ahdi 2010

Transcription for the Future

ACE 2010

All information methods and concepts contained in or disclosed by this document is confidential and proprietary to Multimodal Technologies Inc. By accepting this material

the recipient agrees that this material as well as the information and concepts contained therein will be held in confidence and will not be reproduced in whole or in part without express written permission from Multimodal Technologies, Inc. Client use of M*Modal

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Company Confidential

Agenda

What is transcription and why is it still relevant?

The Career-Minded MT

Managing for efficiency

Transcription Innovation in the World of Meaningful Use

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What is Transcription?

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Company Confidential4

Electronic Health Record Universe

Two opposing needs

Enterprise need for structured and coded information capture

Physician’s practical need for a fast and easy method for creating clinical notes.


The Current Situation

Tedious manual process,

Time-consuming,

Documentation lacks expressiveness of natural language

Transcription can be expensive

Subject to longer turn-around times

Clinical data lost, because documents are neither structured nor encoded.

Direct Data Entry: Structured and encoded information.

Dictation: Fast and easy, expressive.


Substance V Form – Dee Hock

“Substance is enduring, form is ephemeral. Failure to distinguish clearly between the two is

ruinous. Success follows those adept at preserving the substance of the past by

clothing it in the forms of the future. Preserve substance; modify form; know the difference.

The closest thing to a law of nature in business is that form has an affinity for expense, while

substance has an affinity for income."1

1 - Waldrop, M. Mitchell. (October 31, 1996). “Dee Hock on management.” Fast Company. Retrieved from http://www.fastcompany.com/magazine/05/dee2.html , December 18, 2007

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Reality

Medical Transcription is competing with –

• Front-end speech recognition

• EHR – Direct entry

• Front-end speech rec

• Templating

• Direct data entry

Hospitals are looking for the most cost-effective solution…

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Changing Face of Documentation

Back-end speech recognition

Front-end speech recognition

Dictation and speech recognition

Direct into EMR

Eliminates transcription costs

Direct data entry

Physician data entry into fields of EMR

8 M*Modal Proprietary and Confidential


Transcription and Editing

Backend speech recognition plus MT editing

• Efficiencies and cost savings

• Cost avoidance

• Comprehensive and complete documentation

• High adoption by physicians

• Pricing opportunities

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Value of Narrative Dictation

Doesn’t interfere with the doctor’s day

• Where and when he wants to do it

• Lots of information in a little bit of time

• Comprehensive information

• Documents intuition and inclination

• Physician behavior modification -

None!

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Physician Adoption

We can’t rely on lack of adoption to save us for long…

Power shift - Physician to CFO

Physicians will eventually be forced

Alternative methods -

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The “Scribe” Strategy: Could You Use a Scribe?

Are your patient encounters hampered by incessant charting and documenting? Perhaps a medical

scribe can help.

By Shirley Grace

http://www.physicianspractice.com/display/article/1462168/1590060

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http://www.physicianspractice.com/display/article/1462168/1590060


The “Scribe” “Rather, they allow the physician with whom they work

to shift his focus off of his tablet PC or paper chart to his patient. Specifically, a scribe is responsible for:”

Patient histories

Transcribing exams and orders

Documenting procedures

Follow – labs and x-rays

Recording discharge information

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The CDI Specialist

Evolving role…

“More important than coding”

“…pharmacology; knowledge of official medical coding guidelines, CMS, and private payer regulations related to the Inpatient Prospective Payment System; an ability to analyze and interpret medical record documentation and formulate appropriate physician queries; and an ability to benchmark and analyze clinical documentation program performance.”

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The “Chart Reader”

“…when Dragon Medical was integrated with the organization’s EHR, emergency department (ED) transcription costs went from $1.4 million per year to zero.2

2 - Shepherd (July 22nd, 2009) Vive La Voice. For the Record. Vol. 21 No. 14 P. 24

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Value of Narrative Dictation

CMS reduction in hospital base rates

Clinical Documentation Improvement

MS-DRG for coding - reimbursement

Specificity requires documentation

ICD-10

POA indicators

RAC review

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Reimbursement

MS-DRG1

• Uncompensated CHF with

• COPD - $4,820

• Obstructive bronchitis and acute exacerbation

• Acute respiratory failure - $6,921

• Difference of >$2,000 (base rate of $5,500)

• For how many patients per year?

1 - Pam Wirth, RHIA and Kerry Chase, Amphion Medical Solutions, April 23, 2009, The

Impact of Coding and Increased Demands on Specificity in Healthcare

Documentation. MTIA

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The Career Minded MT

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The Career-Minded MT

Professionalism

Remote workers

Scheduling

Productivity based pay

The Independent Contractor

The “hobby MT”

I’m not budging

Compensation

Training and education

Credentialing

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Measuring Success

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Increased % gain is only one metric to be monitored! Increased OUTPUT = organizational efficiencies!

