Healthcare BPO – News compiled by Karna

Only recently, I happened to read one of the articles posted by Dr Deane Waldman in his own blog Medical Malprocess and have started to like his brave and honest opinions about the US Healthcare System which he says is ‘the sickest patient‘. His opinions come out of his professional experience as a Pediatric Cardiologist for over thirty years and also from his Management background.

Dr Deane Waldman says:

” The combination of life and professional experiences with my knowledge of management and strategy makes me particularly qualified to help us understand why healthcare is sick and what we can do to begin healing. Medical Malprocess is my blog aimed at starting a national conversation that will lead to a process to cure healthcare. “

Check out his Background and Credentials:

• Education and Training: Yale (BA in History); Mayo Clinic; Chicago Medical School (MD); Northwestern; Harvard; Anderson Schools of Management (MBA).

• Practicing Physician – 30 years – in both private and academic practice

• Chief of Pediatric Cardiology: San Diego; Chicago; New Mexico.

• Research: $3 million in grant support; over 100 publications.

• Consultant, Professor and Author in Healthcare Strategy

So, I thought of writing this post here in this blog Healthcare BPO in appreciation to his approach in finding a way to fix the Healthcare System…

Source: wsj.com – The Wall Street Journal
May 29, 2008

New Jersey is about the last place one might think to look for free-market policy reform. But this week Jay Webber, a Republican Assemblyman in Trenton, will introduce legislation to let Garden State residents buy low-cost health insurance from any registered policy in any of the 50 states.

Mr. Webber’s proposal is a state version of Arizona Congressman John Shadegg’s federal legislation to let individuals buy insurance across state lines, and John McCain has also endorsed the idea. But New Jersey would be a perfect test case, because its multiple mandates have made insurance too expensive for hundreds of thousands of families.

The average national cost for a family health plan is $5,799, according to America’s Health Insurance Plans, but in New Jersey that same plan costs $10,398 on average. The state’s politicians have driven up these costs by forcing insurers to provide gold-plated coverage – even for such voluntary medical services as in vitro fertilization. New Jersey also follows New York and Massachusetts – two other high-cost states – in requiring so-called “guaranteed issue.” That allows New Jersey residents to avoid buying health insurance until they get sick, which means they can avoid paying premiums until they need someone to pick up the bill.

This one-policy-fits-all system tends to cause the young and healthy to drop insurance, which only raises the cost of insurance for the sick, which in turn makes coverage unaffordable for ever more families. It’s no accident that about 1.2 million people – one of every eight residents – is uninsured in the state.

Under Mr. Webber’s choice proposal, New Jersey residents could buy policies chartered in more enlightened states. For example, a healthy 25-year-old male could buy a basic health plan in Kentucky that now sells for $960 a year, about one-sixth of the $5,880 it would cost him in New Jersey. Residents of Pennsylvania pay health premiums that are one-half to one-third as high as do Garden State policy-holders. A new study by the National Center for Policy Analysis estimates that the availability of lower cost plans would reduce by 25% the number of uninsured.

Opponents of interstate insurance say families would be pushed into bare-bones health plans. Not so. Families could still buy the more extensive coverage, but those with modest incomes would have options other than going uninsured. The goal of public policy shouldn’t be to cover every medical procedure or doctor’s visit, but to prevent families from catastrophic expenses due to a health problem that is no fault of their own.

New Jersey is turning into a microcosm of the national debate on health care. Democrats in Trenton are rallying behind a plan to require that every uninsured individual in New Jersey purchase health insurance from a new state-administered program. So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 billion health subsidy.

The Webber proposal offers lower costs and more choices for consumers, while the Democratic plan mandates public coverage and no choice, while putting a new burden on taxpayers. This is the kind of debate the country should have this election year.

By Steven Reinberg
HealthDay Reporter
Wednesday, May 28, 2008; 12:00 AM

WEDNESDAY, May 28 (HealthDay News) — The quality of children’s health care in America varies widely from state to state, as does their access to insurance and care and the likelihood of living long and healthy lives.

