Medical Transcription Vendor Ratings..!!

In the latest KLAS Medical Transcription Services Organization (MTSO) study, 3 years of provider ratings and commentary have come together to shed light on the current trends in transcription outsourcing. In the ever-changing world of transcription, the most recent MTSO study found an increase in provider satisfaction, adjustments in offshore vs. onshore attitudes and even more changes in transcription needs and pricing. In addition, providers shared best practices to help others navigate the quickly changing world of outsourced medical transcription.

Improved MTSO Performance
While providers have been satisfied with outsourced transcription in the past, scores rose 4.5 points this year, from 77.2 to 81.7 out of 100. Vendors showing the strongest improvement were CBay and StenTel. Only one vendor, SPi CyMed, experienced a decrease in provider scoring this year.

Overall, Encompass, Focus and StenTel had the highest performance scores of the 13 MTSOs that qualified for inclusion in the main body of this report. Vendor scores ranged from a low of 73.7 to a high of 88.3. See Table 1.

It is interesting to note the changes in vendor scoring between 2006 and 2007. Table 2 shows the shift in performance scores, ranks and commentary since the 2006 MTSO report. Encompass, Heartland, MedScribe, Superior and TransTech did not have sufficient 2006 data and were therefore excluded.

Offshore vs. Onshore
In the past, the offshore vs. onshore debate has been a strongly contested issue. This year, while many are still uncomfortable with sending work offshore, overall perception is improving. Of those not currently having work sent offshore, positive perception has increased by eight percentage points, from 13 percent in 2006 research to 21 percent in this report.

When comparing the average overall performance scores of transcription work performed onshore vs. offshore, not surprisingly, onshore has a slight edge with an average score of 7.6 compared to offshore's 7.1 (based on a nine-point scale, where one is poor and nine is strong). Clearly, though, offshore services are more than satisfactory to those who actually use them.

Faster turnaround, reduced costs and improved quality were significant overall benefits cited by providers using MTSOs. When breaking out benefits by offshore vs. onshore, there are notable differences seen in the area of reduced cost and improved quality. Offshore respondents mentioned cost reduction more than twice as often as other respondents. See Table 3.

Despite a slow increase in positive attitudes, the number of provider organizations reporting the use of offshore transcription services has decreased from 55 percent in 2006 to 38 percent in 2007. However, KLAS believes transcription work being sent offshore will continue to increase in the U.S. based on provider feedback, domestic labor shortages and increasing pressure on health care organizations to reduce expenses.

As can be seen in Table 4, Encompass, MedScribe and TransTech have the highest percentage of work performed onshore, while Heartland, CBay and Acusis have the highest percentage of unique provider organizations that use offshore services.

In addition, providers have begun to evaluate if editing services should be engaged domestically or offshore. KLAS has observed the beginning of acceptance of offshore transcription but preference for domestic, onshore editing. Providers who accept offshore transcription expect the editorial staff to be onshore to enhance the language proficiency, but there is not sufficient experience to determine the extent at which this is occurring. Some providers indicate they are willing to redirect some of the speech recognition operational cost savings to shifting offshore MTSO work back onshore.

Needs and Pricing
The need for transcription is increasing due to 1) electronic medical records and the need to populate them quickly and 2) speech recognition services needing editing on the back end. For these reasons, many MTSOs are increasing their capacity.

While providers' needs are changing and increasing, pricing is also changing. Charging per line continues to be the most popular algorithm used, with 67 percent of the respondents using this method, down from 81 percent in the 2006 study. The number charged by Visual Black Character (VBC) has grown to 23 percent from 12 percent in the 2006 study and VBC is the emerging industry standard. Two percent indicate being charged on a per minute basis while 8 percent are charged by project, report, page, exam, average report or a flat fee based on historical volumes.The average transcription price ranges from 11.9 cents to 13.2 cents per line, depending on whether the services provided are onshore, offshore or a mix of both. Pricing depends on the expected turnaround time and whether the line is being transcribed or edited. (Editing often costs less than transcription.)

Consistent with the 2006 findings, the onshore/offshore variable and the total number of lines outsourced to be transcribed/edited per year were less significant than turnaround time (TAT), guaranteed capacity and the mix of transcription/editing in determining cost.