thank you, Mrs. Peace
Posted By: fed up watcher on 2005-08-18
In Reply to: For nice people only no bashers - Mrs. Peace
It's about time! It's unfortunate that NN couldn't pass a single post without saying something negative, but I still think your gesture is wonderful!
I have enjoyed my day! I love my field! I love my job WITH OSI! I am grateful and blessed!
Thank you, Mrs. Peace! I hope you had a bright and wonderful day!
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God's peace to you. . .
and to all of your followers; you need it.
Conversation with AHDI, or War is Peace
This is a conversation I had with Karen Fox of AHDI via e-mail back in September of 2007, back when I still (naively) thought that AAMT/AHDI was on my side. (I didn't know they were giving special discounts to Indian CMT test-takers!) This is verbatim other than to reverse the order, so you don't have to read it from the bottom up, & the elimination of a couple of names in order to protect my employer.
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ME: I'm looking for a position statement on offshoring somewhere on the site & not seeing it. Can you direct me? What is AHDI doing to protect MTs from this?
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KF: Hi. Where are you from? Do you have a phone number where you can be reached? I have class today so I must focus on transcribing right now but I would be happy to discuss the international transcription topic at a time that is convenient for you.
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ME: I live in California. Offshoring is such a huge issue, one that is affecting every MT & has recently affected me directly. I'm not seeing how AAMT is intervening in any way. Is there something AAMT, or I guess it's AHDI now, has published that will tell me how the dues that are paid in are going toward remedying this? It's funny. When I first started investigating becoming an MT I thought VR would the biggest threat to continuing a career as a transcriptionist. I thought I was way ahead of the game by knowing about this trend & decided that if I thought it was threatening me in any way I would sign on with a company that used it & become an editor. Once I saw how reluctant doctors are to make any sort of change (evidenced by the number still using cassette tapes) I figured I would be out of danger for the time I expected to be working as an MT. But now there's an even bigger threat, one that I did not see or know about until I was already working as an MT: offshore MTs lined up around the world willing to do my job for 2 or 3 cents a line. I can't compete with that & am working my way out of transcription altogether. I work for an MTSO and am paid relatively well by MT standards, but recently the account I work on decided they wanted to have the work done more cheaply & so gave over a huge chunk of the work to ..... who offshores to India. In order to keep her share of the work my boss, the MTSO owner, had to try to underbid them. She has managed to keep her staff by basically eating the difference, but it's only a matter of time before she can't do this & will have to pass the pay cut on to us, & I don't want to be around when that happens.
I'd like to know, though, what AHDI thinks about all this & what kind of lobbying they are doing, especially with the UCSF debacle a few years back having made HIPAA something of a household word. I'm looking at the AHDI website & any reference to any of this is glaringly absent, unless I'm just missing something obvious or am not looking in the right place. If you could send me the link to a position statement I'd be happy to read it.
I do see:
- Patient safety and continuity of care through documentation standards designed to ensure and protect the integrity of patient health data.
- Consistent, secure and confidential capture of, management of, and access to patient health data
- Workforce development in allied health that will ensure resource longevity in healthcare documentation
- Establishment of a national health technology infrastructure to address patient safety, continuity of care, and healthcare delivery costs.
*...address healthcare delivery costs???????????* The entire focus of these 4 bullets seems to be protection of the medical documents, protection of the public, protection of the doctors. I'm not really seeing how the MT is being protected in all this, & it leaves me wondering whose side AHDI is actually on.
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KF: You make some very valid observations and echo what other transcriptionists around the country have experienced. Right now, the real numbers are showing that international transcription is absorbing no more than 5% of the total dictation volume generated by the US healthcare system.
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ME: How do you arrive at this?
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KF: The position that AHDI has taken is to endorse that international transcriptionists must meet the same high expectations of transcription accuracy and standards as we expect and get from a vast portion of our domestic workforce.
