The State of Medical Transcription Outsourcing

Vol. 18 •Issue 5 • Page 14
The State of Medical Transcription Outsourcing

Speech recognition, the work force shortage and the ever-controversial offshoring of work—ADVANCE takes a look at all these and more.

Facing decreasing budgets and a lack of time, more and more facilities are turning to outsourcing to get their medical transcription needs met. It’s an exciting time in the world of transcription outsourcing, but medical transcription service organizations (MTSOs) also face difficulties. A shortage of qualified MTs exists domestically, and many MTSOs are turning to offshoring to get the work done and to cut costs.

Many MTSOs are also dipping their toes into speech recognition (SR) technology to increase efficiency and help with turnaround times. SR isn’t perfect, though, and getting the work force trained on the new technology is no easy feat. ADVANCE spoke to three national MTSOs to delve into their strategies for the present as well as their outlooks for the future. Each MTSO we spoke with is seeing an increase in work and each are wrangling with a decreasing supply of qualified domestic MTs as well as a desire to move to SR.

At Home and Abroad

As in any business, for MTSOs it’s important to give the customers what they want. As budgets shrink at hospitals and clinics nationwide, more and more providers are seeking to cut transcription costs, and that may mean setting their sights on offshore transcription services.

At Outsourcing Solutions Inc. (OSi), Douglasville, GA, the work force is almost completely domestic, according to managing partner Andrew Renfroe. Out of OSi’s 38 clients, only three have work done offshore. Those clients requested that some of the transcription be done offshore, and OSi obliged. “They’re very large clients who, because of cost pressures on their institutions, came to us and asked us to provide them a service, because they had heard about offshore,” Renfroe said. “Where cost becomes a very paramount concern, I think using offshore is a very viable solution.”

Renfroe believes that OSi’s offshore component will grow in the future. In fact, OSi has begun offering what it calls a global work force, where clients can choose to use a combination of both domestic and offshore labor. The offshore workers will only work on certain work types, Renfroe explained, and even the three facilities that do have offshore work done through OSi aren’t having work done completely offshore. “Certain specialties I think are better suited to be done domestically, and there are other ones, some of the more simpler, basic ones, that are well suited to send offshore,” Renfroe explained.

SPi, Brentwood, TN, also gives customers a choice when it comes to having transcription done at home or abroad. The company introduced its Best Shore Model, allowing customers to choose where they’d like the work done, onshore, offshore or a combination of the two. Offshore transcription often allows for quicker turnaround times because the work force abroad works at different times, according to Dave Woodrow, senior vice president of sales and global account management with SPi. “I don’t think you can do it just one place or the other, onshore or offshore, because, let’s face it, U.S. MTs, they have to have a life,” Woodrow said. “They’re going to go to bed at some point, but health care rolls on, 24/7/365.”

A number of countries have become what Woodrow referred to as “transcription destinations.” SPi has offices in India and the Philippines, and its offshore MTs work out of the offices rather than at their homes. While India and the Philippines are popular places to have transcription done, Woodrow added that for some companies the work is also being done in the Caribbean and along the coast of South America. Companies are also looking to see if MT operations can be set up in Africa, although Woodrow said that SPi has “plenty on our plate with the Philippines, India and the U.S.”

Since the Best Shore Model’s implementation, Woodrow said that many facilities are choosing to have work done offshore. Offshoring is being embraced, Woodrow said, and for companies choosing to have the work done entirely in the U.S., that’s mainly a personal preference. More and more customers are at least taking a look at offshoring of medical transcription services, Woodrow explained, and many are choosing to go that route. “The market is shifting, and in other industries, the offshoring of work is prevalent and also well accepted,” Woodrow added. “You’re finding, I think, the same thing in health care.”

An important aspect to consider is how the work is done overseas. How are the offshore MTs trained, and how can you be sure that quality won’t suffer if you decide to have work done abroad? Ray Dyer, vice president of business development, Acusis, Pittsburgh, PA, noted that while there are benefits of having work done overseas, you also have to make sure that the company holds foreign MTs to the same standards as domestic MTs. “Our approach is that the quality is the same no matter where transcription’s done throughout the world,” Dyer said.

A Shortage at Home

Onshore, many MTSOs find they’re having trouble recruiting qualified MTs. While Dyer said that Acusis hasn’t really had any problems with the work force shortage, Woodrow and Renfroe said they’ve seen the effects of it. Renfroe said that when OSi posts an open position, and the company receives an influx of 25-30 résumés. “But only one or two applicants can pass our entrance examination,” Renfroe lamented.

