December 10 , 2007

Uncertain About Certification
By Robbi Hess
For The Record
Vol. 19 No. 25 P. 22

Industry experts debate the value of certifying transcription service providers.

Is the certification of transcription service companies in the cards? Is it a necessary progression, or will certification cause smaller transcription service providers undue hardship, forcing them to fold? Will those that contract these services demand certification or even notice a difference from providers that gain such status?

Industry reaction to these and other questions surrounding the idea is mixed.

Why Embrace Certification?
“Certification is a topic of interest for many in the industry,” says Dave Woodrow, managing director of healthcare at SPi and a board member of the Medical Transcription Industry Alliance (MTIA). While he doesn’t speak for the entire MTIA membership, Woodrow says, “I think you will find groups of folks who say, ‘Hey, I’m fine with this and let’s get on with it,’ while there are others out there that would go for certification if it included A, B, or C, and others who would flat out say no.”

Resistance to the certification idea could simply be a fear of the unknown, Woodrow adds.

Jay Cannon, president and chief operating officer of Webmedx, says a certification initiative will support the value of the product being supplied. “Isn’t that the reason behind ISO [International Organization for Standardization] certification and others? To a certain extent, it guarantees consistency in meeting expectations for the product that is supplied,” he says. “I don’t see certification as a negative but feel it needs to be structured carefully and that evaluation needs to go into what certification might look like.”

Just as departments or hospitals are certified through various entities such as The Joint Commission, those organizations qualify for reimbursements that they might not otherwise receive because they attained or surpassed industry standards.

Beth McLaughlin, founder and president of Adept Word Management, Inc., says depending on who promotes and formulates the certification standards, it could be “like the fox guarding the henhouse.” She likens it to the mandate passed by the MTIA regarding visible black characters.

“Transcriptionists are this industry’s most valuable resource and with the passage of visible black characters, that has an effect on their pay,” she explains. “I am afraid that certification would be another mandate handed down that could negatively affect us, and we would have no say in it.”

McLaughlin, whose company employs close to 100 people, wonders if the idea of certification is tied to the MedQuist scandal. “It would be wrong to tie others’ performance to that ideal,” she says. “It is the quality of our product that speaks to those that we provide transcription for. Your reception in the industry with the doctors and hospitals you work for should be what drives the industry, not that you have been certified by your peers.”

“In the [medical transcription] industry, the question starts with individuals and should they have to be certified through some mechanism to be able to perform this task of seeking certification,” Woodrow says. “By and large you have a huge number of practitioners that would say, ‘I’ve been doing this successfully for 20 years, and I can’t afford or don’t want to seek certification.’ You have to sell them on the idea of certification.”

“Some are seeing certification as a glass-half-full scenario,” Cannon adds. “Most of the negative comments have come from the idea that ours is a competitive industry and would certification put further controls—and potentially costs—on a company that might become so restrictive that they might end up having negative consequences on the business owner? This is a question we are very sensitive to. If handled correctly, this is an opportunity for our industry, especially with the sensitivity around risk management and confidentiality of records.”

Certification could show a prospective customer that a company is looking at new products and services, demonstrating a commitment to the industry. Holding a college degree doesn’t mean that one person is necessarily smarter than someone without one, but it does show that steps were taken to meet a set of criteria, standards, and requirements. “If a hospital is seeking the services of a transcription company, seeing one that took the steps necessary to attain certification could show that company is a safe bet to do business with,” Woodrow says.

Cannon agrees, adding that, “As an industry, we need to establish a greater value for the product we provide, and we need to get the sole focus off of price. In an industry where there is skepticism in the price vs. value ratio, my feeling is that, if handled properly, business certification could go a long way in promoting the value of clinical documentation processing.”

McLaughlin disagrees: “I honestly can’t imagine most of the clinicians I work with caring about certification. When I go into an arrangement with them, it includes a way for them to check their bill, and they can let me know if there is a dispute with it. The quality I supply is generally higher than they were expecting when we walked in the door.”

