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Eliminate commuting? No more ‘business attire?’ It sounds great on paper, but is telecommuting all it’s cracked up to be?

(Editor’s Note: The following article discusses the results of the National Medical Transcription Benchmarking Study, which was co-developed by Diskriter Inc. and Hospital Shared Services/AmeriNet. The study piloted with seven health care facilities, including Allegheny General Hospital of Pittsburgh and the University of Pittsburgh Medical Center (UPMC). Due to space constraints, ADVANCE could not print all of the statistical and comparative data used to compute these results. If you are interested in obtaining a complete packet of information about the study, call Diskriter at (412) 344-9700.)

By Anne Miller

ADVANCE Assistant Editor

Maybe the thought occurred last winter, as you were scraping layers of ice off of your windshield. Or the last time you left your house without an umbrella in the pouring rain. Or the last time you sat, fuming, in a rush-hour traffic jam. Whatever the situation, almost every working professional is sure to have had this fleeting thought at one time or another: “I wish I could work from home!”

If you are a medical transcriptionist (MT), you might just get your wish—either now or sometime in the not-too-distant future. “Medical transcription is probably one of the best professions to be in if you want to take advantage of telecommuting,” said Will Hull, president of the Pittsburgh-based Diskriter Health Care Documentation Solutions. Diskriter offers, among other services, consulting to develop home-based, incentive-based transcription programs designed to move MTs into home offices. “Dictation can be accessed by phone lines or over the Internet and work can be transmitted electronically after it is transcribed. There aren’t any administrative tasks associated with the position, nor is it truly necessary for MTs to see physicians face-to-face or attend meetings,” Hull stated. “It’s telecommuting in its purest form.”

By definition, telecommuting is the use of telephones and computers by an employee or independent contractor to accomplish work tasks away from the office—usually in the employee’s home—one or more days a week. It is a trend that is definitely on the rise in the medical transcription industry. According to the American Association for Medical Transcription’s (AAMT) “Member Survey Guide to AAMT Planning,” which was published last spring, 21 percent of MTs already work out of their homes. And, as authors Donna Avila-Well, CMT, and Mary Glaccum, CMT, reported in their 1994 book, The Independent Medical Transcriptionist, some forecasters predict this number will rise to 58 percent by the year 2000.

“Several recent societal changes are responsible for this paradigm shift away from the hospital-based transcription setting,” Hull asserted.

First, unprecedented technological advances have facilitated the quick and easy movement of information across essentially seamless networks—something previously not possible. And, since the advent of managed care, many health care organizations have had to scramble for new, improved ways to ‘do more with less.’

“Factor into this equation the rising number of dual-income-parent and single-parent homes,” said Hull, “and it becomes clear why telecommuting is becoming such a popular option. There are benefits for every party involved. For the employee, telecommuting means being able to stay at home with the family while increasing net adjusted income 10 percent or more. For the employer, telecommuting frees up expensive office and parking space while reducing overall transcription costs by 20 percent to 30 percent.”

Hull quoted some rather colorful examples to illustrate the time and money MTs can save by working out of their homes. “How much time do you spend getting ready for work? Commuting to and from work?” Hull asked. “If you spend 40 minutes getting ready for work, 40 minutes traveling to work and 40 minutes traveling back home again, five days a week, 50 weeks per year (250 days), that’s a grand total of 500 hours of your life—and that’s like 12 weeks vacation!”

And what about other costs of commuting, such as gasoline or public transportation? “If you spend as little as $2 per day, 250 days per year, that’s $500 per year,” Hull pointed out. Order out for lunch often? “If you spend as little as $3.50 per day, 250 days per year, that’s $875 per year,” Hull asserted. And day care costs at $30 per day can add up to $7,500 per year.

There are other factors to consider aside from time and money, Hull addedthings like personal happiness and a decrease in daily stress levels. According to the results of the Ameritech Work At Home Study, conducted by The Gallup Organization of Telecommuters in 1996, 59 percent of telecommuters said that their stress level decreased working outside the office; 47 percent reported putting in fewer hours working at home than they did while working in the office and commuting; and 79 percent said they have been happier since they began working at home; only 7 percent reported feeling less happy.

And what are the benefits to employers, aside from saving money on office and parking space? Quite possibly, increased productivity. More than half of the respondents in the Ameritech study (68 percent) claim they are more productive working from their homes than in an office.

To further study the advantages that telecommuting could offer to MT employers, Hull’s company Diskriter co-developed a study earlier this year with Hospital Shared Services/AmeriNet, a large, non-profit purchasing consortium located in Warrendale, PA.

Called the National Medical Transcription Benchmarking (NMTB) Study, its goals were to encourage benchmarking practices to determine opportunities for improvement and identify potential cost-reduction programs in the medical transcription arena.

