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I was moseying along in the medical transcription blogosphere today – in my opinion, part of my duties as webmaster/owner of medical transcription sites – when I decided to check out a tweet sent out by Kathy Nicholls about some changes being proposed in AHDI governance. Here’s Kathy’s tweet:

KathyNicholls: AHDI proposes governance changes. What are your thoughts? http://bit.ly/dB8eeT

Now, I had nearly made a vow to leave AHDI alone. I’m not a member and haven’t been now for several years (not counting one year of corporate membership). I’d say I don’t care what they do, but by golly I run a forum for medical transcriptionists and they get discussed – so I decided to go see what Kathy was talking about.

This whole thing reminds me of a MTIA annual meeting a couple years ago, where I wanted to register in time to get the early bird discount – but there was no speaker schedule posted. Upon my inquiry (to AHDI, who is in charge of MTIA’s business), I was told one was not available yet. I then asked if the early bird discount would be pushed back so that it was available for a period of time AFTER the speaker schedule was available. I was told no, it would not. Therefore, in order to get the early bird discount, I had to buy a pig in a poke. Well, first it boggles my mind that any professional organization wouldn’t have a speaker schedule set by the time they started advertising their annual meeting; and second, that anyone would be expected to register for a meeting when they had no idea what educational sessions would be offered. Why offer an early bird discount at all, under the circumstances?

So now we have AHDI proposing another change in governance. Whether or not it’s a good change for the organization isn’t the point – I don’t know and I don’t really care. But, according to what I’m reading on Kathy’s blog, AHDI doesn’t even know the financial impact of what they’re proposing, yet it’s supposed to be taken to vote at the annual meeting the first week of August. Am I the only one who wonders why the rush?

Some of the comments at Kathy’s blog indicated that maybe members haven’t been very informed about this proposal. I consider Kathy – a former president on the national board of AAMT and a former HOD delegate and president of the HOD – to be pretty plugged in. If she doesn’t know about it, it doesn’t say much for how well information about this proposed change is being passed along to membership.

It appears the Town Hall meetings were first announced back in February – but the first Town Hall meeting wasn’t until the end of May, just 9 weeks prior to the ACE meeting and a vote on whether or not to implement this plan. Again, I’m reminded of the MTIA meeting – shouldn’t there actually BE a plan prior to announcing the plan? And what happened in the intervening months between mid-February, when this was first announced, and the end of May? According to comments made at the MT Tools Online blog, delegates were not allowed to disseminate information about these changes until a few weeks ago. Another comment was that the concept seems to change with every Town Hall meeting. There are, of course, the rah-rah posts – one commenter indicates she has been attending the BGG webinars “for several months” – which would be hard to do unless her definition of “several months” is what most of us would call a couple of months.

What I found most interesting were the comments by Miriam Wilmoth, a long-time member who has been very involved in the association for years.

Yes, there have been opportunities to ask questions – and to have some of them answered – but the “feel” of these meetings has all been one of an informational meeting and they have each projected that the BGG is a done deal, despite the fact that the House has yet to vote to move forward with it. Not once, when concerns have been raised, has anyone in leadership responded with the acknowledgement that yes, you have raised a valid concern and this is a problem with the new plan, or that anything needs to be taken back to the drawing board and re-thought. There is simply the continual message that this is the only salvation for our association and it must be done right now or we lose everything.

This doesn’t surprise me because this is de rigeur communication of the association to its members. I’ve said it before and I’ll repeat it: AHDI doesn’t actually hold discussions with members, they talk at them. The AHDI board has been very mother knows best with members, especially in the last couple of years. While I understand the need for the BOD to present a united front to membership and to keep its doubts and disagreements private, the united front seems unable to acknowledge the concerns of members or make members feel as though their input is valued, appreciated – or will even be considered. The end result is the feeling by membership that it’s being bludgeoned and the purpose of the Town Hall meetings isn’t actually to solicit input in order to formulate a plan – it’s window dressing for a decision that’s already been made and that will be rammed through because mother knows best.The fact that most of the people who serve in leadership at AHDI work very hard and are very passionate about what they’re doing is beside the point (the road to hell being paved with good intentions, and all).

Barb Marques, who is the current President-Elect to the AHDI BOD, says in her comment:

A couple of points I would make is that (1)perhaps all individual members have not heard first hand about the proposal, even though Townhalls have been open to any member. (2)I suspect the grassroot members will be hearing much more about this now that the component and state/regional association leadership, and the HOD, has been given several looks at the plan, several times now, and I hope ready to speak to their members on he subject with an assurance of understanding. Meetings with specific regional leadership (and anyone else they care to invite) will be held this and next week. The FAQs are available on the website for anyone to access.