That’s the conclusion of a new scorecard produced by the Commonwealth Fund, a private foundation that seeks to promote better health care for all Americans.

According to the scorecard, if all states performed as well as the top few states:

an additional 4.6 million children nationwide would have health insurance; 11.8 million more children would get their recommended yearly medical and dental check-ups; 10.9 million more children would have a “medical home” — a regular source of care; 1.6 million fewer children would be at risk for developmental delays;and nearly 800,000 more children would be up-to-date on their vaccines.

Iowa, Vermont, Maine, Massachusetts, and New Hampshire are the top performing states, according to the report, while Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada and Texas are at the bottom.

“States and the federal government have a very high stake in ensuring that children are healthy,” Commonwealth Fund President Karen Davis said during a teleconference Tuesday. “In fact, more than one-third of children in the United States receive health care funded by the federal government as well as the 50 states and the District of Columbia.”

The report,U.S. Variations on Child Health System Performance: A State Scorecardwas released Wednesday.

There are 28 million children covered by Medicaid and 6 million covered by the State Children’s Health Insurance Program (SCHIP), Davis noted. And the key to providing health care to children is insurance, Dr. Edward L. Schor, the Commonwealth Fund’s vice president for child development and preventive care, said during the teleconference.

“In this study, we found a four-fold difference in the rates at which children are uninsured,” Schor said.

The number of uninsured children varied widely across the states, from a low of 5 percent in Michigan to a high of 20 percent in Texas. States that had the most insured children tended to have the highest scores on quality of care, Schor said.

If all states performed as well as Michigan when it came to providing insurance, then 4.6 million more children would have health insurance, Schor said. “That would cut the rate of uninsured children in half,” he said.

Using vaccinations as a measure of access to care, the scorecard again found substantial variation among the states, Schor said. “In Massachusetts, 94 percent of children were up-to-date on their immunizations, whereas in Nevada it was only 67 percent,” he said.

Another key is having a “medical home” — a regular source of care, Schor said. “Whereas 77 percent of children in New Hampshire had a medical home, in Mississippi, 34 percent had a medical home,” he said. “We know that children who have a medical home have a better quality of care.”

The scorecard took into account 13 indicators of children’s health, including access, quality, costs, equity and the potential to lead a long and healthy life. While no state scored high on all categories, some regions surpassed others. For example, states in the Northeast and Upper Midwest often ranked higher in several areas, while the lowest rankings were in the South and Southwest, the report found.

Studies have shown that in states with high numbers of uninsured children, those children are less likely to get recommended health care, vaccines, dental care and regular checkups. These children are also at greater risk for developmental delays and infant mortality, Davis said.

But even in the highest-ranking states, quality of care falls short of goals, the report noted. In Massachusetts, the top-ranked state in quality, 75 percent of the children were seen by a doctor and a dentist in the past year, compared with only 46 percent of children in Idaho.

“One of the major efforts states can take to improve quality of care is to provide health insurance coverage to children, particularly low-income children,” Davis said. “States that do a good job on that are among the states that are highest ranked on the various dimensions of quality of care. They are also the states that tend to do well on equity measures to help ensure that minority children and low-income children have better access to care and better quality of care”.

One expert believes it’s essential to increase funding for Medicaid and SCHIP to get more children covered by health insurance.

“We think this is a great report and it shows what we have been trying to show for a long time, which is how important Medicaid and SCHIP are to children’s health,” said Jenny Sullivan, a senior health policy analyst with the nonprofit, nonpartisan health care advocacy group Families USA. SCHIP legislation was enacted in 1997 to cover children in low-income families.

More information

To read the full report, visit the Commonwealth Fund.