FACT!!MTE 2 with a 50% gain will produce 450,000 more lines over the course ofa year than MTE 1 with a 125% gain!!!


Output versus “% Gained”

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Managing for Efficiency

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How Do You Measure Productivity?

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Workforce Management

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Workforce

Management

Output –not “% Gain”

Editing –Typing

distribution

FTE/PTE work

assignment

Gap Analysis

Headcount Impact

Output – not “% Gain”

Editing – Typing distribution 75% rule

Use productive typists

FTE/PTE work assignment

Total efficiency – Headcount impact Gap analysis Assign editing to high producers


Performance Management

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Performance

Managemen

t

Effective

Training

Weekly

Mentoring

Most-Common

Edits

KeyboardShortcuts

Final Document

Quality

• Monitor final quality

• Effective training

• Ongoing Mentoring

• Basic editing skills

• Can your MTEs quickly –• Create sections/subsections• Create numbered lists• Replace incorrect text• Insert text


The Value of Training

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Innovation for the Future

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The New Buzz Words

Meaningful Use

Structured Data

NLP

Validation

Reconciliation

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Back to Basics

Valuable Implementation

Meaningful Documentation

Useful Documentation

Partnership

Be the expert

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Document Elements

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Meaningful Documentation

Old Ways

• Sacrifice content for productivity

• “You get what you say”

Or

• Customization

• Invisible service provider

• Focus on print format

• Reactive to complaints

New Way

Standards based on usefulness

Expert service provider

Focus on content

Proactive to needs

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Standard Content

What content is required in each document type for –

• Patient care

• Coding and billing and revenue cycle tasks

• Compliance

• CMS

• Pay for performance

• Quality improvement – PQRI

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Service Level Options

Lowest Cost Line

Optimal Cost Reduction

Meaningful Clinical Document

Useful clinical documentation

EMR readiness

Useful documentation

Premium Service

Retention of demanding difficult customer

Customization

Keeping speech invisible



Lowest Cost Line

Attract the low-cost seeking customer

Retain the high-priced existing customer

Financial incentives to hospital

Driven by draft quality

Hospital requirements changed to accommodate

Transcription “as dictated”

Most accurate drafts

Highest productivity

Involved at typing stage if possible



Meaningful Clinical Document Standards based on useful content

Highest quality for patient care

Compliance CMS

JCAHO

Ease of use for healthcare providers Physicians

HIM

Risk management

EMR readiness The Health Story

Content requirements

CDA4CDT

HL7 CDA

M*Modal Proprietary and Confidential


Premium Service Offering

Keep the demanding customer

Speech invisible to hospital

Customized requirements

Expectations for productivity adjusted

Optimal account implementation including

DMs to the work type and physician level

Rendering automation

Requires highest level of MTE skill

Appropriate MT compensation

Appropriate hospital billing



Premium Service Offering

Cost Impact

High-cost implementation

Customization =

Lower productivity

Higher transcription production costs

Higher implementation cost

Lowest productivity benefit

High-range line rates for MT

Value proposition

Invisible to healthcare provider

Satisfy demanding physicians37


Speech Technology and Pricing

Warning!

Beware of demands for customization at the price of a low-cost line

Don’t provide a Cadillac for the price of a bicycle

Educate customers about what they are paying for

Would they rather pay for –

Physician specific preference

Meaningful Clinical Documents

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Transcription and the HIM

Re-connect with your HIM roots!

What are the documents used for?

Are they used for coding?

If not, why?

What works?

What’s missing?

“What can I do to make this document more useful?”

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Coding – ICD-9-M

Wanted – more documentation!

3 – 5 digit codes

Additional digits add specificity

“unspecified” is bad

Severity indicators - resource consumption

CC – Complications and Co-morbidity

MCC – Major CC

MS-DRG

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Coding – ICD-10

And even more documentation!

~ 5x the number of codes

Lots more specificity required

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The CDI Specialist

The value of complete, comprehensive information…

How can transcription help?

“ICD-9-CM Coding Essentials: What every CDI Specialist needs to know”

CCDS credential

Focus on documentation affecting the DRG (diagnosis Related Group) and payment

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Standards for the future..

The Health Story

www.healthstory.com

CDA4CDT

HL7 CDA

More than electronic standards – think content standards!

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http://www.healthstory.com/

Questions?

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ahdi 2010

Documents

fast company

company confidentialwhat

company confidential45

encoded information

speech recognitiondirect

information methods

itlots of information

timesclinical data