I see no FAQ associated with that BGG. WHICH DOESN’T SURPRISE ME! After all, this is the same group of folks who start selling admission for a meeting with no agenda and asks people to vote on a plan that appears to still be in the planning stages. Link, please?

Of course the Town Halls were open to all members – but were all members adequately informed of them? Or are even members past the point of caring how AHDI reinvents its governance?

Keep in mind that the meeting where this vote is to take place is August 4-7, so all this discussion that’s going to take place is during the remaining two weeks before the vote. How many changes can be made after input from members in that short time?

If AHDI really feels it’s on the brink and needs salvation, and if it really wanted input from its members, it would have a frank discussion about the status of the association and present several alternatives, rather than offering up one “solution” to the problem for a vote in a few weeks’ time, especially when the proposed idea seems to be half-baked at this point. If the association is in such dire straits, surely it would be better served by a concrete plan and financial statement. The phrase out of the frying pan and into the fire comes to mind here, as does “a stitch in time saves nine.”

I’m going to go back to the proposal that got me into so much trouble with AAMT/AHDI several years ago and suggest that it’s past time for medical transcription to roll back into medical records. The case for this is even stronger now than it was the first time I brought it up. The evolving role of medical transcription in the medical records documentation process is bringing it more and more into the health information management sphere of influence. The people who really make the decisions about what happens in medical records – and in medical transcription – are in AHIMA, not AHDI. Let’s forget about MTIA for now – it’s a self-serving alliance of transcription service owners. The only comment of value about MTIA members I can make is to note that many of the C-level executives are most likely also members of AHIMA because they know the value of that organization to their business. At this point, AHDI seems to be spending a lot of time and energy struggling to make itself relevant, and reorganizing itself just to stay afloat. When it comes to legislation, it duplicates many of the efforts of AHIMA – only with less money and less effect. Doesn’t it make sense then to just roll it all into one organization? As a therapist I know once said: Sometimes a good divorce is better than a bad marriage. AHDI has, in my opinion, been a bad marriage for some time.

MT Exchange

You know you’ve really made the big time when your blog starts getting spammed by spammers who are actually on topic. That means your blog is ranking well for targeted search terms; in my case, that would be medical transcription.

I’d like to thank all the spammers out there who have tried everything imaginable to get their spammy medical transcription links on my blog pages. Now – cut it out.

Thank you. Have a nice holiday.

MT Exchange

I recently received an e-mail from a transcriptionist who described a situation that I think will surprise most medical transcriptionists. It’s an issue I found especially interesting in light of a post by Nae at MT Chat, and the responses it got: Yep, my ESP is working real well today doc …

I hadn’t even discussed this with Nae, so when she posted that thread, she was not aware of this MT’s e-mail to me.

Let me preface this by saying there are usually 2 sides to a story and I only have one, so my conclusions are going to be based on that. I’m not going to name names, but if any MTSOs have had a similar experience from their side, or if you’re in management and you think this is your company, I’d like to hear the “other” side.

In a nutshell, an MT who was being paid a premium line rate because of her experience and skills on multiple accounts, was demoted due to “potential reportable events” (PREs) involving privacy and security breaches.

The reason? Selecting the wrong doctor as attending, and sending a copy to the wrong physician. In the first case, the error was noted by the MT, but too late – the report had already been sent in, at which point it was immediately distributed. Even though the MT sent an e-mail, noting the error, this error was counted in the disciplinary action that was taken against her. In the second instance, the name dictated sounded almost exactly like another name – and the MT selected the incorrect name.

As amusing as it is to say “we can’t read your mind, doc,” I’m wondering if some of the people responding to that post at MT Chat want to rethink their answer. Although Nae’s example is “send a copy to Dr. Patel,” in a case where there are multiple doctors with that name, it could have easily been “send a copy to Dr. Smith,” where there are not only multiple Dr. Smiths on a list, but Dr. Smyth, Smythe and etc. All it takes is one large university hospital or VA account to realize there are many, many ways to spell names we all thought had a common spelling, for both patients and physicians. With no training and no physician list, it would be obvious to an MT that picking the correct one among a number of Dr. Patels is impossible and needs to be flagged to QA – but what about Dr. Carter v. Karter? If someone says “send a copy to John Carter” and you find a John Carter on the roster – would you look any further to see if there was also a John Karter and therefore flag the report to someone up the food chain?

In my opinion, there were a couple of errors that occurred prior to the MT making the error.

1. It was a new account and no training was given.
2. No physician list was provided, including a list of attendings and their fellows or residents.
3. The MT company has no written policy regarding PREs and how they will be handled.
4. The MT company has no written policy regarding disciplinary action to be taken in the case of MT errors of this kind.
5. No software safeguards are in place.
6. As is usually the case, training for dictators at the facility also appears to be substandard – GIGO.