SOURCES: May 27, 2008, teleconference with Karen Davis, president, and Edward L. Schor, M.D., vice president, Child Development and Preventive Care, The Commonwealth Fund, New York City; Jenny Sullivan, senior health policy analyst, Families USA, Washington, D.C.;U.S. Variations on Child Health System Performance: A State Scorecard

Source: rockbridgeweekly.com

Acting United States Attorney Julia C. Dudley announced today that Dr. Linda Sue Cheek, age 59, of Dublin, Virginia, was sentenced yesterday in United States District Court for the Western District of Virginia in Roanoke for defrauding Medicaid and Medicare.

“These taxpayer-funded health care programs are designed to allow our friends and neighbors who are in need of medical care, the opportunity to obtain it,” Acting United States Attorney Julia C. Dudley said today. “When physicians like Dr. Cheek take advantage of these programs in order to get rich, it is our job to hold them responsible for their actions.”

Cheek was sentenced to serve four years of probation for her role in a scheme to knowingly and willfully defraud the Medicaid and Medicare health care programs for her own personal, financial gain. In February Cheek pled guilty to one count of health care fraud, admitting that she had been stealing from the two programs from January 2002 to March 2006.

In addition, Cheek was ordered to pay a total of $24,210.37 in restitution to Medicare and Medicaid and will be required to serve 600 hours of community service in a non-medical field. As part of her sentencing, her license to practice medicine was also revoked.

The defendant, who was a licensed physician by the Commonwealth of Virginia, operated New River Medical Associates, Inc. located in Dublin, Virginia. The facility operated primarily as a pain management and alternative medicine practice.

Cheek previously admitted that between January 2002 and March 2006 she submitted a series of false Medicare and Medicaid claims relating to her medical practice, including the practice of billing Medicaid and Medicare for services she had not performed.

In addition, Cheek admitted to billing Medicaid for services she claimed to perform herself that were, in fact, performed by one or both of the two nurse practitioners employed by New River Medical Associates. Cheek admitted that during many of these procedures she was out of the office and, at times, out of the country.

Finally, Cheek admitted to billing Medicaid and Anthem Blue Cross Beneficiaries for individual treatments called “cleansing sessions,” an investigational service. These “cleansing sessions” were performed and billed as regular, individual office visits but were carried out in a group setting. Medicaid, Medicare and other insurance providers do not allow medical professionals to bill for group sessions.

This case was investigated for the United States Attorney’s Office, Western District of Virginia by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, the U.S. Department of Health and Human Services, Office of Inspector General, the Virginia State Police Drug Diversion Unit and the Financial Investigation Unit of Anthem Blue Cross Blue Shield.

Assistant United States Attorneys Patrick Hogeboom and Charlene Day prosecuted the case for the United States.

Economic Times of India May 27, 2008, 9:12AM EST

A report by Four-S Services shows India receiving about $19.5 billion worth of private equity investment in 2007, vs. $12.8 billion for China—a flip-flop from 2006

More PE funds flocked to India compared to China in 2007. For the first time, China PE investments were in the range of $12.8bn; nearly 34% less than the investments in India at $19.5bn. This was a huge change from 2006, when China received $12.9bn worth of PE investments, nearly 70% more than the $7.6bn received by India.

However, there was a qualitative difference in the way funds were deployed in China compared to India. China’s traditional Manufacturing & Infrastructure sectors attracted $8.3bn, constituting 65% of total funds invested; compared to $6.2bn constituting 32% of the total for India in 2007, according to a Four-S Services report .

Interestingly, the core sectors were the main areas of PE interest. Infrastructure (Engineering & Construction) sector accounted for a lion’s share of the deals in 2007 with nearly $4.0bn worth of investments (20.5% of total PE/VC investments announced during the Year).

As core development continues to be a high priority, Infrastructure is expected to be one of the fastest growing sectors in India, requiring huge investments worth $492bn over the next 5 years. The major growth driver within the Infrastructure sector was the Construction industry, accounting for 60.3% of the investments.

