Hospital Transcription Departments

3/96, from Debbie Hahn, debbicmt@visuallink.com
I agree that it doesn't seem very cost-effective for hospitals to outsource the medical transcription, but I must disagree with your statement independents working for a service are making less and less as the years go by. I have worked for a service for five years, and I am making more now, not less. And I don't understand the thinking that the corporate structure of the service would be the sole cause of the independents making less and less. There is enough competition out there among services that if an MT was working for one who did decide to cut their pay in order to make more profits, that MT could move on to another service. I believe that is happening now with one or two services.

I'm not a business person, but don't all companies which provide services of any kind charge their client 100% more than what they pay their workers? I know the temporary help agencies such as Manpower and others do this. The worker might get $6 per hour but they charge the client $13 per hour in order to cover their operating expenses. That is their income; they need enough money to pay the workers and their overhead costs and have some profit for themselves and for the future of the company, Hospitals aren't very different. I'm sure you could scrutinize their profit margins and feel that the share they allot to MT salaries isn't fair compared to some other departments.

For 20 years I worked in hospitals, doctors' offices, for myself, and in various other settings as an MT. In those first 20 years, my salary went from $3.25 an hour to my maximum of $10 per hour at the last job for a group of cardiologists (and it took me 10 years with them to get to $10 per hour). Then five years ago I started with the service at 7 cents a line. Within the first 3 months I was making over $15 per hour easily. After five years, between a raise or two, adding a new abbreviation program to my computer, and getting used to the doctors and accounts, I can now make over $30 per hour. And I get to do this without leaving my home and kids, and with all the other benefits of working at home, which I certainly didn't have for the first 20 years. The freedom from going out in the rat race is worth countless dollars per hour to me.

My point of view is this: If the service I work for hypothetically charges their clients 20 cents per line and pays me 8 cents per line, that's fine with me. Obviously that 20 cents per line must be the going rate for services or the client wouldn't pay it. As long as they are paying me the comparable rate to what other services are paying their MTs, I don't feel like I'm being taken advantage of. I could start my own service and charge my clients 14 cents a line, and do the transcribing myself for that 14 cents a line, but the extra 6 cents a line isn't worth the aggravation to me. I've seen what other small local service owners have to deal with. I may only be getting paid 8 cents a line, but the service I work for is providing a service to me, also. They are the ones getting the accounts so I have a steady flow of work anytime I want, providing the support staff to take care of my technical problems, and taking care of having someone else do the work when I want to take time off. All I have to do is transcribe and earn my money - nothing else. It's worth a lot to someone living in the boonies who has to choose between driving an hour or more to a hospital MT job or working locally in a department store or McD's, to be able to work at home for a national service with no commute at all and make good pay, and be an MT instead of a clerk or cashier.

In the past 25 years, I have worked in practically every setting available to MTs, and I can say without reservation that working for this service for the past five years has been the most rewarding, most financially lucrative, most satisfying, most family-friendly and most stress-free job that I have had as an MT in all those 25 years.

Jerry: I work in a hospital where my entire job is to make our transcription department the most productive and cost efficient that it can be. I see this as the trend for the future and eliminating the middle man.

Jerry: I have always wondered why anyone serious about this business could possibly conceive that an outside company with its seperate overhead and need for profitability would be more cost effective that "inhouse" transcription.

Jerry: What we had was a lack of management ability, not transcription capability. Our department maintains a cost of 13.7 cents a line (65-character-equivalent line) including charting, management, technical support, record status, copy generation and quality management. Our MTs make between $35,000 and $40,000 on average. It is possible but it takes work to make it happen.

2/96: From Jerry DeRoche, jader@ix.netcom.com
Productivity enhancement philosophy
I am working for a medium-size hospital in Fort Worth as technical support to the Transcription Deptartment. I was reading some of the articles on Angelfire and in the newsgroup and noticed everyone griping about production standards of 100 minutes a shift.

Three years ago, I began a methodical review and revision about the way we work in our department. At that time we had six full time transcriptionist and three full time clerks in the day and one at night. About 40-60% of the work was subcontracted to outside transcription agencies.