Years ago, Renfroe explained, MTs started out in hospitals and went through apprenticeship programs to get on-the-job training. Hospitals could invest time and money into getting a good MT; that’s usually not the case anymore. Numerous transcription education programs exist, Renfroe pointed out, but becoming an MT is something that requires spending a certain amount of time actually working in the field. “A lot of companies like ours have developed what we call mentoring programs, where you take someone who’s graduated from one of these accredited schools but they’re still not qualified to pass our entrance examination, so we work with them 3-6 months to try to get them up to that skill level where you can leave them on that account where all you’re doing is sampling their work statistically,” Renfroe said.

Getting MTs up to speed can be costly though, as companies are basically paying two people—the quality assurance professional, who reviews 100 percent of the work, and the new MT—to do one person’s job. The shortage of qualified MTs may make offshoring all the more attractive, according to Woodrow. “Manpower is a critical part of the equation, so anytime that you can inject additional skilled people into the equation, the customer’s going to benefit,” he noted.

Is SR in the Cards?

The customers may also benefit from the use of SR technology. All three MTSOs that spoke to ADVANCE are currently using SR, but the opinions are less than optimistic. “I think it was overhyped for many years,” Renfroe said. “It is today finally starting to deliver some meaningful production increases and turnaround, and I think that 3 years from now, I would bet that 75 percent of all of our work will be going through SR, on a backend basis.”

No industry has a bigger vested interest in the success of SR than the transcription industry, Woodrow said, and facilities are looking to MTSOs to foot the bill. MTSOs are investing in the technology, which he said is “finally beginning to come into its own,” so that customers don’t have to, Woodrow said. He believes that all of SPi’s employees will be trained on SR in the future, although he would like to see the technology improve. “I think it’s inevitable,” Woodrow said. “We do want to make sure that the technology does get better, that people are trained on that type of technology because there’s value in this report and in this process.”

Acusis has integrated back-end SR into its own technology platform, however SR technology does have its limitations, Dyer noted. The company is using it as appropriate, but Dyer said that Acusis wants to make sure that it’s not just using the technology for the sake of using technology. He doesn’t believe that there will be a full-scale move to SR in the industry. “I see it continuing to develop, but not a huge shift all at once,” Dyer said.

Renfroe noted that he sees promise in using both front-end and back-end SR technologies. Front-end involves no editing on the MT’s part, but the physicians must change their habits and do the editing themselves. Back-end SR doesn’t involve a change in physician behavior at all, and, as Woodrow said, the physicians can still “pick up, talk up and hang up.” Physicians who use front-end SR through OSi can opt to use what Renfroe called “the uncle button.” If the report is lengthy or complex, they can choose to dictate in the usual manner and have the document go through the editing process on the back-end.

What Lies Ahead

Choice is a big theme in medical transcription outsourcing, as facilities want options of where and how the work is done. Dyer noted that customers are also looking for that little something extra. They no longer just want simple customer service and technical support, but they’re looking for what Dyer called “the whole customer satisfaction package.” “They’re looking for more than just providing the transcription,” Dyer added.

Renfroe noticed that more and more facilities are seeking out a total package approach from another aspect, as well. They want the MTSO to provide transcription services as well as the technology to get the job done. As budgets at facilities tighten, hospitals and clinics can no longer afford to dish out capital expenses for costly dictation equipment. “They want the technology and the labor all wrapped up into one contract,” Renfroe said.

Woodrow said he doesn’t see the price pressures on facilities easing up anytime soon, and he predicted that the functions of transcription, coding and billing will come closer together, perhaps with some sharing of those responsibilities. “The more things that you can do with the information when you have it in front of you, the better off you are,” he said. “I think that bodes well for U.S. MTs and MTs wherever they are.”

The cost constraints that hospitals and clinics face also bode well for MTSOs, as more facilities look to outsourcing to cut costs and improve efficiency. None of the MTSOs we spoke to see the outsourcing of transcription slowing down anytime soon, and despite the challenges, all are looking forward to the future. “I think for companies that enter into it as a partnership relationship and perform to the customers’ needs, it’s a very exciting business to be in,” Dyer said.

Lynn Jusinski is an assistant editor with ADVANCE.