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.     

Challenges in 2011

As we start a brand new year, it is going to be particularly important to take notice of all that is happening in healthcare documentation. The sense of urgency for hospitals and providers to adopt EHR technology is on the rise and shows no signs of slowing down, despite the challenges, expenses and the myriad of complexities also known as meaningful use.

So what is an MT to do? Do we just go through our normal day and hope that our job is not the one eliminated? Or should we look at credentials, education and find new roles that we can do? Personally, I think it is a mistake if we don't get active in taking a long, hard look at this head-on instead of hoping that we can ride the wave to the shore.

We have heard for years that medical transcription and coding are similar (from the standpoint of clinical knowledge) and yet they remain, for the most part, very separate processes. It seems prudent to revisit these 2 tasks and see how we might bring them closer together in an effort to gain efficiencies and speed up the billing process. Having worked as both a coder and a transcriptionist, I know the skill sets are very similar. We must know and understand the language of medicine, A&P, pharmacology, disease process and so much more.

Even aside from the obvious coding option, there are others that come to mind. For those who aren't necessarily resigned by geographics or other requirements to working at home, becoming a scribe may be an option. There are probably individuals working as scribes who will tell you it isn't the same job and I completely acknowledge that it's not the same, however, it still comes back to all the medical knowledge and then training to perform the tasks that the physician needs for entry into the EHR. It can be learned, and you clearly have a huge head start.

Then what about analytics, quality reporting and a host of other tasks that we can learn? There are many options, and AHDI is exploring these with several current initiatives, but there is one step first. We need to understand that much of what will take place when the nation's healthcare goes electronic hasn't quite yet been fully determined. The roles are still being discovered. So the potential is there -- and it won't come without additional training, possible college preparation and credentials. This is just simply a call to keep eyes and possibilities wide open.

What can you do today? Start learning all you can about these new systems and keep your networks strong. Be informed and don't be afraid to consider going back to school. At a time when I thought I wouldn't need to go back to school, I find myself today enrolled at the University of Cincinnati in their BS HIM program to convert my RHIT to RHIA. Funny thing is that I looked into this program back in 2006 and decided not to do it, because I didn't think I needed to. Of course the enrollment advisor reminded me that had I done it then, I would already have gradutated. I guess the moral of this story is never say never - you might be surprised by the necessities in an evolving career!

ACE Summary!

Gaylord Opryland, Nashville, TN – Music City USA was the scene for the 31st annual AHDI Annual Convention and Expo. And what an event it was. We kicked the event off with a Wednesday night welcome reception and everyone showed up in their jeans and boots to learn a few line dances from 3 very talented instructors. Later (once we had a few steps figured out), we were entertained by Les Richardson and County Line. What an awesome event and everyone was there!

Thursday morning we heard from our opening keynote, Donna Hartley who shared her incredible story with the message being that you can be more than a survivor, you can really thrive even in tough situations. She shared 9 tips you can do to get the most out of your career and your life.

At 10:00 AM the exhibit hall opened and our exhibitors were there with new offerings and great solutions for our members. Next followed the afternoon educational sessions with 3 tracks, medical, industry and MT practice. There were so many wonderful sessions to attend that it was really difficult to choose. What I did was buy the CD so I wouldn’t miss a thing.

Thursday afternoon was the continuation of the QA Summit (first launched in Louisville, KY at the MTIA meeting) and the summit leaders spent time in lively discussion on blanks and how best to address that segment of what is often a dissatisfaction indicator. Our next steps are clear and we will continue on towards a white paper on quality for our industry standard.

Friday morning early Nick van Terheyden, MD spoke on the Health Story Project (www.healthstory.com). This is the solution that uses CDA language to deliver narrative text in a format that is searchable data in the EHR. This is one of the single most important developments for our sector and every one in our profession should know about and begin to talk about how this will get implemented at every MTSO and every hospital across the nation. This is what builds the bridge from dictation and allows physicians to continue to be efficient (dictate, their preferred method of documentation by over 80%) and still allow the information to be formatted for EHR systems.

Next, we had the opportunity to hear from Bruce Mast, our Thursday morning keynote on the evolution of our role. That was a powerful, eye-opening session that proposed many possibilities based on the knowledge of our professionals – not the method of how we do it.

Then on Saturday morning, we were incredibly fortunate to have Jonathan Perlin, MD, PhD speak to us about what’s happening in healthcare and the opportunities that will abound with healthcare reform. His background and experience with both the VA and currently as the Chief Medical Officer for HCA puts him in a key position to share his insight with our members. He has also been named one of the top 10 physicians in America.

