What does the Medical Transcription Industry Sell?

Are you selling what your healthcare provider customers want?

Do your customers know what they want?

The average MTSO does not differentiate between the service levels it offers its customers, except perhaps to price differently for tighter TATs and sometimes for the methods used to produce the documentation.

But how many MTSOs consider actual documentation service levels beyond TAT and quality when selling, implementing, and servicing a customer?

How many bill differently for differing levels of documentation service?

Even more interesting – how many MTSOs pay the MT  differently based on these same levels?

What do I mean by documentation service levels?

When it comes to clinical documentation, a healthcare provider (even if they don’t realize it) is usually looking for one of the following – or something somewhere in between:

  1. The lowest-cost line
  2. Meaningful documentation and EMR readiness
  3. Premium level service  – customization according to individual preference

The following will help you to determine the healthcare provider’s goals, and how to accommodate them in a way that makes financial sense.


Requirements and Specifications

There are providers out there, despite all the fuss about the EMR and meaningful use, who are –  let’s face it – only interested in how low that price can go. In fact, cost reduction is often the driver behind a provider who adopts a technology hoping to reduce or eliminate transcription. The dollar is all they are worried about.

To achieve the lowest-cost line, the focus for the use of speech recognition in the production of transcription needs to be on producing draft text that requires –

  • The fewest edits possible
  • At the lowest implementation cost

For the lowest-cost line, rules to handle content should be “as dictated”  or “verbatim” whenever possible. MTs should not deviate from verbatim transcription/editing unless what the doctor said is actually incorrect. They should not over-edit. The hospital should be told that in order to achieve the highest productivity and lowest cost line, they need to accept true verbatim transcription (unless of course what the physician says is actually incorrect).

What this means is that changes that might be made to the draft text for other service level types shouldn’t be made – if you are selling (and being paid for) the low cost line, you’ve got to deliver the low cost line! This means the onus for the content of the document is placed on the physician – not on the MT as it often is.

At a high level, this means the provider gets the sections and subsections they dictate, in the order dictated. They get numbered lists when explicitly dictated. They get abbreviations and acronyms as dictated. If they dictate clipped sentences, they get clipped sentences. They get document formats that are easy and cheap to implement, and which do not interfere with speech recognition.

Yes – many requirements of this type can be automated in some systems.

But remember – selling the lowest cost line does NOT mean focusing ONLY on decreasing the MT cost per line! It also means decreasing implementation and other support costs.

Selling the lowest cost line while maintaining high implementation and support costs means your MT payroll is taking the entire hit for the low cost line – and come on everyone, how low do you think MT pay can go if you still expect to deliver quality?

When offering a low-cost line, it is not cost effective to require the MT to lose productivity by performing manual formatting tasks.  It is not cost effective to pay implementations staff to create custom templates.


This type of implementation when done effectively will result in the fewest edits, highest MT editing productivity, and lowest implementation costs.


An MTSO providing the lowest cost line option to a hospital MUST require that hospitals comply with the requirements agreed upon during contract negotiations.

Sometimes a hospital agrees to requirements to get the lowest price, but after go live will request customization based on physician preference. “Can you please make this exception just for Dr. Smith? Just for Dr. Jones? Just for Dr. Miller?”

And before you know it – you’ve got a custom implementation for which you’re being paid a rock-bottom price!

The MTSO who gives into these requests while providing the service at the lowest price will find itself providing a high-cost product at a losing price. Implementation cost will increase, MT productivity will decrease, and the MTSO will lose.

And before we go on to the next service level – please folks – don’t let anyone tell you that “verbatim” transcription is the same thing as application of standards.  The only time “verbatim” means “standards” is if the physicians all, always, dictate according to standards. Which of course (ahem) they all will, right?

“Verbatim” transcription is often the furthest thing from useful standards there is…


This option is the one most encouraged by me  – and by my employer M*Modal.

The goal here is to create standards that increase the usefulness of documentation. Emphasis is on the value of the clinical information within the document, rather than on the individual document itself.

  • Physicians and clinicians know what content to expect in every document improving ease of use for patient care – EVEN if they are not the author of the report.
  • Coding and other HIM activities are easier because variation in clinical vocabulary is normalized.
  • Coding and other HIM activities are efficient because content requirements are designed to ensure that the clinical event is appropriately documented.
  • There is less re-work in the HIM department and less need for additional physician querying to collect information needed for coding and billing.
  • Compliance with the above and with JCAHO and other requirements can be reported on and enforced.
  • There is less risk of physician or MT error when deviation from standards is not allowed.
  • Documents are more useful in an electronic environment because they can be more readily structured and encoded for EMR consumption. An EMR cannot make use of data that it does not understand.

