Click here to edit subtitle

Focused Action Forums

Improving Working Conditions

Posted by Moderator MT Coalition on November 17, 2017 at 1:50 AM

Home-based workers in MTSOs have indicated improvement needs in the following areas:

1. Market-based wages comparable to peers in healthcare organizations commensurate with the education, skills, and knowledge required for similar positions (Reference Bureau of Labor Statistics).

Many healthcare facilities employ telecommuting MT/E employees, and pay at the same rate as their inhouse employees.  Traditional, in-office positions do not factor in commuting or office wear into their salaries, and this should not be used as a reason for reduced pay.  Employers realize savings from reduced office space expense, overhead, and in many MTSOs, equipment, furniture, references, and telecommunication costs.

2. Hourly wages that include currently noncompensated time for adding demographics, researching terms and names, training, correspondence, QA review feedback, timekeeping, breaks, etc.

3. Working conditions such as those found in #2, that reduce the negative impact of continuous, repetetive, robotic work such as repetetive strain injury, fatigue, and reduced focus leading to errors and reduced productivity. 

4.  Affordable, customary, market-based benefit packages.

5. Performance incentives, if used, are beyond hourly wages to reward additional and exceptional effort, and are not punitive by wage or benefit reductions. Workers can count on their wages and benefits remaining stable until uncorrected poor performance results in transfer or termination.

6. Performance metrics are reasonable and weighted for the complexity and/or variability of work performed, and the time and effort required. Measurements are transparent, verifiable, and nonmanipulated.  Workers can easily check and self monitor productivity, work volumes, and turnaround, and verify quality reviews and challenge results.

7. Performance metric feedback is given at reasonable intervals so that they become meaningful and productivity enhancing versus micro-managing, reactionary versus self adjusting over time, and productivity sapping due to stress (e.g. monthly or quarterly as opposed to daily to biweekly, particularly for experienced workers versus the novice and/or those in new account training).

8. Individual metrics should not be rigidly applied, rather used as guides and goals to identify overall needs in coaching, training, and performance rewards or improvement.   Metrics should factor in extenuating or changing circumstances, variable conditions, and be balanced with other metric measurements (production, quality, attendance, team effort, etc.) for an overall individual contribution.  

Having the ability to monitor every keystroke, pause, and error doesn't necessarily mean it should be done or is an accurate or effective means of human resource management.  A shift to a focus on overall team performance, company turnaround time results, and quality may be effective.

9. Work assignment changes due to account changes should be weighted as ramp-up time in performance measurement and compensation systems.  Production credit is given for computer-caused retyping and speech recognition jobs that become essentially straight typed.

10. Access to coworkers, managers, technical assistance, and trainers with collaborative input into work processes, performance measurement, feedback, and compensation.  Workers know their processes best and how well technology and systems actually work for them.  They should be involved in systems design and process and performance measurement, rather than persons far removed from the process. 

Training materials and company information should be uniform, current, and easily accessible.  Communications should be efficient and timely including response to questions and notification of stat work via messenging systems.

11. Work relationships based on mutual respect, trust, and collaboration, rather than statistics, authoritarianism, and fear.  Remote location workers, effectively managed, should not require more stringent monitoring and micromanaging, or reduced pay and benefits than in-office workers.  

12.  Annual review of wage rate with cost of living adjustment. 

13.  Protections from employment or contract termination due to account losses with provisions for transfer, job reassignment, severance pay, etc.

14.  Use of ethical outsourcing methods:  Promises to healthcare organizations as to quality and productivity gains should be realistic, verified, and specific to each MTSO, account, platform, and workflows. Organizations should understand that human error occurs, and that excess customization in an outsourcing environment with rotating workers working across multiple healthcare accounts adds to the likelihood of error as opposed to a steady and stable workforce.  Complaints by customers are often factored into MT/E metric performance, which may not necessarily be a worker issue versus a sytemic issue. 