The NMTB study was developed in cooperation with seven health care facilities: two large metropolitan trauma centers, three community hospitals and two rural hospitals. For purposes of the study, Diskriter used AAMT’s definition of a “character.”

According to Hull, his team of researchers have answered the following questions: How do MTs compare to one another (and to MTs in similar organizations) relative to production and individual costs? How does the cost of an organization’s MT services compare with similar organizations? Where can an organization save money? Is it more cost-effective to outsource medical transcription, to handle it in-house or to use home-based, incentive-based MTs?

“The findings were rather surprising to the health information management (HIM) department heads of the facilities that participated in our pilot study,” Hull reported. “The results strengthened the argument for sending MTs home to work.”

For example, the NMTB study revealed that individual MT production ranged from a high of 19,000 typed characters per hour to a low of 2,700 characters per hour for all pilot study participants. The cost of a typed character for participating hospitals ranged widely, from .0010 to .0026 cents—two and a half times more costly, in some cases, for the same output.

“Two MTs working for the same hospital might be paid the same hourly rate and receive the same benefits package, but one is producing twice as much as the other,” Hull commented. “This is not a fair situation for either the employer or the higher-producing MTs.”

In addition, data from the NMTB study showed that outsourcing overflow transcription was 200 percent more expensive than the use of home-based, incentive-based MTs; and that home-based MTs working under an incentive program were 30 percent to 40 percent more productive than hospital-based MTs working for hourly wages.

Hull stressed that an incentive-based compensation program is a very important factor to making home-based work a fair and equitable proposition for both employers and MTs. “Most highly skilled MTs would find it desirable and lucrative to be rewarded based on their output, because they often produce so much more than many of their colleagues,” he said.

Despite the many benefits that telecommuting offers, the arrangement does have a downside as well—especially for the telecommuting MT. Pat Forbis, CMT, associate director of AAMT, commented that telecommuting is a rather controversial issue for the members of her association. “In an ideal world, MTs would have a choice between working in an office or telecommuting,” she said. “AAMT does not recommend one setting over another; it’s a very personal decision that each MT must make. But we do caution MTs to carefully investigate the pros and cons of telecommuting before deciding to work at home.”

Isolation is one of the biggest negatives that Forbis mentioned. “The downside of isolation must not be underestimated,” she stated. “You might never get to meet any of the other MTs working for your company. If a question or problem arises during your work day, no one is there to help you solve it, which can be frustrating and may contribute to the loss of production time.”

Of course, some types of social contact do pervade in a home-based setting, but are completely unwelcome. “Your family and friends might not respect the fact that you actually are ‘working.’ Small children are difficult to work around; you almost have to wait until another caregiver gets home before you get anything accomplished,” Forbis noted. “But it isn’t only kids—it’s teenagers, mothers-in-law, other family members and friends. All of these people may demand your time because you have a ‘flexible’ work schedule. Unless you are extremely self-disciplined and able to say ‘no,’ you will find it impossible to work efficiently.”

Some home-based MTs suffer from a lack of resources. “You do not have an information systems department at home to help you with computer glitches. You might not be able to afford subscriptions to all of the latest trade publications,” Forbis related. “You might have to purchase and update your own reference materials, which can be costly. It is likely that you won’t have any clerical assistance at your disposal. After adding these things up, many MTs discover they are missing a lot.”

Other crucial things might be missing from a home-based, incentive-based work situation as well—things like sick pay, vacation pay, personal days and health insurance. “MTs have to factor such benefits into the equation before they accept an incentive-based contract, and then ask themselves if it’s really still a good deal,” Forbis stressed. “If incentive-based pay is the only wage you make, and you are only being paid based on what you produce, the situation can easily turn into an electronic sweatshop. AAMT has spoken to MTs who haven’t taken a vacation in 15 years because they don’t get paid for time off and therefore can’t afford it.”

In fact, working under incentive-based plans, even at home, can actually add stress to an MT’s working situation and increase the risk of an occupational injury. “It’s very stressful to attempt to work as quickly and accurately as possible all day, every day,” Forbis commented. “It can really wear an employee down. Also, unless you take regular stretch breaks and perform ergonomic exercises, you can end up with a repetitive stress injury.”

Forbis concluded by stating that certain types of individuals will be more suited to meet the demands of an incentive-based telecommuting arrangement than others. “An MT with 20 years’ experience in a variety of specialties might not want to work any other way,” she said. “They will be rewarded for their vast knowledge, speed and accuracy. But newcomers to the field should exercise caution—they might end up feeling ‘punished’ (with low pay) for merely trying to learn their trade.”