Action speaks louder than words. Too contradicting for me.

Don't believe that garbage. The hospitals are NOT agreeing to blanks. - No way.

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There is no way they want to put a half done report in a chart and then have JCAHO come in and sock it to them, possibly losing their accreditation.

Don't believe for one second.

I worked for years in a hospital. Our MR director and doctors - FUMED over the blanks.

[ In Reply To ..]
I HAVE worked in hospitls. Don't tell me about what I heard in meetings I had to attend. The MDs would get furious over blanks sent from the services. They said it just will not do.

They want their work done correctly WITHOUT holes in it.

I worked in a HUGE teaching hospital system. DON'T ASSUME THAT OTHERS ON HERE HAVE NOT BEEN ON "THAT SIDE."

I am currently leaving MQ to go BACK to the hospital system I left -- to the MR department (non-transcription job). Don't know why I left in the first place.

They are also one of MQ'S BIGGEST clients. They are just about through with MQ. They are using EPIC now. They were furious when they saw all the holes in the reports coming from India, along with all the other garbage that was in the reports. They said they don't want swiss cheese back from their dictations. They told MQ NO MORE INDIA. But it doesn't matter, they are going all EMR anyway.

Believe me, MQ will be sorry. The clients DO NOT WANT BLANKS all through their reports.

Time will tell how many clients tell them to ram it. Then you will see QA rise from the ashes, but with a whole new kooky name -- a favorite pastime of MQ suits -- come up with a new name for the same old job.

Maybe so but it is the CFO and CEO who make the final - money decisions, not docs or HIM. nm

[ In Reply To ..]
nm

WRONG. The board and the CEO do what JCAHO says. - No accreditation means no money.

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JCAHO visits were a week of total stress for the ENTIRE hospital. They would go over the charts with a fine tooth comb not to mention the rest of the hospital. Those visits still stress me out thinking about them, but it is a necessary evil. BLANKS were not acceptable in the reports. They were considered incomplete reports.

If a hospital loses it accreditation, they make NO money. I don't think that would be acceptable to them.

Well, you are screwing up big time. - Us MTs need to be running this outfit.

[ In Reply To ..]
Oh boy, I see major lawsuits coming and MQ will turn out like Spheris, bankrupt.

Of course what do I know, just been an MT for 25 years and just about seen everything.

Is this in CA? - Famous movie star hospital?

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Oh no! Providence in the Northwest has been using EPIC for the last 5 years or more.

No, not in CA. Most hospitals near me have been - using EPIC for a while.

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Even the smaller community hospitals. Well, I guess everyone wanted to get that money from the government before the deadline anyway. Even my PCP and all my specialists have been using it.

What you are saying may be true, about the - Kiki

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hospitals "fuming" over blanks and don't want their reports to look like swiss cheese. But if this is so, then they need to

TELL THEIR DOCTORS TO DICTATE CLEARLY, MAKE SENSE, GET SOMEONE ELSE TO DICTATE FOR THEM IF THERE ACCENT IS SO THICK YOU CAN CUT IT WITH A KNIFE, AND PULL THAT SANDWICH OUT OF THEIR MOUTHS WHEN THEY DICTATE.

THEN,and only then, will they get their hole-free reports. If MQ loses clients because the hospital supervisors are such woosies they refuse to say that to their doctors, then so be it....

Yes, but when we were in house and making a decent - hourly rate, we could actually

[ In Reply To ..]
pull the chart or talk directly to the MD. MDs will never ever change, we all know that. Maybe having access to the prior reports will help us in this regard, I hope so.

But it was a whole different game plan then. You could spend time on a report to research the blanks like I said.

But knowing that the MDs are not going to change -- why MQ would not implement more of a QA/mentor/liason type of position where we could get the difficult reports from the MT and communicate with the hospital and get those reports done completely. No fault to the MTs that the dictators are crap, but MQs attitude of oh, so what, send a blank, is wrong.

I proposed just a position like that years ago, many of us would love to do that, be more of a mentor and talk directly to the MT and the client. But they told me it could not be done. I used to let the MTs call me, I got caught, one mentioned it to the QTC not thinking, and I got in trouble deep.