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ME: This is ridiculous. All it says is that doctors will now get Pakistani transcription equal in quality to that of a US Transcriptionist and still pay 3 cents a line. If the yearly cost of living for someone in a 3rd-world country is something around what I make in a month, there is no way I am going to be able to compete, & if all you do is raise their standards, you still have not raised their cost of living. They still have an incredible margin with which to outbid American companies.
*****
KF: Another reality is that international transcription has created a huge market for transcription editors and higher QA expectations much like speech recognition has. We have also discussed international transcription in our legislative interactions as many of our state and national policy makers have no clue we have international transcriptionists. I have attached a joint statement made back in 2004 when the UCSF transcription issue made headlines. At that time, Senator Figeroa wanted to close down the California border and not allow any transcription to be performed outside of the state. This was not a practical response. The fact is – we are a global economy. Add to that, if you want to limit international transcription so must you limit outsourcing transcription,...
*****
ME: why? Why is it necessary to limit outsourcing within the US as well? I'm not seeing the connection.
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KF: ...outsourcing being a primary source of transcription employment for a huge portion of our members, either as a home-based employees or as independent contractors, some using subcontractors.
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ME: I don't see how these are related. Outsourcing within the US should be fine for anyone. Outsourcing outside the US should not be. You seem to be throwing the baby out with the bathwater.
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KF: What we can ask for is full disclosure of where the transcription is being performed – we have those rules in place; they just need to be enforced. What we can ask for is for our domestic MTs to raise the bar and become credentialed to meet the work force need.
*****
ME: I became a CMT but did not renew, for quite a few reasons. My MS in physiology means more to my employer than a CMT. I can teach most of the courses required to renew, & I am so busy living from paycheck to paycheck, I don't have time to write down the literally hundreds of pages of surgical technique on equipment manufacturers' websites that I have read cover to cover, or the e-Medicine account I maintain to read in-depth accounts on every medical condition I come across, or even the MS Word users' websites I frequent in order to become ultra-skilled at MS word. Besides which, at this point I don't really want to support AAMT. I really do feel that your position is completely lukewarm and not representative of your actual constituency, the MTs.
*****
KF: We may not be able to compete on price or on Turn Around Time but we can compete in the arenas of skill and knowledge and show how that skill and knowledge can actually save companies money in the long run.
A bigger threat to our industry and most importantly patient care (after all, that is the business we are in is to provide the highest quality documentation that affords excellent patient safety and care and lower risk management issues) ...
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ME: That's the business I am in, definitely. And as an MT it's the business you are in. But as an AAMT representative, it's not the business you are in...
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KF: ...besides international transcription is the input from point-and-click technologies, clinician data input with no editing prior to finals being signed, speech recognition reports with no editing before finals, the merged electronic health record that may exponentially repeat a medical error that is now currently housed in one institution in one paper document, an EHR that contains no narrative that affects clinical decision making – these things are a focus of our association and its leaders as far as how to secure a place for the knowledge-based transcriptionist in the healthcare documentation domain.
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ME: AAMT's business was, or so I thought, to represent MTs. Liability-wise, it's the doctor's responsibility to ensure the quality of the document in terms of whether s/he chooses to use a point-and-click technology. If they have made an informed decision as to the limitations, there's nothing you or I or anyone else should be able to do about it. If you mean helping them to make an informed decision, then great, but again, it sounds like you have jumped some sort of fence. You are trying to satisfy too many factions & in the end will satisfy no one. I know many, many MTs who have nothing but negative things to say about AAMT specifically because of the lukewarm stances it takes on the issues MTs are most concerned with.
*a focus of our association and its leaders.* What does this mean? That you think about it a lot? I'm not sure how these ideas are translating into action. Do you lobby the AMA? What is the action associated with these ideas?
*****
KF: You mention a focus on the profession versus a focus on the MT needs. This is intentional and while it may feel unfair to the working MT,...
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ME: It does indeed. It feels like a form of bait & switch, & it's the reason I & so many others don't really want to be associated with AAMT anymore. Did you ever read Orwell's Animal Farm? AAMT reminds me of the pig. (I'm not saying that to be mean, I'm talking about the actual character.) The pig started out representing the masses & got enough power to rise above & became part of the very thing the masses needed help overcoming. This feels exactly like what has happened to the original organization.