The top four sectors of Infrastructure, Telecom, BFSI and Real Estate (in that order) received nearly 72.3% of all PE investments during 2007.

Indian PE performance rocked last year mainly due to the fact that there are more private enterprises in India than in China that are attractive to PEs. Though India has always had a higher percentage of private sector companies compared to China, it is only in recent years that there has been a spreading of awareness among the investing community of the strong education system, English language proficiency, legal & financial structures and democratic governance in the country, says the report titled Indian Private Equity Report 2007.

This awareness, combined with sustained growth, has led to increasing investments in India. Also, the year saw some mega IPOs in China, drawing large investments from FIIs & PEs, leading them to limit their private deals and thus maintain their China exposure at certain levels.

Year 2007 saw Private Equity (PE) and Venture Capital (VC) investments ‘Riding a Wave of Euphoria’ in India. If 2006 was about PE/VC activity ‘Bursting into Bloom’, by 2007, the sentiment had risen to ecstatic levels as can be witnessed in the phenomenal growth of PE/VC investments in India, which hit an unprecedented $19.5bn in 2007, 2.5 times the $7.6bn figure of 2006, the report adds.

Total PE/VC investments announced in Indian companies was $19.5bn across 394 deals in 2007, compared to $7.6bn across 298 deals in 2006. The average deal size nearly doubled compared to 2006 ($41.7mn v/s $21.7mn), as even smaller investors that earlier used to look for $5-10mn deals began looking for $20-25mn deals. Also, there was a sectoral shift towards Infrastructure, Telecom & Real Estate,which witnessed the major big ticket deals of the year.

IT/ITES sector was the biggest loser, with investments dropping by 37.5% on YoY basis due to the slower profitability growth forecast. The slowdown in the sector was based on the adverse impact of the over 10% appreciation in the rupee and the depressed conditions in the US economy, which is a major source of revenue for Indian IT companies. Also, most of the big IT firms were not looking to raise funds. However, the sector still managed a record 84 small size deals, mainly in the web-based Information Services Industry and in the BPO/KPO Industry.

Traditional favourites like IT/ITES, Manufacturing and Healthcare together comprised only 18.5% of all investments by value in 2007, compared to 40.6% in 2006, mainly due to better and bigger opportunities in other areas of the economy and comparatively slower growth rates in these 3 sectors.

Source: www.ftc.gov – Official website of the Federal Trade Commission, US.

If you’re looking for a home-based business that can help you pull in $20,000 to $45,000 a year using your computer, a work-at-home opportunity doing medical billing may sound like the perfect choice. But before you part with your money, consider this: The Federal Trade Commission (FTC) has brought charges against promoters of medical billing opportunities for misrepresenting the earnings potential of their businesses and for failing to provide key pre-investment information required by law.

Medical Billing Scams

Ads for medical billing business opportunities appear on the Internet and in the classified sections of local newspapers and “giveaway” shopper’s guides. In the “Help-Wanted” classified sections, the ads may appear next to legitimate ads for hospital medical claims processors, leading consumers who respond to think they’re applying for a job, not buying a business opportunity.

The ads lure consumers with promises of substantial income working from home full- or part-time – “no experience required.” They direct consumers to call a toll-free number for more information.

If you call, a sales representative will entice you to sign up by telling you that the processing of medical claims is a lucrative business, that doctors are eager for help with electronic claims processing, and that you – even without any experience – can do this work from the comfort of your home.

Medical billing scammers charge a fee of hundreds, or even thousands, of dollars. In exchange, they claim to provide everything you supposedly need to launch your medical billing business: the software program to process the claims and a list of potential clients.

But the reality is that few consumers who pay for medical billing opportunities find clients or make any money, let alone earn the promised substantial income. Competition in the medical billing market is fierce, especially for those who are new to it. Many doctors’ offices process their own medical claims. Doctors who contract out their medical billing often use established firms, not individuals working from home.