So, let the chips fall where they may, I guess. MQ is thinking of money and not the end result here.

Meant QTL. oops. - no message.

[ In Reply To ..]
nm

AMEN!! YOU ARE MY HERO OR - YOU ARE MY ANGEL!

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I have tears! THANK YOU FOR YOUR POST.

QA, Blanks, Turnaround Times, Penalties and - Dictation Quality

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Let me say, first, that you are perfectly correct in asserting that an accurate, complete report should be the primary goal of everyone involved in healthcare documentation.

And let me add that I believe this IS the primary goal of ALMOST everyone involved, from the HIM director at the hospital to the MTSO to the MT.

ALMOST everyone, unfortunately, isn't good enough and so it's very important to identify the "mavericks" and then to take corrective action. It's also very important to do some root cause analysis and identify any ways in which structural aspects of the documentation chain are conspiring to degrade our ability to meet our primary goal.

The documentation chain begins with the dictating physician, and I need to do no formal analysis to prove to anyone that this is also where our problems begin, because the simple fact is that we cannot say that ALL physicians share the goal of a complete, accurate documentation - at least when it comes to their own CRITICAL ROLE in that outcome. Where we would need to do formal analysis is if we wanted to say just how LARGE the proportion of physicians is who just "frankly, Scarlet, don't give a damn"...and who, as a consequence, present the system with a primary input the equivalent of a sow's ear, asking all the rest of us to turn it into a silk purse.

Even without a formal study, I can say from experience that most physicians don't care much for the documentation aspects of their jobs, and that this might even account for that age-old mystery - the "doctor's handwriting" phenomenon.

And, of course, we quite understand that doctors are busy. In fact, some are probably TOO busy for EVERY aspect of their work to be done as carefully and deliberately as it should be, so they "prioritize" their activities. And prioritizing one thing (like patient care, reviewing lab results, etc) means that something else (like chart notes, dictation) must be de-prioritized.

Indifference, impatience, time pressures, fatigue, etc. all add up to significant defects being introduced into the very first, and the most critical, process of the chain - dictation.

Are there other problems at this link in the chain? Yes, there are. Toss in the significant number of physicians who speak such poor English that they can barely order a Big Mac, let alone cope with the sophisticated language of medicine.

Then, there are technological elements starting with background noise and on through the complex systems and subsystems involved in order to finally deliver the dictation to the transcriptionist's ear. Here, we are talking about everything from poor design choices (e.g., inadequate sampling, inferior codex, etc.) to degradation in elements (e.g. phone lines, etc.) over time.

And, if we could by some magic eliminate ALL of the factors mentioned above we would still be left with ordinary human error. Yes, doctors make mistakes.

And so we have the equivalent of a custom widget factory where every widget must be created from scratch, and the engineers are turning in their design specifications as anything from a blueprint complete with parts specifications to a scrawled mess on a soggy cofee-stained napkin. But every widget must be perfect!

Moving on to the next link, the client HIM department - can we find elements here that conspire against producing the "perfect, complete document"? How much time do you have? We have HIM directors who seem to believe that when their signature on the transcription contract has dried, their obligations have been fulfilled. We have HIM directors who allow physician delinquencies to accumulate until, perhaps with an audit of some sort looming, they send out a spasm of delinquency notices and predictably jam the system with a spike in the work level that can be as much as double the average daily load. We have HIM directors who believe that contracts are managed by shaking them under the nose of the vendor and making threats. We have HIM directors who "forget" to provide the vendor with up-to-date physician lists. We have HIM directors who drag their feet when asked to provide specifications and samples. And, most of all, we have HIM directors who absolutely REFUSE to take corrective actions with respect to the physician problems noted above. Tell a doctor that his dictation isn't acceptable? Heavens to Murgatroyd!!

Now, let's take another structural issue, which is turnaround time and contractual penalties associated with TAT.

I've been in this industry since the days when the TAT for most hospital documents was 24 hours, and 48 hours for most clinic work. In those days, we had ALL of the issues noted above to deal with, from crappy dictation to bad phone lines and other technology issues to HIM directors with impoverished notions of contract management, variability in workload, etc.

