Tit For Tat

In today’s world of heightened expectations and demands for instant gratification, people often assume that skilled professionals meet deadlines by magic. Snap your fingers and the job is done – just like you saw in that nifty commercial on television! Medical transcription doesn’t work that way. And if there should be one guiding rule in negotiating contracts and maintaining healthy relationships with clients, it is the old adage that “Lack of planning on your part does not constitute an emergency on mine.”

Turnaround time (TAT) has always been a thorny issue in the medical transcription industry. Whether clients wish to have a 48, 24, 12 or 4-hour turnaround on dictated reports, many a contract has not been renewed because of an MTSO’s inability to consistently meet the stated guidelines for turnaround time as set forth in a contract. Failure to meet TAT may be due to some very real factors. Sometimes a server is down, there is a rolling blackout, or a lightning storm has prevented people from working. In certain instances, an MTSO may be trying to service too many clients without enough transcriptionists. More often than not, several clients have suddenly doubled or tripled their volume of dictation without giving the MTSO any warning. Yet, they expect to receive standard TAT without any excuses.

What causes sudden surges in dictation? The two most common culprits are (a) procrastinating physicians who, unless they catch up on all their delinquent dictation, are about to have their staff privileges suspended, and (b) the threat of a medical records audit by the JCAHO. Other seasonal influences include heavy pollen counts in rural communities, natural disasters (floods, hurricanes and flu epidemics), or the yearly invasion of snowbirds migrating to Sunbelt communities from Arizona to Florida.

With remote medical transcription being out of sight and out of mind, there is rarely any thought given to alerting an MTSO that a local crisis is about to impact the volume of work headed toward a digital dictation system. The expectation is simply that, with the work being outsourced, the MTSO will have all dictation transcribed within the usual turnaround time and, if the contract includes a penalty clause, absorb the costs of any transcribed documents that fail to meet TAT.

Isn’t it ironic how penalties always seem to go in only one direction? At present, MTs are asked to rescue delinquent dictators as a routine part of their work. With each client believing that s/he is the most important, there is a peculiar challenge in trying to keep everyone happy. No one eversees penalties being applied to clients who are past due with their payment. Or doctors whose dictation is so abominably indecipherable that no one wants to transcribe their work.

With the Internet creating a false expectation of a virtual workplace in which people are supposed to be up and available, bright and perky, with fingers on their keyboards -- 24 hours a day, seven days a week -- there is a surprising lack of awareness of the value an MT’s work hours have in relationship to other events that occur during the work day. Simply stated, you can get just so much done in so much time by so many people using so many productivity enhancement tools.

Contrary to what many offshore firms would have you believe when they boast about their “excess capacity,” this isn’t about having extra transcriptionists available. This is about being given notice that more work than usual needs to be done within a limited amount of time. If MTs are expected to field curve balls every 20 minutes, their productivity will go down the toilet. If MTs are expected to meet excessive demand that no one alerted them to, some work is not going to meet TAT. If MTs must stop and do all kinds of damage repair because a physician didn’t dictate a report properly, then the amount of time spent cleaning up that mess is going to be robbed from the amount of time available to transcribe other reports.

Sometimes it seems as if doctors and medical records departments model their expectations on the clueless and incompetent behavior of the pointy-headed, moronic middle managers made famous by Scott Adams in his cartoon strip, Dilbert. The only way the situation can change is if MTs and MTSOs learn how to set boundaries and stick to those boundaries.

Let me explain. An exceptionally vainglorious and self-absorbed prima donna surgeon who is a client of ours recently called to inform me that he had dictated a report which he needed on a stat basis. When I asked him if he had coded the report as a “priority” according to the instructions he received and was supposed to carry with him in his wallet, hebellowed “I DON’T READ INSTRUCTIONS!!!!”

My answer was short and simple. “Then I guess you’re not getting stat delivery on that report.”

Another physician (who dictates sporadically and is a notoriously slow-paying client) decided to dictate two hour-long reports onto microcassette tapes and then leave his tape recorder propped up against a speaker phone while it played his dictation into our digital dictation system. He left a message for me stating “I just got back from vacation and I need these jobs done as soon as possible.” After listening to the atrocious sound quality, I left a message for the good doctor stating that he was not using the equipment properly and that we could not accept any work in which the sound was so horribly distorted.

Managing human resources and staffing appropriately is a challenge for any hospital or MTSO, regardless of whether the people doing medical transcription are employees or independent contractors. It’s all about managing work flow and keeping up with the flotsam and jetsam left by the rising and falling tides of dictation. The assumption has always been that MTs should have no problem juggling an extra 25% of the workload on a moment’s notice because they have nothing else to do with their time.

Think again.

Just because a doctor hands you a lemon doesn’t mean that you have to stand there and make him lemonade at no extra charge. That’s not how things work in the business world when someone is up against a short deadline. And that’s not how things should happen in the medical transcription industry, either.

• If a doctor swears up and down that he dictated a report and insists that you go back and check to find where it is (often a sure sign that the doctor never dictated the report but is merely looking for a scapegoat), make sure the good doctor understands that there is a $25 charge each time your staff embarks on a wild goose chase to satisfy his ego.

• If clients lose files that were sent to them – or can’t find a document that they need –make sure they are charged for the backup copy of the file that you deliver. That file is a tangible asset which should be treated as a billable item.

• If, in the course of handling a hospital account, you discover that several ESL doctors are so difficult to understand that it is almost impossible to transcribe their work, demand an appointment with the Medical Records Director and try to negotiate a higher rate for the reports dictated by these doctors.

• Finally, an MTSO should have the right to refuse dictation that is so appallingly bad that it is not worth asking an MT to suffer a loss in earnings while trying to transcribe such garbage. If the client insists on having such work transcribed, the MTSO should have the right to charge exorbitant rates to get it done.

MTs have always been expected to sit down and tackle ridiculously counterproductive challenges because their time was not perceived as having value. But entrepreneurs and venture capitalists are starting to realize that speech recognition is not going to eliminate the need for qualified medical transcriptionists. At a certain point, it becomes necessary for MTSOs to ask which loss is potentially more devastating to their business: Losing an account with low profit margins that no one wants to work on? Or losing a cluster of loyal and professional transcriptionists who are extremely difficult to replace.