Promoters of fraudulent medical billing opportunities are not interested in helping consumers, either. They only want their money. Many times, the client lists they provide are based on out-of-date databases of doctors who haven’t asked for medical billing services. The software they send may not work or may not have been properly authorized and so is useless. And the money-back “guarantees” often prove worthless. Even after making repeated calls to the promoter or complaining to their credit card companies, government agencies or consumer groups, only a few people actually get refunds.

How to Protect Yourself

To avoid losing your money to a bogus medical billing business opportunity, the FTC advises you to:

• Ask the promoter to give you the names of many previous purchasers so that you can pick and choose who to call for references. Make sure you get many names from which to choose. If the promoter provides only one or two names, be careful: The contacts may be “shills” – people hired to give favorable testimonials. Interview the references, preferably where the business operates, to get a better sense of how the business works. Ask for the names of their clients and a description of their operation.
• Consult with organizations for medical claims processors or medical billing businesses and with doctors in your community. Ask them about the medical billing field: How much of a need is there for this type of work? How much work does medical billing entail? What kind of training is required? Do they know anything about the promotion or promoter you’re interested in?
• Check with the state Attorney General’s office, consumer protection agency and the Better Business Bureau in your area and the area where the promoter is based to learn whether there are any unresolved complaints about the business opportunity or the promoter. While complaints may alert you to problems, the absence of complaints does not necessarily mean the company is legitimate. Unscrupulous companies may settle complaints, change their names or move to hide a history of complaints.
• If the medical billing opportunity sells another company’s software, check with the software company to find out whether company representatives know of any problems with the medical billing promoter.
• Consult an attorney, accountant or other business advisor before you sign any agreement or make any payments up front. An attorney can review the promoter’s contract and advise you on how best to proceed.

Where to Complain

If you think you’ve been defrauded in a medical billing business opportunity scheme, contact the company and ask for your money back. Let the company representatives know that you plan to notify law enforcement and other officials about your experience. Keep a record of your conversations and correspondence. If you send documents to the company, send copies, not originals. Send correspondence by certified mail – and request a return receipt – to document what the company received.

If you can’t resolve the dispute with the company, file a complaint with:

• the Federal Trade Commission. Call 1-877-FTC-HELP (1-877-382-4357) or log on to www.ftc.gov.
• the Attorney General’s office in your state or in the state where the company is located. The office will be able to tell you whether you’re protected by any state law to regulate work-at-home programs.
• your local consumer protection offices.
• your local Better Business Bureau.
• your local postmaster. The U.S. Postal Service investigates fraudulent mail practices.
• the advertising manager of the publication that ran the ad. The manager may be interested to learn about the problems you’ve had.

The FTC works for the consumer to prevent fraudulent, deceptive, and unfair business practices in the marketplace and to provide information to help consumers spot, stop, and avoid them. To file a complaint or to get free information on consumer issues, visit ftc.gov or call toll-free, 1-877-FTC-HELP (1-877-382-4357); TTY: 1-866-653-4261. The FTC enters Internet, telemarketing, identity theft, and other fraud-related complaints into Consumer Sentinel, a secure online database available to hundreds of civil and criminal law enforcement agencies in the U.S. and abroad.

May 23, 2008. IndyStar.com

A lawsuit filed by the federal government in Indianapolis accuses a medical products supplier based in northeastern Illinois of falsely billing Medicare for $789,579 in medical equipment.

The government claims Criterion Medical Corp. of Braidwood, Ill. submitted 1,427 false claims between May 2002 and October 2007, billing the government for knee and calf replacement liners.

A government investigation determined those liners were not medically necessary and that Criterion acted recklessly.

The government seeks reimbursement and unspecified damages.

Attempts today to reach Criterion were unsuccessful.

Although the company has an active Web site, phone numbers listed for Criterion are disconnected.

The billings were for Medicare patients in Indiana.

