Thursday, August 23, 2012

Production Pay and Revenue Cycle Management

AHDI has published a position paper that was released at the annual convention in Indianapolis earlier this month.  In this paper, the association presents the current state of healthcare documentation and why it is essential to consider a more flexible compensation model that takes into account the many other duties of the professional medical transcriptionist. 

In a recent article published in For The Record, Sherry Doggett, President of AHDI states "There are many things that medical transcriptionists perform in many scenarios in the work envionment that really are not conducive to production pay."  Additionally, healthcare documentation specialists (MTs) are often asked to move from one computer to another, a different transcription platform or system, work back and forth between straight transcription and speech recognition, work multiple accounts and different doctors through a single shift.  All of these transitions are counter productive.  

Take into consideration different account specifics that vary within a single account to accommodate different physicians' style and add the numerous queries and flags MTs notate throughout the day, the corrections they must make to errors during dictation.  These things take time - uncompensated time and you have the makings of upheaval that may erode the future of this important sector.  When allied health professionals consider their work to be of decreasing value and say they work in a "sweatshop for minimum wage," it is beyond time to pay attention to the type of comments seen here.  

Year after year, healthcare documentation specialists have been asked to do more for less while the commoditization of this profession has been squeezed from every angle.  It is considered a cost center when there has been a failure to recognize the value of this knowledge-based field.  Consider coding.  How can coders code without the documentation that tells the unique patient's story and is the basis for coding?  How is it we will be able to move successfully into ICD-10-CM/PCS without better and more specific documentation?  

It is interesting to observe the conflicting opinions about whether or not front-end speech is better for quality patient care.  On the topic of front-end speech, Jeffrey Linder, MD believes that "physicians are more likely to see and respond to alerts if they are using an EHR."  While the AJR published a study that revealed a 23% error rate in front-end speech compared to 4% in dictation/transcription reports.      

In all the efforts to employ technology to improve healthcare, the technology advances absolutely have their place and merit in moving us away from paper.  That said, providers are faced with more demands, larger case loads and in truth they need choices that suit their preferences that will lead to efficiencies.  Forcing any one solution on multiple providers will be met with resistance and will not accomplish the goals of patient safety and better outcomes.  Rather, in a current article, Nick vanTerheyden, MD states "The most appropriate means of documentation is the one that is most effective and productive to a physician's workflow.  It will take a combination to deliver the highest clinican satisfaction."    

When all is said and done, it seems that in order to get more information, meet the needs for the clinical documentation improvement required for ICD-10-CM/PCS, and achieve meaningful use goals, healthcare organizations that intentionally keep dictation and transcription as well as other options will come out on top.  Looking at creative compensation methods for the professionals behind the scenes that help produce these quality documents from which coding and billing take place must move higher in priority in order to keep them engaged.  Many have left the profession already due to poor compensation and we cannot afford to lose any more at a time when the language of medicine is a premium concern.  We must value these hard-working professionals and look at other areas for controlling costs in the revenue cycle.