Outsourcing healthcare organizations should be aware that promises as to pay and conditions for their outsourced former employees may not last once employees are absorbed into and reassigned within the MTSO.  Outsourcing organizations should specify in contracts and verify that all workers on their accounts are receiving market pay and fair working conditions.  MTSOs should provide transparent evidence of fair billing and compensation methods to outsourcing organizations and their employees or contractors.  

Offshoring to other countries, which can increase the labor and costs required to train and supervise workers, pose increased risks to quality, security, and privacy, and be more difficult and expensive to enforce HIPAA/PHIPA and other privacy laws, should not be used as a means to avoid market base, living, or minimum-wage wages, and is inconsistent with public interest in supporing local and national economies.

15.  There are existing studies which identify the negative impact on employee morale and performance when they are in a punitive atmosphere, or impoverished and/or underpaid in comparison to equivalent peers for the technical knowledge, skill, and responsibility required (impact on patient care and HIPAA/PHIPA).

From 8 Principles of Collaborative Leaderships: "Treat people like human beings, not human resources. People are not assets. They are human beings. Without them, there is no organization. The health and well-being of your team or organization is dependent on the health and well-being of its members."

"I pity the man who wants a coat so cheap that the man or woman who produces the cloth will starve in the process."   President Benjamin Harrison

Without being company specific here, what would you add or modify to the above identified needs that you want to become the standard in existing or future MTSOs?  

Please share your thoughts and ideas in the comments above (or via the contact form).

Categories: Improving Working Conditions

Post a Comment


Oops, you forgot something.


The words you entered did not match the given text. Please try again.

Already a member? Sign In


Reply lynneallyson
4:19 PM on December 4, 2017 
There would need to be cost of living increases yearly included in the work contracts we sign.
Reply lynneallyson
6:50 PM on December 8, 2017 
About working conditions for ICs, I am alarmed/appalled at the job postings I see of late for openings for ICs but with schedules like an employee. If you want someone to commit to a stringent schedule on a regular basis, you need to hire an employee. True IC would mean no set schedule in my opinion, though if you want a steady stream of work, you need to available, just not necessarily in the strict employee sense.
Reply MTE Activist
1:31 PM on December 9, 2017 
#2 could add noncompensated time to fill in patient demographics and research terms, physicians, community resources.
Say more about types of benefits, affordable health insurance, timeoff, etc. Benefits should not be held or reduced with flucutating metrics/ training time while working on improving metrics, changing accounts, etc
Quality reviews should be able to see the original report and corrected report with the ability to relisten to dictation and challenge the finding.
Reply CMTatwork
1:47 AM on January 25, 2018 
Just joined. Amazed this site has so little activity but sounds like we ae all in the same boat. I took the liberty of writing AHDI yesterday (see e-mail at bottom of this post) and received the expected lots-of-nothing reply. Very discouraging. Need to trace AHDI loyalty.

Sheila Guston, CHDS, AHDI-F

Association for Healthcare Documentation Integrity.
4120 Dale Rd., Suite J8-233

Modesto, CA 95356

Dear Ms. Guston:

As I sit here at my computer in the wee hours of the morning, as part of my continuous around-the-clock work as a Certified Medical Transcriptionist, working for an MTSO, I am wondering where this profession is headed.

I received your group e-mail in October 2017, informing me of the "slight increase in 3-year recertification fees effective January 1, 2018." I am wondering where I will come up with the funds for this.

Also noted in your e-mail, "It is our pleasure to serve you."


How are you serving me?

Does my CMT mean anything to anyone other than ADHI being able to render "a slight increase" in the cost for that certification?

I have been in the medical transcription and editing field for over 25 years. In that time I have seen my "title" changed from a spectrum of medical transcriptionist to medical language specialist, to whatever the flavor is for this year. To what end? Is that how ADHI is serving me?

I have seen my average hourly rate now plummet to BELOW MINIMUM WAGE in the state in which I reside. That being across the board it seems with all the MTSOs. It is unclear to me why, as independent contractors, our line rates dropped from 0.8/line (or less) to 0.4/line (or less) for editing in a matter of just one month. That is across the board. If you do a quick search of such on-line sites as you can verify this.

