August 13, 2012

A Matter of Productivity
By Robert J. Murphy
For The Record
Vol. 24 No. 15 P. 8

Nearly all medical transcription service organizations (MTSOs) provide individual access to their medical transcriptionists’ (MTs) productivity figures. As a result, MTs can track their line production to meet daily or other periodic goals to which they have committed. Some companies take it a step further and share productivity measures with an entire team of transcriptionists working on an account, usually without attaching a name to the numbers.

The manner in which productivity statistics are managed and divulged—individually or as a team—makes a difference. The team approach can promote camaraderie and a sense of shared purpose. An individual who has fallen behind is probably best served by a private talk with a supervisor—rather than being criticized or disgraced—to try to identify the cause of the productivity lapse.

Productivity is important in an industry in which clients demand quick turnaround and high quality. Speech recognition software—increasingly used by hospitals trying to curtail costs—and EHRs add new challenges for MTs that extend beyond typing.

“If there is any industry or profession that is in the midst of a transition, I think it’s this one,” says industry veteran Beth Friedman, RHIT, president and founder of The Friedman Marketing Group.

Multitasking MTs
The problem with raw numbers is that they often tell only part of the overall story. Any number of distractions and interruptions can pull an MT out of the “zone” where he or she achieves peak performance. For example, a family health crisis or other emergency may take an MT away from the keyboard altogether. A new employee may still be scaling a learning curve. A supervisor may call and ask an MT to pivot to a new quick-turnaround project that delays production on another assignment. “These types of interruptions throughout the day can really take their toll,” says Susan Lucci, RHIT, CHPS, CMT, AHDI-F, chief operations officer at MedScribe HIM.

An MT’s job description has evolved in the last decade. An increasing number of MTs are working with an EHR as hospitals transition to the technology. Others spend large amounts of time editing speech recognition text from doctors and other healthcare providers whose speech might be only intermittently discernable.

Documents lacking necessary information, such as names, addresses, and phone and fax numbers, often required in a text’s “header,” force MTs to stop what they’re doing and track down the missing pieces. Speech recognition software often fails to properly distinguish words that sound similar, so “Plaquenil” may turn up on the page as “plaque windmill.” This is not to mention flat-out mistakes left to the MT/editor to correct.

Clearly, medical transcription today requires more than just typing skills. This is reflected in part by an MT’s typical education, which includes courses in anatomy, physiology, pharmacology, and medical editing. It also suggests that a pure pay-for-production compensation model may be inadequate to match an MT’s daily tasks, particularly for those in a hospital setting.

“There are many things that medical transcriptionists perform in many scenarios in the work environment that really are not conducive to production pay,” says Sherry Doggett, president of the Association for Healthcare Documentation Integrity (AHDI). “In a hospital setting, many times medical transcriptionists are working in the electronic health record. And they might be doing some speech editing, and they might be doing some transcribing, or doing quality assessments on the doctor or medical assistant or nurse who is already entered into the electronic health record. You’re looking at risk issues. Maybe you’re looking for inconsistencies. There could be wrong medication dosages that are inconsistent in different sections of that encounter. They do a lot of front-line risk management.”

All of this means that MTs in that type of work environment may fare better being paid hourly with or without incentives for surpassing a specified production threshold. Sometimes MTSOs base incentive pay on meeting certain quality assurance standards. Even so, a large majority of MTs is paid by the line.

Individuals and Teams
These concerns lead back to the question of whether a supervisor should address productivity lapses with individuals or with an entire team.

“I personally wouldn’t feel comfortable sharing [productivity data] with the whole team,” says Linda A. Allard, president of New England Medical Transcription. “As a transcriptionist—and I have worked as a transcriptionist—I wouldn’t want the other transcriptionists to see what I was typing that day. I think that’s a privacy thing, and I wouldn’t want to cross that line.”

Some MTSOs share productivity statistics with the team but attach a code or other pseudonym to each MT to protect identities. The theory is that by allowing the entire group to see performance statistics helps motivate everyone to work a little harder to meet production goals. Perhaps it even engenders friendly competition. It may also reinforce the concept that each team member takes ownership of an account with a shared responsibility to fulfill its demands.

“Everyone already knows where they’re at just based on the information they get each day when they’re working,” says Brenda Drake, vice president of operations for Accentus, an MTSO based in Chicago. “We specifically set company goals that we’re trying to reach.”

Drake, who prefers not to identify people by name when sharing productivity data except to bestow acclaim on outstanding performers, says one downside to sharing statistics with the team is that it may place an excessive emphasis on productivity at the expense of quality. A document riddled with errors is worth little more with quick turnaround than delayed submission. Consequently, most MTSO supervisors place an equal or greater premium on quality than production and view it as vital to patient safety.

Unsettled Waters
These are difficult times for many MTSOs as hospitals face uncertainty both in terms of government regulation and new and largely untested technology. Speech recognition—however reliable at present—is encroaching on larger swaths of what had been traditional medical transcription. Turnaround times are shortened and budgets squeezed. And even though healthcare organizations managed to weather previous economic storms, the downturn in recent years has sharply diminished their bottom lines.

“A lot of hospitals are struggling,” Lucci says. “They’re trying to curtail costs. There are so many pressures on healthcare organizations right now that everybody is trying to hold the line and see how everything shakes out.”

Call it a brave new world for medical transcription, where survival lies with the fittest not only in terms of productivity and quality but also worker morale.

— Robert J. Murphy is a freelance medical journalist in Philadelphia.