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

It's all starting to make sense now - OKMT

Posted: Jan 10, 2015

I'm cross posting part of something I wrote today on my FB page.

Something's up with The Big N. This is my personal opinion only, based on things I've been reading over the past couple of months. The link is to an article that seems to bear my thoughts out.

I think Nuance is going to break up into smaller pieces. There's been talk about this over the last year or so, but as usual there is (almost) never a mention about NTS, only the VR side of things and other healthcare entities, and the mobile stuff. We know Paul Ricci isn't all he was cracked up to be. Big N has a lot of debt, but is okay for now. Big N is just that, too big, too much diversification to even be a little bit cohesive. No wonder Ricci isn't making much money for stockholders.

Reading your recent posts about TSMs being let go, coupled with the ridiculous new and exciting pay plan, some of the puzzle pieces may be falling into place. It's possible they are streamlining in order to build up cash and be more attractive to whoever might want to buy this piece of the Big N pie.

Let me know if the link doesn't work. Be sure to read past all the graphs.

http://seekingalpha.com/article/2803715-potential-acquisition-and-break-up-value-represent-huge-upside-for-nuance-communications

I agree, happened like this with Webmedx - anonMT

[ In Reply To ..]
Anyone that worked at Webmedx right before being bought out by N, remember we had a pay cut, then they consolidated and eliminated positions (my favorite STM was let go, they had eliminated another position, I think the person who worked directly with the hospitals as I recall, and everyone had to reapply for the STM position). My brother, who has been in mergers/acquisitions, warned me that this might be what was happening. I am no longer with Nuance, but it sounds eerily familiar.

yes, sure does sound like WMX all over again. sm - here we go again

[ In Reply To ..]
My favorite STM was also let go at that time. Maybe some of our wonderful tech folks, as well. Even at least one manager that I recall disappeared.

Only worse now because at least they still treated us decently nm - acuteMLS

[ In Reply To ..]
x

The only thing they are gearing up for is moving - the majority of work to India

[ In Reply To ..]
and increasing their profits this year. They don't hide that fact though, it is out there.

I agree, especially with the new ISR rules - sm

[ In Reply To ..]
They are asking us to report the same ISR problems that we've had for years now. Why didn't they fix them in the first place? Are they just trying to get a nice little list together to provide to the Indians?

India - RTR

[ In Reply To ..]
Yes, it definitely seems like Nuance's main goal is to provide employment for the people of India. I know for a fact some of the doctors have complained about the quality of work once it is sent over, so Nuance brings it back. Then, they try to sneak it back over again, but the providers aren't dumb. Nuance is so sneaky. When the providers say they want the work done here, they don't mean for a few weeks and then give India another try. This company is so underhanded I really believe the transcription part will eventually fall apart. They're completely motivated by greed and that's never good.

nuance breaking up NOT - rock bottom

[ In Reply To ..]
I have read a lot of articles about N over the past year, here's the gist.

1) Bought too much, over leveraged.

2) Dominating the transcription industry, but fell from good standing to poor standing.

3) Stock value is plummeting in a year when the stock market rising tide should be raising all boats.

4) Cash value is not what it looks like on paper. It's not money in the bank, its liquidity, assets that you can sell quickly for actual cash. Lot of number tweaking that really does not mean a thing until you liquidate the assets and get the actual cash. The 'asset values' and 'cash value' are always on the high side. See what somebody will really pay you for it, very likely a lot lower.

That might be reason to split, but who would take the transcription business? Frankly it is too big for anybody to buy unless they split all their purchases apart again, not likely to do that.

Could sell off accounts, but wouldn't get enough money for it.

Paul Ricci is not making money on the other reasons for Dragon etc. that is the main concern for the stockholders and board. Why the board gave him a $5 million raise when they were unhappy with his performance is beyond my understanding.

Unfortunately, ambulatory, clinic work will dry up very very quickly, so we're pretty much left with acute care hospital.

All the physicians and clinics I've been to in the last year have done their own reports and handed me a copy as I checked out. I'm sure a medical transcription company did not do it, too many typos.