If ADHI really wants to serve your members, do an investigation as to why this has happened? Who is reaping those profits? Do we have any recourse? When a company demanded that I sign a new contract LOWERING my line rate, did/do I have any recourse?

The national cost of living goes up every year, yet I have not seen a line increase since I began this line of work over 25 years ago - rather, I have seen MANY decreases, now to the point of, again, earning less than the minimum hourly pay in my state of residence. How do I get by? You cannot even begin to imagine.

I believe I speak on behalf of the community of medical transcriptionists, medical editors, whatever title you want to bestow on us, that we demand some assistance in our plight and your association should be at the top of the list in providing that.

Reply CMTatwork
1:48 AM on January 25, 2018 
Reply from Shelia to my e-mail:
Hi Denise ? thank you for reaching out and sharing your questions and concerns.

You are certainly not alone in wondering where our profession is headed as ?traditional? dictation/transcription continues to decline or be outsourced. ?Healthcare Documentation Specialists? (the term is inclusive of a more broad array of expertise and skills than ?medical transcriptionist? alone) have increasingly seen the need to expand their skillset and look outside of ?traditional? medical transcription skills alone to remain viable now and in the future.

AHDI is acutely aware of what is going on in the industry today and working diligently to understand the changing needs of our members. Leigh Anne Frame, AHDI President, spoke directly to how AHDI serves its members at our recent Town Halls. Allow me to share her comments here:

AHDI serves its members by fostering a professional and collaborative community to support careers. AHDI works with the knowledge and talent of members to develop evidence-based, best practices in clinical content capture and reconciliation. AHDI tries to amplify and elevate the roles and contributions of healthcare documentation professionals in the healthcare environment. And AHDI educates members and advocates for the need of credentialed professionals. These are just a few of the ways AHDI supports you and the work you do.

I would be remiss if I didn?t mention the numerous challenges facing healthcare documentation specialists and the transforming healthcare documentation profession. Namely, the evolution of the electronic health record with voice recognition technology, outsourcing of jobs, domestic and global, and the resulting economic pressures.

Let me say first off that with as much as AHDI may want to intervene with employer disputes over wages, we cannot--AHDI is not and never will be a labor union. But AHDI has tried to anticipate and prepare for emerging trends and changes in the industry by developing a Career Map as a guide to help you move forward in your career in the Healthcare Documentation field by using your existing skills and knowledge base to position yourself in new and changing roles in the industry. Additional continuing education may be needed, but your current knowledge and work experience give you a step up.

AHDI also provides career resources and networking opportunities for members to help you prepare for a successful career in healthcare documentation.

I realize that at a time when many of our members are struggling with decreased work and lower wages, that increased costs, no matter how small, will never be welcome news. We are committed to keeping costs as low as possible and very rarely increase membership dues, conference costs, or credentialing fees. We would be financially remiss, however, if we did not ensure we are able to cover costs and continue to provide the benefits we do to our members.

If you have any suggestions on other ways we can assist our members, I would be extremely open to hearing them! We need people who are passionate about this industry to help us shape the future of what this association looks like and what it can do. So, again, thank you for reaching out. I will certainly share your concerns with the National Leadership Board.

Sheila I Guston, CHDS, AHDI-F

Interim Chief Executive Officer

Association for Healthcare Documentation Integrity

Reply Moderator MT Coalition
12:10 PM on January 25, 2018 
It is disappointing about AHDI. We received a similar position from them about labor issues, and so are consulting with other labor experts to guide our efforts in working with MTSOs. Many who are employee status in MTS0s report a line reimbursement of 0.4 for speech recognition and 0.8 (or so) for straight transcription, so it may be they are changing rates for IC status. Could you say more about your contracts for IC conditions, requirements, and rates so that we can incorporate their unique needs? Regarding activity, many prefer to send their comments via the contact form rather than on the forum comments, and so we add them to working conditions, other forum content, and/or MTC activity as applicable. Thank you for your comment!