Then with an afternoon filled with outstanding educational sessions, it was time to wrap it all up with our first ever, Integrity Awards Red Carpet event and after party. The paparazzi was there snapping photos of our members who were dressed to the nines and everyone looked fabulous! The awards were presented then everyone moved over to the Gaylord’s Fuse nightclub for music, food and beverages. There was more dancing and fun for all there and as the main part of the conference concluded, we all agreed that this was one of the best events ever. The Gaylord facility was filled with greenery, waterfalls and blooms from all over the world. And speaking of the “world” their waterway complete with boat rides shares water from 17 countries worldwide.

For those who just didn’t get enough of the conference, Sunday morning the Managers and Supervisors special interest group conducted their annual event (8:00 – 11:30 AM) with great attendance and content-rich topics about how they are working and evolving in this new generation of EHR systems with SRT technologies and it was an excellent event with panel discussions and idea sharing.

When it was time to leave, I anticipated a feeling a sadness that it was over, but surprisingly, most of what I was thinking was how great the event was and how much more there is to look forward to. Our sector is evolving and as we prepare for this future, gaining knowledge and being involved in these changes at this level is something I treasure. For those who could not attend, I encourage you to get as much information as you can. If you aren’t a member, consider joining your professional association because there’s never been a more important time to be connected. The next few years are going to be amazing and we all need to be involved in securing our place as the knowledge worker for the future. Our roles will evolve, and the more visibility we have, the more opportunities we’ll have to stake our claim and say, “Yes I can do that – I have the expertise.”

Nashville, Here I Come!

As the song goes..."Well my bags are packed and I'm ready to go"... And I couldn't be more excited about annual conference this year. ACE at the beautiful Gaylord Opryland is going to be one of the most amazing conventions we have ever had. We are doing so many new things this year. AHDI is always looking for more ways to share the latest information with attendees and this year there are many events with a new flair.

We are for the first time, doing a simulcast of a panel discussion with our closing keynote, Bruce Mast, Linda Yanisiewski, MTIA president, Peter Preziosi, CEO of AHDI and MTIA and me. One of the reasons we thought this was important is because we understand that times are tough and not everyone can travel to a convention. But we thought it would be innovative to take some of the convention to you.

This year our initiatives have been clear from January 1, 2009! We must produce an SRT curriculum and it is ready. We must update the QA standards for our industry - that collaborative work is well underway to be complete this year and we are having a face-to-face meeting in Nashville to continue to advance the work. We must continue to be visible in Capitol Hill. This work continues not only at our summit, but meetings have continued all year long and we have retained a lobbying firm, Dewey Square Group to ensure our voices are heard. We must develop our future roles that will evolve with the EHR and that work is well underway. We need to draft an open letter to all MTs to unite for the purpose of a louder, stronger voice in showing tremendous value we bring to healthcare and that has been drafted. And we must do all of these things and more for every person working in this sector and help support them in getting credentialed because it is high-time for us to join the rest of the healthcare field in doing that and having better tools/resources such as the Interfix Knowledge Base (KB).

We know that these are challenging times. We also know that if we sit quietly on the sidelines, that change will take place without our input or consideration. As the saying goes, out of sight, out of mind and it does happen when we are silent and invisible regardless of our many contributions. We can let change happen to us, or we can actively participate in ensuring that healthcare reform includes healthcare documentation professionals.

So as many of us gather in Nashville, (making this our first ever green conference in keeping with that socially responsible initiative) for those of you who can't make it this year, I wanted to be sure you know that AHDI is working for all of you who are working at home, in offices and in hospitals and clinics and we will continue to work on your behalf to secure a great future.

Hope: Where to Find it

We have talked about change - now let's shift the focus to another word that we must keep close at hand and that's "hope." In difficult times when the economy is down, it's hard to remain hopeful when the headlines are less than encouraging. But if you have your health, a job, and a place to live, you are ahead of about 1/3 of the world's population. We've heard growing up that it is so important to be thankful for all we have, but often it is easier to see what we don't have and what would be nice to have and we lose focus on all that is right with our lives, our jobs and our future.

The other day, I signed up online for a 401K plan with my employer. It was a great process and the 401K plan itself is a great one with a well-known company with many offerings. But I was less than excited to see the return rate of the investment choices. All but 2 were in negative numbers (and had been for longer than 2 years) and the 2 that weren't were less than 2 points each. Pretty discouraging and I nearly considered not signing up. But then I got to thinking that this big economic situation we are in won't solve itself. It is going to take each of us to do a few things to help us turn this thing around. We have to keep on moving forward every single day. So where do we find hope?