But little ambulatory left. All acute care, long term.

Therein I believe lies one of the problems with what is going on. Losing work. Not going to India or anywhere else, the providers are not dictating, just clicking and printing.

Seriously, about 15 minutes after my procedure, once I was out from under the anesthetic, I saw the doc at the computer working on the report. He got up, walked over to the printer, picked it up, then walked over to me and handed to me, complete with pictures of my insides!!

My ophthalmologist sat there at his laptop, clicked, typed, talked to me, then when I checked out the receptionist handed me the finished report. Lots of typos, but good enough, no major typos, or as we say CPSEs.

Same thing at every place I've been clinic wise over the last year. No transcriptionist involved at all.

As the older guys give up, will not learn the software and retire, we will have only acute care left.

I agree with your assessment. I think, in fact, they are streamling operations - to hold on to what assets they DO have.

[ In Reply To ..]
My reasoning flows along the same lines. I predict there really IS no future need for ambulatory MTs at all...and Nuance just might actually make enough on their EHR software sales to better support continued acute operations a little while longer.

I'll bet some of those recently acquired ambulatory MTs will soon be contacted by a supervisor telling you that you are needed over on this X account. The ploy goes something like this...

To keep a job at all, the MT agrees to give it a try. The MT is told there are only third shift positions, so very few will actually make the move. (Score another one gone for the Nuance team; remember, one of their goals is to avoid laying off anyone, they would rather just offer plenty of reasons for the MT to leave on their own...)

Those who do fall for it will continue to endure the Fiesa torture and hardly any work, continually jumping from account to account, etc, until you too, can bail. (Score another one gone for the Nuance team).

This has been the pattern for at least the last 4-1/2 years.

The new Point of Contact sheet for my team only has 3 supervisors on it-- and it is called the Franiczek POC list.

I googled Franiczek, Nuance, and it brought up the name of a Director of Operations, Christoph Franiczek, with plenty of prior experience in outsourcing and offshoring. (No big surprise). Always before, the COMs had several of the supervisors under them... the AB team had their own contact sheets, the JL team had their own, etc., and these had their own Team Leads, supervisors, etc. I think this new POC sheet demonstrates the eliminated layers.

Furthermore, with a few TLs no longer siphoning off every decent MD in the accounts, these backlogged out-of-turnaround time reports actually justify them offering many of you an "exciting opportunity to advance your career goals" by taking on the acute care accounts...and so the consolidation and downsizing continues unabated, as it has been going for a long, long time.

When you make the move to acute care, you will then be placed on accounts that are "better" than others for training purposes. This, too, continues the pattern... bailing out, moving around, etc. I put the quotes around "better" because it is really only better for Nuance.

So, bottom line, this pattern is not new, only some of the particular players are. It is a model that works sorta well for Nuance overall. The streamlined operations will definitely improve profits on the accounts they do retain, and they will still be doing this until that very last clinic is under wraps.

Sorry this was so long, I guess I just needed to type this out to see it all for myself.

Disagree - sm

[ In Reply To ..]
There is a lot more to Nuance than MT. I think you all keep missing that, and you keep missing why Nuance even has MT.

Their MT operations are not there because MT is a super-lucrative, fabulous business. They bought up all those companies and are pulling in outsourced facilities in order to have clients ready for their SR products. Front-end SR associated with EHRs, not the back-end you do.

They don't have to sell off the MT to get rid of it. It will disappear on its own soon enough. Once facilities have front-end, they stop sending dictation out.

The N "vision" is to do away with MT completely and - only use SR.

[ In Reply To ..]
Someone actually said that.

That might be their wish, but I think time is running out for it - Will

[ In Reply To ..]
I am sure that this was their original intention when they bought up all those transcription companies but, if Nuance keeps losing money quarter after quarter, the shareholders will demand changes. When one considers the Nuance's inability to make money for its shareholders, combined with the fact that VR just isn't sophisticated to do the job without human help to clean up the mess, I think that Nuance really is out of time to make this work and will have to sell off some of its assets in order to avoid a shareholder revolt.