She believes that those doing the dictation for transcribing don’t concern themselves with where the punctuation goes. “They expect us to flag errors, point out inconsistencies in jargon, and the like,” she says. “If you have a relationship with your clients, they should come to you if they are unhappy—and believe me they would. I remain approachable to them at all times. I can’t see them going to a certifying body and saying, ‘Hey, Beth and her organization are doing such and such.’ They want the job taken care of. They don’t want to have to deal with the product until it comes back to them in complete form.”

Who Would Provide the Certification?
“We [SPi] understand that there is a lot of time, effort, and money involved in attaining certification, so it is a legitimate question to ask who would be sitting in judgment of your practices and to whom would you be compared,” Woodrow says.

“Some individuals in the industry are looking to MTIA as an option to supply the talent to put together criteria for certification,” he adds. “It is a monumental undertaking.”

Roughly two years ago, he says there was a conversation between the MTIA and The Joint Commission about the possibility of the commission performing the certification process for the transcription industry. “Many people still don’t understand that [The Joint Commission] is not a government agency. It is a for-profit company that gets paid to come to your facility and perform certifications,” Woodrow says.

Would the same standards be applied to a mom-and-pop transcription company as are applied to MedQuist, a company that has more than 10,000 transcriptionists across the United States and the world? Woodrow believes that would be the case.

“Who will determine what the quality measures are? What entity? What would we be certified for? Who determines the quality? Turnaround time?” McLaughlin asks. “It’s hard for me to imagine that my clients would be happier with my services simply because I was ‘certified.’ The proof is in the pudding and in the high-quality services we—and others in the industry—continually provide.”

Woodrow says questions of who would oversee certification and formulate criteria are obstacles that need to be overcome before the idea can gain traction. “Once those questions are answered, they will give rise to the questions, ‘What makes them qualified? What kind of input do they need? What kind of research needs to be done to decide what are the best practices? What kind of input will be necessary from the constituency, and what would a customer be looking for in the measures by which a company [would] be judged?’ There is a short list of folks out there that might have a shot at putting this together,” he says.

“From a trade association standpoint, MTIA is exploring certification as an opportunity. But we don’t know if it’s proper for an association to take on that role,” Cannon says.

Another question that’s been raised concerns whether the certification should be mandatory. “I would be all for voluntary certification, but it is a lot of work and will cost a lot of money to attain it. But with required mandates, that is something that is a little different,” Woodrow says. “Required takes on the feeling of regulatory, and to me, any time the government gets involved, there are too many cooks in the kitchen. Would there be a law of unintended consequences? Would certification inadvertently break things that aren’t broken? We don’t know yet; all consequences have to be taken into consideration.”

As a board, Cannon says, the MTIA has agreed to move forward in completing further due diligence and exploring market intelligence around business certification. “We know how invasive the process of certification can be, and we need to objectively evaluate that based on the cost. Of course, then there is the significant administrative responsibility that needs to be compared against some market research on whether there is truly a perceived value in certification,” he says. “Do I think certification would resonate with the consumer in the industry? Yes. Would people be willing to pay for that? Would the value offset any potential cost that may be incurred? That we still need to explore.”

How Will the Little Guys Compete?
Woodrow is against any proposal that could potentially harm smaller transcription service providers. For the larger providers, would the price of certification force them to pass the cost on to consumers? These concerns lead to more questions. “Does certification help them do a better job? Is it helping the customer sleep better at night because [their provider is] certified? I don’t know,” Woodrow says. “This is a question that has to be looked at with an eye on opportunity, not necessarily with a [suspicious] eye.”

Certification could change a company’s perception within the industry. However, will smaller providers have the cash to seek certification, and is the hospital that has used their services—and been pleased—for the past 10 years going to be required to use the services of a certified supplier? Will certification be a “nice thing” to have, or will it be a mandatory cost of doing business?

Being proactive rather than waiting for government mandates to be handed down is something that the MTIA and the Association for Healthcare Documentation Integrity (AHDI) would certainly like to focus on, Woodrow says.