Today we have 15 fulltime and part-time transcriptionist and all except two work from home, no work is sent out, and we now do our own emergency department (which was previously subbed) and have added several other departments and some of the MSO doctor's offices which our hospital corporation is now supporting. We have people producing at the rate of 140-180 minutes a shift and have not sacrified any quality whatsoever, if fact it is much improved. Reports that have "blanks" are not printed until reviewed by the department supervisor and the blank filled in. Also we have not beaten up on our people. Our top producers earn in excess of $40,000 per year working 40 hour weeks. And yet, it is very beneficial to the hospital as our total cost per line is 13.6 cents. This includes all transcription, copies, charting, posting to record statusing system, supervision and myself as technical support. The hosptial is realizing a tremendous savings over what is provided by outside vendors and maintains the highest quality standards.

The secret to this is not to make transcriptionists type faster, but instead maximize the time spent transcribing. I have worked diligently to remove every time-consuming task that could be possibly removed from the transcriptionist. They do absolutely no formating of reports but simply fill out a template (which has drop down list for report types, dates, and the like) and type the report as straight text without headers, footers, signature lines or the like. The only formating they do is insert paragraphs as they type. When they complete a report it is processed into the final product with associated copies automatically produced by another PC on the same network. Remotes send their work via a communication program script file to this directory on the network using 14.4 modems taking approximately one minute to send two hours of work. All log in of reports and production reports are automatically compiled by computer without transcriptionist intervention. Patient name and number lookups are also on each and every PC, including remotes. So in short the philosophy is not to transcribe faster but to transcribe more or better yet, more efficiently. I am dedicated to the belief that hospital transcription should remain "in-house" and it is our mission in life to produce accurate, timely reports in a cost-efficient environment.

I agree that there is much to be concerned about in our field with managed care placing so much emphasis on cost, yet I maintain it is possible to boost productivity without sacrificing quality. I also believe more hospitals will embrace the ideals I have outlined here in the future as they realize that paying a "middle man" is not cost-effective. I do all of this from the standpoint of making the transcriptionist's life the best in can be in a difficult time.

Connie,
Unfortunately, I am not sure there are any easy answers to your questions. I have been a transcriptionist for a long time; and, in my opinion, accuracy must come first. Without it, speed doesn't mean much, particularly if you or someone else has to spend the time to correct the mistakes. This takes considerably longer overall than doing it correctly the first time, even if the transcription speed is a little slower.

Even today, I have good days and not-so-good days. When I discover that I am making an inordinate amount of typos, I force myself to slow down considerably. Sometimes I find that after typing for a little while at a forced slow speed and concentrating on accuracy, my speed will begin to build back up again without the errors. It seems to take the establishment of a certain "timing" or rhythm to attain the best combination of speed and accuracy. Macro programs can help increase speed; however, working with them can be the ultimate disaster if the user is prone to typos. A typo on the short form can produce something entirely different than what was intended.

Falling asleep while transcribing was not something that bothered me in early years. I think my concerns about doing it right provided enough stimulus to keep me awake. There are some things that do help, however. Do not eat a large meal just before or during your shift, and stay away from snacks which are high in sugar or fat. These can bring on a bad case of the 2-o'clock droop. Make sure you have adequate fresh air circulation in your workspace. Inadequate air circulation systems, closed windows, and those modular work-station "walls" which separate transcriptionists can all serve to make you sleepy. If you find yourself getting sleepy, it sometimes helps to get up and get some kind of exercise that will increase your heartbeat more than just walking (perhaps deep knee bends, jogging in place, or doing a flight of stairs). Working with the room temperature a little on the cool side sometimes helps.

While so much emphasis on speed and production is certainly understandable, it is unfortunate and provides a difficult atmosphere in which to "blossom" as a really good transcriptionist. I think in some instances, where a happy combination of accuracy and speed cannot be attained, some transcriptionists are better suited to a work environment outside the hospital setting. Accuracy must always prevail, especially if your ultimate goal is to develop a business of your own. The independent marketplace has little tolerance for errors; however, they generally don't care how long it takes you to do a report as long as you meet the turnaround.

Also, this company is quite concerned that, as transcriptionists, we are not money makers. We wonder what ever happened to physician/patient satisfaction and liability issues, from the standpoint of accurate medical records? Aside from the fact that they're installing Meditech early next year, the other thing we are concerned about is that we've all been told that quite likely all transcriptionists will be fired and an outside service hired to do the work. At that point, if we are lucky enough, I suppose we might work for the outside service by the line. Don't get me wrong, I've done transcription independently and can earn a good income by the line any time again, but I find it disturbing when employees who've been there for years are suddenly completely dispensable. I'm not one of those who's been there for years and don't have as much at stake as one of the older woman with cancer who has full benefits and most likely will not be able to get a job with another company due to her health problems.