Suggestion #1. Watch President Obama on Wednesday night, 7/1 during his live Town Hall meeting. Better yet, submit a question and get involved. I agree that we can't fix the economy without fixing healthcare at the same time - it is too great an issue and this is something that not only affects everyone, it costs everyone. Let's get it solved.

Suggestion #2. I read somewhere recently that we have to give up all hope of creating a better yesterday. Yesterday is gone, but there is still time today to be the best you can be, make a difference for someone else, contribute where you can, and take a first step of many to have a hopeful, realistic tomorrow. Tell someone you appreciate them and ask your boss how you can help your company be more successful. You may be surprised at the response.

Suggestion #3. No matter your current situation, challenge yourself to create a positive outlook for tomorrow. Rather than seeing things as hopeless, envision that this is a difficult situation and then set out to make tomorrow better than the day before. Ask yourself what should I do next to get back on track.

We cannot undo the past and we also should not worry about the future. The past is gone, the future is not here yet, but our opportunity today is large and alive. Healthcare reform will happen. We have had the opportunity to speak to the decision-makers about meaningful use and we have continued to speak up and our voices are being heard.

What if we all decided that the most important thing we could do is work together as a profession and help healthcare decision-makers realize how valuable our contributions are? What if we help make the point that healthcare reform can take place better with us meaning that EHR systems are in use, nationwide with narrative text? What if we decided that the issues we sometimes take issue with in this profession are really not big issues at all? What if we all finally realized that as healthcare evolves, we need to be right in step with it and engage in the process? That's meaningful use of all of our time. That would spell a very hopeful future!

MT Relevance in Healthcare's Future

There is a lively discussion taking place here not just on the topic of mandatory credentialing but also the facts around MT relevance and our place in healthcare documentation's future. There are a number of great issues being presented and the burning questions seem to be larger than life.

Read this and more below:

For the purposes of history, very few professions willingly seek regulation and credentialing. AAMT/AHDI has always known we would have our work cut out for us by going down this road. But history has also shown that professions that are unwilling to self-regulate will either be (a) forced into regulation by the government or (b) forced out of relevance by technology and automation. Any unregulated, noncredentialed profession that can’t demonstrate a significant value-add is bound for marginalization. And unless you’re completely isolated from what’s going on in our industry right now, that is exactly what’s happening to our profession

Here is a final excerpt from that final post made by Lea Sims regarding what our choices are when faced with the reality of what is happening and why we need to engage this entire sector. We must face the facts of the transformation that is taking place - thought provoking:

...So…it’s really up to every MT, not to AHDI. How long can you count on your behind-the-scenes, no-credential, no-accountability, low-visibility role to sustain you in healthcare? Most experts say that within the next 5 to 10 years, a great deal of what you are doing will be automated (if you don’t believe that, you should be attending HIMSS) and all healthcare might need an MT for is to capture some complex narrative at the acute care level. All “normals” will give way to automation. All “templates” will give way to automation.

What value will you demonstrate to healthcare of the future? What cost-saving solution can you demonstrate? What ability to protect the patient can you market? What assistance with clinical decision-making can you offer? Instead of arguing with me here about what you are NOT, how much time are you spending thinking about what you ARE? You can say “no” to “risk management” as a value-add role, but what are you willing to say “yes” to? That’s all healthcare is going to listen to, folks.

When it comes to the art of this profession, at the end of the day, is our role to simply document what is dictated or is there an element of critical thinking involved? I have to say that some of the many MTs I know make sound decisions and corrections every day, many times a day - because they have the skill to do so. There is compelling information here that we all need to consider as those who would suggest that our role is clerical and therefore potentially just an expense that systems and technology can replace or do we choose to validate our skills and evolve them to the next wave in healthcare reform?

The issues around AHDI and what we do in support of MTs is substantial. That too, has evolved. Yes it is true that AAMT was different in earlier years, but as all things must, we had to change our mission and direction because frankly our members needed more. In order to provide membership with relevant and meaningful offerings, we too had to evolve with healthcare. Membership in AHDI is substantive and provides value in many forms. Through the Knowledge Base (KB), advocacy, credentialing, continuing education, leadership development, standards of practice, networking and more.

Will end this here but would ask that our members start speaking up and share what you think. And don't just tell us - tell those who are hearing misinformation. What is AHDI doing that we need to do more of? What aren't we doing that we should? And what do you think about some of the comments that have been made on this post? Do you agree or disagree? What further points need to made. We are listening - and your thoughts matter.