M-mode would buy - nm

[ In Reply To ..]
xx

Right after a bankruptcy? - Unlikely

[ In Reply To ..]
MModal is going through their own junk right now. I doubt they're looking to buy another company.

M-Mode not buy - rock bottom

[ In Reply To ..]
This is not a type of business that does well at all as a large multi-account, multi-layered, multi-platformed model. It falls apart under that situation because

1) TSMs competing against each other for fewer and fewer accounts. Blood starts flying and we the MLS get the brunt of it.

2) Imagine the nightmare of platforms and speech engines. They'd have to have a software IT department about the size of IBM to keep up with so many platforms and 2 different speech engines.

Gotta do it though, or lose the accounts completely. How many does Nuance have right now, 4 or 5 different platforms? Two or three at least separate IT sections for the different platforms, FIESA, etc.

3) Could work if they kept them completely separate though, like mergers without the merge. Many companies do that but in such a low profit margin industry, not realistic to have 2 distinct companies ending up being 3-4 IT departments, 2 separate layers of management, etc.

Betcha Paul Ricci didn't realize what he bit off when he bought all those companies with all those platforms. Good part of the money is going into keeping so many platforms alive and running, and therein lies the speech wreck issue.

Check Spark IM, look at the ratio of MLS versus support. Look at how many different support systems.

Yep, they all use Dragon of some version, but the text software is unique, editscript, bayscribe, enterprise, Edmat, etc.

Doubt M-Modal would want that headache/nightmare.

I think you're right. All the signs of a breakup are there - Will

[ In Reply To ..]
All the signs are there. It remains to be seen what shape the breakup will take but I think it's coming.

I think you're right. All the signs of a breakup are there - OKMT

[ In Reply To ..]

Yes, the signs are there, Will. In fact, the red flag for me was discovering Carl Icahn and his group now own just a percentage point or so shy of controlling interest. Any time Icahn is involved, it's bad news for a company's employees. It could go a few different ways. Icahn could end up with controlling interest, put his own people on the board, and proceed to divide up the company. I'm not sure that's still possible - I thought I had read somewhere Nuance had filed "anti-takeover papers" to prevent this happening, even if it would be better for the shareholders. Worst case scenario is he loses his patience and dumps his stock, or most of it, and I suppose that would tank the entire company unless someone else bought controlling interest. Or, Nuance Communications could cannibalize itself and start selling off divisions on its own. As far as the MT portion is concerned, I can see the Indian investors snapping that up. They'd just pay the subscription fee to use Dragon and eScription like everybody else. I won't pretend to know what would happen to the US accounts that refuse to send work overseas. I suppose they would just dissolve their contracts and and find another MTSO.

The most important thing to remember is this is about all of Nuance Communications, not just the MT division. I don't work for Nuance anymore, but what happens with their MT division has the ability to affect the entire industry of the MTSO. Some of you may have worked for MedQuist when they merged with Spheris, or even for another company - surely this had an impact of some kind on nearly everyone. I was settled into a cushy hospital job when that took place, so other than knowing they merged, I paid no attention. I left EDiX in 1998 for that hospital job and what I now call the "real world" of MT was out of sight and out of mind.

I'm not saying this is going to happen tomorrow, next week or next month. I am saying it is a possibility. Even if it doesn't, eventually there will a shakeup the industry. It could be something as simple as demand for MTs and editors grows higher, but most of the experienced folks moved on to better jobs or retired and younger people aren't becoming MTs. Competition to hire the best of us would grow, driving up wages. The scarcer something is, the more valuable it becomes...just sayin'.

Duh-read the Wall Street stuff- Nuance (NUAN) is readying for an acquisition - Whassup

[ In Reply To ..]
It's pretty plain and simple. There transcription division has the highest profit margin, but Wall Street doesn't like the outlook for medical transcription so their greatest asset is bogging down their sale so they have to get it to have even higher profits so they drastically cut pay. They will only sell the 4 divisions if they can get the same price as selling individually, so you think we have bad change now, wait until we're sold to someone who thinks there is no future in transcription.

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