Some of these seem like no-brainers, don’t they? I don’t know how anyone can be expected to perform with minimal errors on a new account without any direction or instructions, regardless of how experienced they are. An experienced MT may be able to pick up and transcribe any dictator at any facility – but years of experience is going to give an MT the ability to somehow instinctively grasp account specifics.

This is not a small company, this MT is not an independent contractor. The disciplinary action taken cut the MT’s pay by 20% to 25% yet there’s no written policy in place. No inservice on HIPAA, no training on the account, no written disciplinary policy – but with no warning, the company takes action that cuts pay 25%.

Hello, MT employees – have you asked your employer what the written policy is for your company? What happens when a mistake like this happens? What are your responsibilities? What disciplinary action may be taken against you? What recourse do you have?

Technology being what it is, why doesn’t the EMR software – that same software that immediately routes the transcript to all interested parties upon completion by the MT unless it’s flagged – have some safeguards built in? I realize that EMR technology is evolving, but is anyone doing anything to ensure that copies don’t go to Dr. Carter if he’s not involved in the patient’s care and Dr. Karter is? If not, why not? You’d think that while everyone is out spending money on streamlining the process and reducing labor costs, they’d also be doing something to ensure security is more automated. Even a delay of a certain number of minutes would be helpful (something like the 7-second delay on newscasts), so if errors are caught shortly after the report is completed, there’s some hope of rerouting it before it’s gone out for distribution.

Are MTs paid enough to take on this kind of responsibility? Are YOU paid enough to take on this kind of responsibility? What I see happening is that more and more MTs will send every questionable physician name to QA or to the hospital staff to deal with. Then, someone will get mad – probably at the MTs. Because it seems nobody is willing to hold the dictators responsible. So here’s a tip for all you working MTs out there – unless you’re 100% certain, flag that report. The sooner these questions start piling up on the desks of people who are actually paid enough to deal with PREs, the sooner the problem will be resolved.

This situation was a FAIL of epic proportions, primarily on the part of the transcription service for not having policies in place, by not having in-service sessions for employees to train in HIPAA compliance and on account specifics. Well, shame on management for taking its shortcomings out on the transcriptionist.

MT Exchange

An interesting subject came up on one of the MT boards this week. (I’m not going to give them a link back, because they don’t allow links to other MT sites on their site.)

The MT posting the topic said she’s an independent contractor for an MT service company and was recently notified that if the hospital account she works on goes out of TAT, there is a 15% penalty – so the MTSO is passing that penalty onto the MT contractors.

Huh??

Whether you’re working as an employee or an independent contractor, I have news for you, so MTs – sit up and take notice.

The contractual agreements between an MTSO and client, including penalties for failing to meet turnaround, aren’t your problem, whether you’re an employee or an independent contractor. Unless, of course, you’re the employee responsible for staffing, scheduling and making sure the account stays in turnaround. If you’re an MT (employee or IC) who is just putting in your lines – not your problem.

And MTSOs – here’s a news flash. If you agree to a TAT penalty, it’s your responsibility to meet it – not the MTs who are doing the work. It simply isn’t the responsibility of your contractors or employees to make sure you are meeting the contractual obligations agreed upon between your business and your client.

In my opinion, it’s just shameful for a business to attempt to pass contractual penalties along to the MTs doing the work.

Let’s understand something – being an independent contractor isn’t the same as being a chump. Your IC business may accept TAT penalties from your clients, but they’re agreed upon in advance and you would only agree to them if you have full responsibility – and control – for the entire account. If you’re one of five MTs contracting with a client (because maybe they don’t want to work with a unified service), you would never agree to a contractual penalty for TAT because you have no control over what the other four MTs working on the account are doing. Working on an account for an MTSO as an IC is no different – you have no control over their staffing, their management, their operations management, their workflow process or the other MTs. Why in the world would you accept a penalty because they’re not meeting their contractual TAT?

The post I’m referring to also makes a reference that this is how you treat employees, not ICs. Another news flash – you don’t treat employees like this, either. Would you, as an employee, agree to a policy that makes YOU responsible for the overall TAT of the account? It’s the same story – whether you’re a contractor or an employee, you don’t control the management of the entire account.

Here’s a clue: the people who control the management of the account are the ones responsible. And they should take that responsibility, not pass the buck on to the people who don’t control the process. And it doesn’t matter whether those people are employees or independent contractors.

My advice to this MT is to write a letter to management, pointing out that contractual obligations are being met by the independent contractor and that any attempt to reduce payments will result in suspension or termination of services. Then start looking for another contract.

MT Exchange

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MT Exchange