CAMP HILL, Pa., May 22 NJ-Highmark-NJ-claims

CAMP HILL, Pa., May 22 /PRNewswire/ — Highmark Medicare Services will begin processing Medicare Part A claims in New Jersey on September 1, 2008 and Part B claims on November 14, 2008. In October 2007, the Centers for Medicare & Medicaid Services awarded Highmark Medicare Services the Jurisdiction 12 (J12) Medicare contract to provide the Medicare Fee-for-Service Part A and Part B administrative services for the states of Pennsylvania, Maryland, New Jersey, Delaware and the District of Columbia. The award is part of a Congressional requirement to replace all current Medicare Part A and B contracts with new contract entities called Medicare Administrative Contractors (MACs).

In fiscal year 2007, Highmark Medicare Services processed about 48.8 million claims and served approximately 2.3 million beneficiaries and 57,000 providers. As the MAC for J12, Highmark Medicare Services is expected to process approximately 131 million claims annually, accounting for more than 11 percent of the national Medicare fee-for-service workload. Highmark Medicare Services will be working on behalf of approximately 4.2 million beneficiaries and 137,000 physicians and practitioners.

As a MAC, Highmark Medicare Services will serve as a single point-of-contact entity processing Medicare Part A and B claims from hospitals and other institutional providers, physicians and other practitioners within the J12 region. Highmark Medicare Services currently administers the Medicare Fee-for-Service Part A business for Pennsylvania, Maryland, and the District of Columbia, and the Part B business for Pennsylvania.

“As this work transitions from other contractors to Highmark Medicare Services, we are committed to making this as seamless as possible for Medicare beneficiaries and health care providers,” said Patrick Kiley, president of Highmark Medicare Services. “We understand that one of the keys to accomplishing this is through timely and direct communications by the MAC and timely response by those who need to react to changes due to the transition.”

If you have any questions related to the transition or Highmark Medicare Services, visit http://www.highmarkmedicareservices.com.

About Highmark Inc.

Highmark Medicare Services is a wholly owned subsidiary of Highmark Inc.

Highmark Inc. is a major force for Pennsylvania’s economy. According to a Tripp Umbach study, Highmark has a $2.5 billion impact on the economy and that includes about 11,000 employees of Highmark in Pennsylvania. Overall, Highmark and its subsidiaries have 19,000 employees.

As one of the leading health insurers in Pennsylvania, Highmark Inc.’s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.6 million people through the company’s health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people’s health. Highmark exerts an enormous economic impact throughout Pennsylvania. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

SOURCE: Highmark Medicare Services

© 2008 earthtimes.org.

18 May, 2008, 1410 hrs IST, PTI
Source: The Economic Times

NEW DELHI: After engineers and lawyers, now doctors are also gearing up to join the BPO brigade, with the outsourcing firms opening up alternative career options for medicos.

With more and more outsourcing firms moving into healthcare sector and medical transcription, the job opportunities for doctors and nurses in the country are getting widened, an industry expert said.

In a BPO firm, the job of a doctor can include medical billing, transcription and coding for the US hospitals.

Medical transcription, also known as MT, is an allied health profession, which deals in the process of transcription, or converting voice-recorded reports as dictated by physicians and/or other healthcare professionals into text format.

However, some companies like the Patni also provides high-end knowkledge process outsourcing where a doctor is required to study the reports of elderly patients and do risk assessment and prepare reports for health Insurance companies in the US.

At present, the IT services and business outsourcing company has 10 doctors in its team who does insurance claim processing, claim and long-term care management.

Nishikant Kadam, Head of HR of medical BPO CBay said: “We generally hire doctors for training our workforce. The doctors in our firm also works as quality analyst for our medical transcription work.”

CBay currently has 11 doctors on its roll. The doctors are also enjoying this corporate job which comes with fat pay-packet.

“It takes at least three to four years for a fresh medical graduate to establish a successful medical practice. In this period a person can work in a medical BPO and earn good cash,” a doctor working with a Noida-based BPO said.

