Tuesday, September 25, 2007

RFP This!

Several years ago, my business partner and I decided that competing against large national services for hospital accounts simply wasn’t in our best interest. Having looked at what was happening to colleagues in the industry who kept trying to maintain a sweatshop work environment while operating in a constant state of crisis management, we decided that a business plan based on white-knuckled stress was not for us.

We had seen what happened to MTSOs who bit off more than they could chew before coming to the sad realization that, with such a tiny profit margin, they could barely stay afloat. We had listened to stinging complaints about the lack of quality transcription and the failure by some large national services to meet contracted turnaround times. We had examined RFPs from hospital purchasing departments that demanded every bell and whistle imaginable (while itemizing lots of penalty charges for MTSOs), but didn’t want to pay diddlysquat for the services they requested. Like many small MTSOs, we had been screwed by a hospital that kept us working like dogs up until the very last minute when it transferred its account to a large national service that promised them the world at 25% less and failed to deliver on those promises.

Some entrepreneurs (who went into medical transcription as a way to make a quick buck) woke up to the rude shock that having a positive cash flow was an important factor in retaining staff. Other MTSOs (who were outsourcing work to India in the hopes of saving a penny per line) were appalled by the amateurish level of transcription they received for their money -- not to mention the hidden costs and extra time it took to correct numerous mistakes.

It’s no secret that certain MTSOs have an extraordinarily high rate of turnover among transcriptionists (go online and you can read hundreds of complaints from disgruntled medical transcriptionists who hate their employers but feel they have nowhere else to go). But things don’t have to be that way. Signing more clients just for the sake of boasting that you have more market share doesn’t always produce the best results. And, believe it or not, there is life beyond medical transcription.

Recently, while watching the Charlie Rose Show, I listened to Tom Hanks talk about the ultimate form of power. In so many ways, being able to say “no”can be the definitive act of liberation. As I listened to Hanks talk about what this means in terms of the movie industry, I thought of all the performers and artists I had interviewed who had struggled to find the courage to turn down roles that would have harmed their careers. I thought of businesses I had read about that, dazzled by potential revenues, had taken on one monstrous account which proceeded to redefine (and in some cases destroy) their businesses.

Our decision to redefine our business as a “local boutique service” continues to fly in the face of industry norms. But our clients are happy and our transcriptionists do good work. By running a clean, lean, and mean operation we have managed to avoid certain kinds of overhead and stressors that can undermine profit margins in the most insidious ways. That’s why I couldn’t help but chuckle last December when I received a desperate e-mail from an MTSO seeking immediate backup help in order to handle a heavy holiday load. Keeping in mind the old adage that “lack of planning on your part does not constitute an emergency on mine,” I politely replied that our service was unavailable because our transcriptionists were looking forward to a stress-free holiday season.

She was not amused. In fact, she threatened to tell everyone that I was no longer in business. She obviously missed the point. Saying no to new business can be a risky proposition. Unless, of course, you’re pretty sure it’s not worth the trouble.

When a new client comes knocking at the door, an MTSO will do much better by not responding like a love-starved adolescent. Hard questions should be asked about any new client’s potential value. Is the money being offered really that good? Or are you being asked to clean up someone else’s mess? Is there truly the potential for a long-term business relationship? Or does this seemingly urgent request for your services bear all the signs and symptoms that, as soon as the new client’s crisis disappears, your business will fall victim to the old “humped and dumped” syndrome?

Get a clue. The mere fact that someone desperately needs work done doesn’t mean that you have to do it for them. Especially if doing so could (a) jeopardize relationships with your regular clients, (b) put an unnecessary strain on your business, and/or (c) ruin the holiday season for the people who you depend on throughout the year.

Like any business owner, I prefer to have an informed shopper as a potential client (not some administrative clerk who was asked to call every MTSO in the phone book and find out what their line rate is). I want to talk to a practice manager or physician who understands that dictators and transcriptionists share the responsibility of creating a coherent work product. I want to deal with someone who is computer literate and not prone to angry tantrums. More than anything else, I want a client who will pay his bill on time.

Laugh, if you like. But in years past, I’ve had to deal with clients who liked to rotate which vendors they paid every other month. When dealing with large teaching hospitals, there is always the nightmare of battling a bureaucracy in which (a) the accounting department won’t authorize payment unless you have a current purchase order, (b) the purchasing department won’t issue a purchase order unless it is requested from the clinic using your service, and (c) the clinic’s administrative support staff insist that they can’t request a purchase order because that has to be issued -- as if my magic -- from the folks in purchasing without any prompting from the clinic!

There is also an unfortunate element of “noblesse oblige” at play within the healthcare industry. Some physicians are so used to being fawned on by vendors that they don’t think there is any need to pay their bills on a timely basis. Often, vendors are forced to pad their invoices to compensate for the costs incurred by slow-paying accounts.

This much I can tell you from first-hand experience: Doctors and hospitals don’t appreciate being asked how long it will take for the check to show up – or if their check is going to bounce. But cash flow is a very important part of running any business -- especially in today’s dismal economy. And it is important to educate clients who insist on service with a fast turnaround that, when signing a contract, the TAT speed also applies to payment for services rendered.

Don’t get me wrong. RFPs are all well and fine. But a service owner has the right to set a few specifications as well. I know of one colleague who lost an account because she protested the working conditions for her transcriptionists (who had to listen to terrible dictators speaking under extremely poor acoustical conditions). If a hospital’s purchasing department wants to include a clause which heaps penalties upon the MTSO for each and every mistake found in its transcribed reports, then there is no reason why the MTSO should not be able to charge a similar penalty (perhaps one dollar for every physician’s mistake that was corrected by a transcriptionist).

Establishing clearly understood guidelines early in your relationship with an MTSO will lead to improved service. If you are a physician in private practice and are about to enter into a business relationship with a transcription service, certain courtesies should be taken into consideration:

  • As with any relationship, good communication is a key factor to success. If you are unhappy with the quality of transcription or the formatting on your reports, you need to communicate your thoughts clearly to the MTSO. Psychic interventions are not a value-added perk.

  • Once you have worked with an MTSO to establish certain formats for your work, you need to stick to those formats and not try to reinvent the wheel each time you dictate a report.

  • You need to dictate in such a way that people can understand what you’re saying – and try not to contradict yourself throughout your reports.

  • Procrastination on your end can create a bottleneck for transcriptionists who are suddenly asked to handle a larger volume of work than usual. If you are planning to dump an excessive load of dictation in one fell swoop, give the MTSO advance notice by phone or e-mail.

  • When you’re leaving town on a vacation, let the MTSO know about your impending absence so that work flow can be adjusted accordingly.

  • Tech support (whether it involves word processing software, an ISP, or a networking issue) is a drain of time for all parties involved. Patience and understanding are required while the problem is being fixed.

  • Dysfunctional behavior, angry accusations, and playing the blame game only sour a working relationship.

  • Last, but certainly not least, pay your bill promptly so that people can continue to deliver the level of service you expect.

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