“As the industry is moving more into electronic patient records and as the skill sets for MTs [medical transcriptionists] are changing, and as the government is looking more and more to regulate information, it may very well [require] your company to be certified and that could be a huge issue,” he says.

Would there have to be varying levels of certification? “If I am doing transcription for a doctor who is a sole practitioner, do I need different certification than if I am doing transcription for a company that is handling a level one trauma center vs. if I am doing referral letters and office visit notes?” Woodrow asks. “I hope certification focuses more on competency and quality than speed.”

McLaughlin says she can’t see any reason to seek certification. “I can’t imagine the motivation behind it for me,” she says. “The proof remains in the work that I do. I don’t see how certification would make me a better transcription provider. I don’t know how I would sell it as a value-added to my clients, and I imagine it would raise my costs if I had to undergo a certification process.”

Should infrastructure and platforms figure into certification? How about whether you adhere to a HIPAA audit? If the certification process asked these questions, it would be moving beyond content and the practitioner, and into best-business practices.

What Will It Take?
According to Woodrow, getting requirements in place for certification in the transcription industry would involve getting people to the table and saying, “Let’s get this done.”

Some weight would be needed behind certification to enforce compliance. “Various constituency groups would need to be behind it. Time and effort would have to be put into answering tough questions,” Woodrow says. “One of the questions we need to look at is if we, as an industry, don’t come together and get this done, will the government come in and do it? We hope not.”

Policing your own industry is the best mode of business, Woodrow says. “If policing is viewed as a bad word, then we have to think of it as it’s always best to be involved in the improvement of your own industry, and this [certification] could only be viewed as an improvement because we are telling customers that we are taking the steps to do the things that hopefully make us the type of company you want to do business with, and that will lead to more satisfied caregivers,” he says.

Maintaining open lines of communication with customers is the best way to “police” the industry and the quality of service, according to McLaughlin.

Bottom Line
Woodrow and Cannon agree that implementing a certification process could take years, but now would be a good time to get started. “The clock is ticking, and this isn’t something that can be thrown together in a couple of months,” Woodrow says.

But how can compliance be ensured? “MTIA could have a preponderance of its membership come out and say, ‘Let’s change the bylaws to state that if you want to be a member, you are required to attain certification’,” Woodrow says.

McLaughlin doesn’t see the benefit in such thinking. “How would that add value to me and my membership in the organization?” she asks.

“Bottom line is we shouldn’t be afraid of certification for our industry. Certification is already out there in the ISO arena, and it is an internationally recognized standard,” Woodrow says. “Certification in our industry will let us be in control of our own destinies rather than having some legislative subcommittee that understands nothing of our business come in and make decisions.”

McLaughlin says transcription is not the same as talking about the components of a machine or the other certification requirements necessary to attain ISO recognition.

“ISO certification is an enviable goal, but we are talking about an industry that is made up of a chain of people—from the clinician dictating a note to the individual transcribing it to the patient it affects,” she says. “Bottom line, as a provider if you don’t provide exemplary services and a great product, you don’t get the work. Certification won’t change that.”

Woodrow says that while he has his own thoughts on the matter of certification, it doesn’t make him the MTIA’s mouthpiece. “I am speaking from the idea that in life and in business there is a right thing to do and you always want to try and do the right thing, but you need to put the time and effort into researching it before making any decisions,” he says.

“Business certification for the transcription industry deserves further exploration as to the real value and responding to those current initiatives and drives within the clinical documentation arena,” says Cannon. “Will [certification], based upon all the dynamics in play, resonate and create additional value for MTIA members and industry companies? That is the question we need to answer in finalizing a decision to commit to move forward.”

Woodrow cites the success of the ADHI’s certification program for individual MTs. “I wish more companies and cultures valued certification,” he says. “The reality is it’s out there; let’s talk about it and see how we might apply those standards to our own industry.”

— Robbi Hess, a journalist for more than 20 years, is a writer/editor for a weekly newspaper and a monthly business magazine in western New York.