American College of Physicians: Internal Medicine — Doctors for Adults ®


How to make the most of your transcription dollars

Changing your dictation style can help you lower your transcription expenses

Copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Gina Rollins

Transcriptionists have plenty of tales to tell. They transcribe records for physicians who eat, discipline their children and even carry on conversations while they're dictating.

As a harried doctor, it's not unusual to dictate anytime, anywhere-in your office, at home, or even in your parked car outside a hospital with ambulance sirens blaring in the background. Besides dictating in bad acoustic environments, some physicians have bad speech habits: mumbling, breathless speed talking, and perhaps worst of all, pronouncing every single punctuation mark.

However imperfect it may be, dictation-and the transcription that follows-is a vital practice function. It can also be a big part of practice budgets. A survey conducted by the Medical Transcription Industry Association (MTIA) found that on average, small practices with one or two physicians spend $24,100 each year on transcription. Groups of three or more physicians average $162,400.

Transcriptionists say that by improving your dictation, you can help lower those costs. They offered the following tips to help you get the most out of your documentation dollar:

  • Dictate well. To improve the quality and efficiency of your dictation, start by finding a quiet area where you can focus on the task. Remember that background noises come through loud and clear, and that dictating late at night when you're tired can take much longer for you and the transcriptionist.

    When you start to dictate, identify the patient and the type of report that you want the transcriptionist to generate. You can also save some time and money by giving the transcriptionist an overview of all the reports you are going to dictate for each patient and identifying common elements between them.

    "Doctors may dictate a chart note and then a letter to the patient's referring physician," said Molly Malone, executive director of MTIA. "But the body of the letter is often basically the chart note. So if the doctor says 'Utilize the chart note for the body of the letter,' he or she only needs to dictate the beginning and end of the letter."

    Claudia Tessier, chief executive officer of the American Association for Medical Transcription in Modesto, Calif., said that "the best dictation is pronounced clearly, at a normal speech rate. Too slow may be even worse than too fast. Provide punctuation only when it's really necessary and spell only the words that require spelling, such as new terminology or medications."

  • Use templates. Establishing standard verbiage for normal findings in various system reviews and procedures will also save you time and transcription expense. George P. Rodgers, MD, president of Austin Heart, a 25-physician cardiology practice in Austin, Texas, said he uses a template to dictate interpretations of echocardiography results. "Instead of stating all the normal findings," he said, "I note only abnormalities or problems."

  • Provide feedback. While giving transcriptionists feedback will help improve their performance, it's something that physicians don't do nearly enough. Ms. Tessier described a common situation: "When the transcriptionist either doesn't understand or doesn't think the word she heard fits the context of the sentence, she leaves a blank. Often, the blank is filled in later in the office, but the information doesn't get back to the transcriptionist. That's a missed learning opportunity."

  • Talk to your transcriptionist. Consider quarterly meetings to review performance and talk about ways to increase efficiency, particularly if your dictations tend to be lengthy. Gwen Hughes, practice manager for the American Health Information Management Association in Chicago, suggested asking whether you're supplying the language to satisfy third parties like payers. She also suggested asking transcriptionists to suggest ways you can streamline your dictation. "Some doctors over-dictate, some under-dictate," she said.

  • Articulate your transcription needs. High quality and fast turnaround are important whether you use internal employees, outside contractors or a combination of the two. If you're considering making a change, first analyze how you're currently using transcription.

    What's the overall volume? What types of reports are you generating? Who makes copies and prepares envelopes, the transcriptionist or your office staff? Understanding your usage patterns and needs will help you structure the best configuration without experiencing costly surprises down the road.

    Finally, remember that outsourcing doesn't mean you've washed your hands of transcription issues. You should go through an extensive request-for-proposal with more than one organization, and contracts should specify everything from the definition of 24-hour turnaround to the methodology used for storage and retrieval of completed transcripts. Payment by line count is common, but before signing on the dotted line, have several samples run through the potential vendor's system, and get in writing the definition of a line, Ms. Malone said.

Gina Rollins is a freelance writer in Silver Spring, Md.


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