“Salaries are lucrative compared to regular medical job. A senior doctor with three-five years experience could earn about Rs 8-20 lakh per annum in KPO,” Patni Senior Vice- President Sanjiv Kapur told PTI.

As more medico-related work comes to India, the opportunity for more doctors in the business is rising.

The concept of the “greying of America” is widely accepted today. By 2020, the US population over the age of 65 is projected to grow to 55 million and 42 per cent of them would enter a nursing home in their lifetime. This has opened alternative career options for Doctors in KPO,” Kapur added.

“By outsourcing these jobs, the hospitals and clinics in the US aim to reduce your administrative burden,” Kadam said.

This column explores the realm of the medical language specialist. This week, read about “Are MTs Necessary?”
By Rebecca A. McSwain, PhD, CMT, CPC-H-A

Experienced transcriptionists spot mistakes or inconsistencies in a medical report and check to correct the information. Their ability to understand and correctly transcribe patient assessments and treatments reduces the chance of patients receiving ineffective or even harmful treatments and ensures high-quality patient care. US Department of Labor, Bureau of Labor Statistics, www.bls.gov/oco/ocos271.htm

The above paragraph, at the US Department of Labor’s Bureau of Labor Statistics Web site, mentions an aspect of our job that seems underappreciated: quality assurance. Patient by patient, report by report, for every one of the millions of files that pass through our hands every day, the MT is closely scrutinizing the medical record for accuracy, our own and others’. Currently, there is no one else, and no machine, doing this job. Health care providers, though ultimately responsible for the content of records they create, do not have the time or inclination to control quality at this level of detail in their documents. Health care institutions can (and do) conduct random assessments of medical record quality in various ways. But it is literally impossible for such programs to scrutinize every narrative record. Fortunately, medical transcriptionists are doing it. Unfortunately, various systems that eliminate or drastically reduce the role of the MT are also getting rid of this quality assurance (QA) function, thus throwing a pretty important baby out with the bathwater.

Anyone who honestly assesses documents currently created by voice recognition systems, and those created through self-entry by health care personnel, must acknowledge that these documents today pose a major quality risk. It’s likely that in the future–and, by the way, after extensive feedback training provided to the machines by human MTs–VR systems will improve. But will it be enough?

As for self-entry: there may come a day when health care providers can evaluate, diagnose and treat patients while at the same time writing and keyboarding accurately and efficiently–with a mastery of spelling (even in areas outside their expertise) and grammar (even if English is their second language)–but I suspect that day is not now dawning. I think it may arrive about the same time that all health care providers are capable of doing their own coding accurately and efficiently.

And the medical transcriptionist brings something else to the creation of the medical narrative: a global understanding of language (medical and secular) and medical practice, combined with a comprehension of relevant community, provider, technology and individual patient circumstances for each of millions of encounters. This wide knowledge base, of course, grows bigger and better the longer an MT works in a particular context. But an experienced MT brings a store of information into any clinical situation, even an unfamiliar one. This specific kind of knowledge is not really held anywhere else in the health care system. Individual providers don’t have it–they have pieces of it, but not the whole picture. Electronic data bases don’t have it. I won’t assert that computers will never be capable of this level of value, but they are far from it now. And this MT knowledge is a source of quality in the medical narrative for which there is currently no substitute.

If this QA function is, in fact, important, then HIM managers, administrators, planners, need to consider how to preserve it, whatever the mode of record-creation may be in the future. If not MTs, then who?

Rebecca A. McSwain is currently working as a production MT for a national service. She has worked as an MT supervisor, business owner, instructor and QA manager. She’s a member of AHDI and the American Medical Writers Association. She has a PhD in anthropology and continues to work on anthro-related writing projects in her spare time. She can be reached at rmcswain_985@fuse.net.

Copyright ©2008 Merion Publications