The HIM then goes on to say that she envisions some transcription remaining in-house vis-a-vis outside services have told her that they would prefer not to do radiology, cardiac caths, Holter monitors, EEGs, ECGs, etc. and so we can compete for the few remaining jobs. In addition, the HIM division has always allowed several employees to take work home at night. They presently use a local service for some overage, but letting employees take home work at night is even less expensive, as they pay 8c per line.

However, the HIM made it quite clear at a meeting about a week ago that she flat out resents the fact that we transcriptionists end up making more money than she does and that all take-home work will cease pretty much forthwith. She then somehow came up with the statistic that the 8c per line we get paid for take-home work actually costs the hospital $1.79 per line. In addition, over the relatively few years that this HIM has been there, the line count has lengthened. No credit for carriage returns, etc., nor do we get credit for any line which is not a wrap-around. If a line just says: "Diagnosis: Otitis media," no credit as a line. It's as if we didn't transcribe it.

We've always worked by the line and there is an incentive system over x amount of lines which has actually encouraged production. Now we hear that the HIM is strongly considering going to a minimum of 100 minutes per day, which somehow she thinks she's statistically discovered is the norm in hospitals. More importantly, the incentive we presently have will be raised to such high levels that we will rarely reach it. The HIM has made it quite clear that she wants to reduce income that way. Some of the people I work with have counted on the take home work for such things as mortgage payments.

Our group started out with 14 full-time and 2 part-time transcriptionists. For the last two years I was there, every time someone quit (not an uncommon event given the slave labor mindset around there), no one was hired to fill the position and the position was not even posted as being open. So, less transcriptionists but same amount of work. Now it looked like we couldn't keep up, so they began hiring outside services to keep up with the overflow.

Next came worries about layoffs because of budget cuts, even though they added four more administrative positions and our department manager was making in the six-figure salary range. We were all made to feel like we were lucky to still have our jobs and were told to work harder to ensure we still had them, but with less people around to pick up the burden. Our HIM intimated that we were all eventually going to be fired and an outside service was going to replace us, as well as our coding department. We had level 1 and level 2 transcriptionists: Level 1's had to do 85 minutes/shift and level 2's had to do 100 minutes/shift.

We were also told that the outside service they were hiring did not want to do radiology, cardiac caths, etc. So the poor few who remained there were left to do that while people who had quit and joined on with the outside service were getting the easy-to-do, long reports while we worked our tushes off doing multiple 0.2 to 0.5 minute-long dictations and worked frantically to make our minimum for the day. Our HIM also came up with the magic number of 100 minutes per shift as the norm for hospitals, although there is no documentation out there to that effect. AAMT will not even give you a norm on that if you ask because they even say that the circumstances vary.

I feel for you, Cathy. By the time I left, there were nine of us. Now, nine months later, I am working in a private clinic of eight orthopedic physicians and am quite happy. However, I keep in touch with the few who are still working at my old place of employment. There are now three people left on day shift, three on evenings, no part-time positions, and the night shift has been eliminated. It sounds like they are just waiting for the rest of the crew to quit one by one. Another person is ready to quit at the end of October because she will be vested and can go on to look for work elsewhere, so there will be one less. I spent 9 years in that particular hospital and watched it go from bad to worse to nightmare with each passing year. I've also seen other people who came to work with me there who had gone through what you're going through; it looks like this is becoming a bigger and bigger trend at hospitals throughout the U.S. All I can say is, keep you're eyes open for a good job at a private doctor's office or see if you can get on with a service. I was looking for the job I'm in now for at least the last 7 years I was there and took this one because it had gotten so bad that I hated to go to work anymore. I'm glad I took this one, however, because now the people I work with are wonderful, as are the doctors.

I have met an MT recently who had worked at a hospital for many years and was suddenly laid off, along with the whole department. She used her severence pay to buy a computer and is now working for the service doing the same work and getting paid better. However, when her COBRA insurance runs out, she will have a problem obtaining reasonable health insurance. It was a very painful transition for her.