Content requirements should be based on industry standards, such as that provided by the Health Story Project (CDA4CDT).

In general, requirements should be designed for usefulness and value; not based on individual preference, and should be consistent across every work type.  Emphasis should be on effective and useful display of content; not on aesthetics. Use of hanging indentations, complicated tables, graphics, use of special characters, formats that differ from work type to work type, physician to physician, or from one section of a document to another, should be weighed against the usability of the information.


MTs for these accounts may take a slight productivity hit since they will on occasion need to make changes to the draft text that they would not have to make for an “as dictated” account.   Implementation costs for this service offering are low, but MT compensation plans should be mindful that MTs may not be as productive on these accounts as they are on true “as-dictated” accounts. Physicians do not often dictate according to standards even when willing to accept them.

In general, when considering requirements for clinical documentation, the question “does this requirement make the document more valuable for patient care, for HIM or other healthcare constituent purposes, and for use in the EMR” should be asked.  If the answer is no – don’t do it.


There are times when it may be necessary to cater to individual physician or departmental preference, even if the preference is of no particular value.  Though this is never the optimal method of creating useful documentation, it may be necessary from time to time in order to satisfy that very demanding customer.

NOTE: Be aware that your competitors are continually presenting your customers with low cost options, which the provider may accept even if that option requires them to give up customized requirements.


Style Specifications

  • Section and subsections per preference – regardless of what the physician dictates.
  • Selections for style according to preference – again, often regardless of what is dictated.
  • For productivity purposes, “as dictated” MAY apply – but only if physicians actually accept verbatim transcription.  Many times, “as dictated” hospitals actually require a great deal of manipulation that contradicts the “as dictated” requirement. Examples:
    • MTs are asked to put medications and procedures in numbered lists even if physicians clearly dictate in full sentences.
    • MTs are asked to create section or subsection titles that are not dictated.
    • MTs are told “if Dr. Smith dictates xyx, type abc”.
    • When setting up the requirements for speech recognition, be sure the customer really wants “as dictated” before selecting “as dictated” options.
    • Format requirements are based on individual preference. Meeting these types of requirements usually decreases MT productivity, since MTs will be expected to comply regardless of what is dictated.  Or if the requirements can be automated, they will increase implementations costs because of the more time-consuming set up.


MTSOs providing this level of service must be aware:

  • This level of service almost always contradicts meaningful, useful documentation since compliance cannot be enforced and is not reportable –
    • You can’t enforce compliance if there is nothing to be compliant with.
    • Customization is expensive to set up and to maintain.
    • MTs who edit documents requiring a great deal of customization will not be as productive as MTs who work on accounts who want the lowest cost line, or who have standard requirements.
    • Expectations for productivity and compensation should be adjusted appropriately.

In summary – keep this in mind as you sell, implement, and produce work for your healthcare provider customers.  To retain the healthcare provider customer in today’s competitive and changing market, you must get your hooks into them.  You’ve must become a necessity  – irreplaceable.

Create hooks:

  • Competing on price rather than on more useful documentation increases the risk of replacement by the next vendor to offer the same service at a lower price.
  • Providing more useful documentation allows you to get “hooks” into the facility, making replacement by another MTSO or a technology more difficult.
  • Get your hooks in everywhere you can – through technology offerings,  USEFUL service levels, expertise, and knowledge of how the provider uses the documentation.
  • Competing on traditional differentiators such as price, “quality”, and TAT increases the risk of lost business.

Always remember:

You are not differentiating yourself by offering customization and individual user preference at a low price!

If I had a dollar for every MTSO who has told me that their willingness to provide custom requirements is their “differentiator”  I’d be…well, I’d have a whole bunch of dollars.   🙂

Guess what folks – if everyone offers the same “differentiator” – it ain’t a differentiator.

Even if this strategy helps you win the healthcare provider customer  – will it help you retain them?

When the next MTSO offers them the same TAT , quality, and custom requirements at a lower price….

Or when a technology vendor tells your customer that they can eliminate transcription costs entirely….

What reason does the provider have to stay with you?

Til next time,


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