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KF: ...another vision includes the broader picture of where MTs fall in the stream of the healthcare client (institutions and the patient) and providing patient care; ensuring we have a place at the table of decision makers and a hook to hang our industry hat on and continue performing our craft. The Association for Healthcare Documentation Integrity (AHDI) – Capturing America's Healthcare Story is committed to development of a professional association poised to impact heath data technology and patient safety and risk management and ensure our industry is a part of the transition into the next age of healthcare and health information exchange.
All of those things may not solve your individual circumstance and I understand that is very frustrating. I truly believe there will be a pendulum swing in the advent of international transcription when companies start really looking at how many times the report must be touched in order for it to be a final product and I think the cost factors will eventually blur. We are going to see a continued increase in documentation and an even higher demand from the client/consumer for accurate and complete records – hopefully with a human interface. We are already seeing some backlash from some the technology in place, point and click and doctor-input narratives, as the physicians are reading the final reports 3 months later upon patient followup and realizing the mistakes and gross medical errors that are contained within that any transcriptionist worth their salt would have caught and changed. We have made MDs look good for a long, long period of time. The pendulum may need to swing around a bit before it comes back to our court but I think in many instances, this is already happening.
I empathize with the plight of your account and the company you work through. You are not alone in losing accounts to international or just larger MTSOs or technology such as speech recognition or electronic input mechanisms. Hopefully you will continue to see value in what the association does on your behalf.
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ME: Continue is not the right word to use here, Karen. I really have not seen what the association does on my behalf for some time, & although I really appreciate the time you have taken to lay all this out, I'm not seeing it now.
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KF: While it may not be the blatant denouncement of internal transcription you were hoping for, perhaps I have given you some other ideas to consider and you will support me and your California and AHDI leaders in the cause.
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ME: Actually, no. What I think, (& I'm saying this in the most fervent, democratic, question-authority voice possible) is that I'm hearing a lot of political double-talk, the likes of which would make anyone in Washington proud, & I don't mean that in a good way.
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KF: In California my primary goal is to build an apprenticeship program in this state so that we can provide a real answer to our workforce need; providing qualified domestic MTs to include those in our military spouse program via the community colleges in California. As Legislative Issues Group chair, another primary purpose I try to achieve is to educate our members nationally so they can tell their unique stories, such as the one you have shared with me, with their elected officials so that ultimately we can have educational programs that invest in this viable career option in allied health much like the international countries are doing and so much more.
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ME: It actually feels like not only are you not denouncing international transcription, it seems like the organization now sees itself as some kind of Peace Corps of transcription. I'm not getting where you think an *answer to a workforce need* is any kind of issue. The MT schools are pouring out newbies. Supply is not the problem; in fact, it's quite the opposite, which is the exact reason it's so hard for MTs to make a living. It's because the supply is so abundant that companies can bid each other down to 4, 5, 6 cents a line & still get resumes.
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KF: I hope some day to meet you. I live in San Diego but I travel extensively throughout California so maybe we can visit face to face one day. Please let me know if you have further questions and I will be happy to try and answer them.
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ME: I think, in truth, that I feel utterly betrayed by AAMT & I'm on my way out of this profession. If you want an earful on what prompted me to write this letter to you in the first place, go to http://forum.mtstars.com/main/v/1/88501.html.
Thanks for your time, Karen.
******
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Peace Corps of transcription. LOL! That
was THE BOMB!! Thanks so much for sharing. We need to be recognized for the highly intelligent and eloquent professionals that we are, and you nailed it! By the way, I canceled my membership as well a while back. Thanks for the great read. Also reminded me that one can never read Animal Farm too many times. The Pig - that was SO great, too. Oh, the burn, yet you did it so honestly and sincerely. Off to read it again! 
Peace will guide the planets! Finally! nm
I'm on Peace River, Shasta and Carolina Pines. Too much work!!. NM
nm
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