But we also had the TIME necessary to deal with a lot of these issues effectively and even, if I might say so, much more gracefully than we are able to do now in the Age of Magical Thinking.

The Age of Magical Thinking is one in which we imagine that technology has no limits in its ability to shorten production times.

The Age of Magical Thinking is one in which we imagine that the theoretical possibilities of a system should be achievable.

The Age of Magical Thinking is one in which we have been taught to believe that "what the mind of man can imagine, the mind of man can achieve". If we can imagine an operative report hitting the patient's chart (complete and accurate, remember!) within 20 minutes of the last suture being placed, we can DEMAND it!

The Age of Magical Thinking is one in which we rush to replace people, whom we undervalue, with systems, which we overvalue.

The Age of Magical Thinking is one in which we believe that something can always be done cheaper AND quicker AND better, all at the same time.

All of this is complete rubbish, of course, and it all contributes to what has truly become a broken system.

Now we come to the MTSO link in the chain. Again, how much time do you have? Or, more accurately, how much time do I have? Unfortunately, I have duties awaiting and can only say this. In part due to unrealistic client expectations (both with respect to performance and price) and some rather treacherous and short-sighted client behaviors in the marketplace, and in part due to some very bad managment practices on the part of MTSO's themselves, most of which can be attributed either to ignorance or greed, the consequence of failures in this link has served to kick not only the problems, but even much of the cost of those problems, downhill to the MT. SHE is the one who bears the brunt of this chain of failures. SHE is the one who is expected to take this mess, and out of it to produce the silk purse.

Not just sometimes, and not just most of the time. 98% of the time, or 99% of the time or (OH JOY!) 100% of the time...and she'd better be quick about it, too, because we don't pay her enough to be able to afford to be very deliberative about her work. We don't pay her enough to research a new clinical study that no one outside of the study itself has yet heard of. We don't want her fingers off that keyboard for one blessed minute - and neither does she, if she hopes to pay her rent.

But it's okay if her fingers are still when there's no work. At such times, she's expected to remain "at-the-ready", UNCOMPENSATED, whether there's no work for an hour, a day or a week.

And what, our bitter experience shows us, she can expect by way of any improvement in her situation (for instance, her compensation), is that three years from now, five years from now, she will be paid the same line rate she is paid today - if not less. If she earns any more money, it will be due entirely to improvements in her own efficiencies with no increase whatsoever to reflect the shrinking value of every cent she earns.

By some miracle, this system has not yet collapsed, but there are serious signs that it could, and there is every reason to believe that a lot of very bad bets are being made that technology - specifically speech recognition - and offshore outsourcing will prove to be the duct tape that saves the day.

It's a mug's bet...but we have a lot of duct tape salesmen who are doing a masterful job of finding every mug out there and convincing them that just a little more tape will fix things. "No need to get to the root causes of failure in this system! What you need is more technology! No - what you need is OUR technology!"

Magical thinking. Predictable outcomes.

AMAZING POST!! ABSOLUTELY 100% RIGHT ON!! - mt

[ In Reply To ..]
You have summed up the entire business perfectly.

Are you the one had the long post about - auditing? Just wondering.

[ In Reply To ..]
You should get into technical writing. You can work at home doing that, too.

Just saying.

I will say as a patient I don't give a rats rear about anybody's time constrictions. I want my report and my children's reports to be done correctly without holes in the them, without incorrect information. I don't think that is too much to ask.

MQ systematically eliminating a step in the process of preparing a complete report is precarious to say the least.

All MTs should have access to QA without being punished for it. All QA should be kept on the same page and have access to both the MT and the clients if need be. All in the name of patient safety. And we all are patients at one point in time or another.

That's all I can say.

very well stated - mushroom

[ In Reply To ..]
If no one has patted you on the back for this post, here goes -- wish it could be printed somewhere else where it would make a difference and get the attention of someone who would step up and try to do something with this train wreck that unfortunately affects others -- the patients.

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