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Monday, February 28, 2011

Outsourcing general surgery medical transcription

General surgery is a surgical specialty that focuses on abdominal organs, e.g., intestines including esophagus, stomach, small bowel, colon,liver , pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists). They also deal with diseases involving the skin, breast,  and hernias. These surgeons deal mainly in the Torso.

General Surgery medical transcription involves the transcription of audio records dictated by General surgeons and other related healthcare professionals’ encounter with patients. Knowing that it takes a specialist to take care specialist medical transcription needs, TransDyne has trained a team of medical transcriptionists in the language of General Surgery.  This has enabled the medical transcriptionists to become domain specialists.

How does specialty training in General Surgery medical transcription affect accuracy levels?
Specialty training in General Surgery medical transcription helps the medical transcriptionists produce quality work from the very beginning.  The medical transcriptionists are familiar with the terminology, therapies, procedures and drugs related to General Surgery. Due to the specialty training in General Surgery medical transcription the medical transcriptionists are able to achieve accuracy of above 99% maintaining the integrity of information captured.

How does specialty training in General Surgery medical transcription affect turnaround time?
Specialty training in General Surgery medical transcription enables the medical transcriptionists to produce high quality transcripts within the turnaround time guaranteed. Due to the familiarity with the language of General Surgery, the medical transcriptionist need not spend much time researching difficult terms in the Internet. Due to the higher levels of accuracy the number of quality checks required are less thus reducing turnaround time.

How does specialty training in General Surgery medical transcription affect pricing?
Specialty training in General Surgery medical transcription increases the productivity of the medical transcriptionists and decreases the time required for frequent quality checks thus bringing down the cost per line of transcription. The healthcare facility benefits from the economies of scale

General Surgery medical transcription from TransDyne not only has the benefits of accuracy above 99%, turnaround time of 24 hours and reasonable prices, it has other benefits like:

  • Security: One of the main concerns that healthcare facilities have is regarding the security of data. During the medical transcription process, data is transmitted back & forth; the protection of data during this process is vital. TransDyne ensures security of data by taking on a three pronged approach, which involves security measures with regard to technology, people and processes. This ensures the confidentiality of data is protected at all stages
  • Flexible modes of dictation: Realizing that time is a precious commodity for healthcare professionals, TransDyne has made it possible for them to retain familiar modes of dictation enabling to manage their time for maximum productivity
  • Benefits of advanced technology: TransDyne offers healthcare facilities the benefit of advanced technological features like automatic uploads of dictation; automatic downloads of finished transcripts, remote printing & faxing, power archiving facilities and HL7 integration etc at no extra costs.

To avail superb General Surgery medical transcription services from TransDyne, click here

ESIC RECRUITMENT

More Hospitals Settle, But Not for Much

In late February, there have been several notable legal settlements made by more or less prominent hospitals, discussed in rough order of size.

United Regional Health Care System

Per the Cypress Times,
The Department of Justice announced today that it has reached a settlement with United Regional Health Care System of Wichita Falls, Texas, that prohibits it from entering into contracts that improperly inhibit commercial health insurers from contracting with United Regional�s competitors. The department said that United Regional unlawfully used these contracts to maintain its monopoly for hospital services in violation of Section 2 of the Sherman Act, causing consumers to pay higher prices for health care services.

Note that this appears to be the first settlement involving the Sherman Anti-Trust Act that included a hospital system, or any health care organization which we have discussed. As the Times article mentioned,
This is the first case brought by the department since 1999 that challenges a monopolist with engaging in traditional anticompetitive unilateral conduct.

Here is more detail about the alleged offenses:
According to the complaint, United Regional is by far the largest hospital in Wichita Falls. Its share of general acute-care inpatient hospital services is approximately 90 percent, and its share of outpatient surgical services is more than 65 percent. It is the region�s only provider of certain essential services such as cardiac surgery, obstetrics and high-level trauma care. In Wichita Falls, United Regional�s average per-day rate for inpatient hospital services sold to commercial health insurers is about 70 percent higher than its closest competitor for the services that are offered by both hospitals.

The department said that in order to maintain its monopoly in the provision of inpatient hospital and outpatient surgical services, United Regional systematically required most commercial health insurers to enter into contracts that effectively prohibited them from contracting with United Regional�s competitors. United Regional�s contracts required these insurers to pay significantly higher prices if they contracted with a nearby competing facility. Since United Regional is a must-have hospital for any insurer that wants to sell health insurance in the Wichita Falls area, and because the penalty for contracting with United Regional�s rivals was so significant, almost all insurers offering health insurance in Wichita Falls entered into exclusionary contracts with United Regional. As a result, competing hospitals and facilities could not obtain contracts with most insurers and were less able to compete, helping United Regional maintain its monopoly in the relevant markets and raising health-care costs to the detriment of consumers.

As far as I could tell, however, for this apparently severe offense there will be no actual penalty. The settlement only appears to provide for a promised change in future behavior by the hospital:
The proposed settlement, which if accepted by the court would be in effect for seven years, restores lost competition by prohibiting United Regional from using agreements with commercial health insurers that improperly inhibit insurers from contracting with United Regional�s competitors. In particular, United Regional is prohibited from conditioning the prices or discounts that it offers to commercial health insurers based on whether those insurers contract with other health-care providers and from inhibiting insurers from entering into agreements with United Regional�s rivals. United Regional is also prohibited from taking any retaliatory actions against an insurer that enters into an agreement with a rival provider.

So if a hospital engages in actions that restrain competition and results in a de facto monopoly, all the hospital leaders must fear is that at some point it may have to change its monopolistic behavior, according to this settlement.

Catholic Healthcare West

Per the San Jose Business Journal,
Catholic Healthcare West, parent company to local Mercy hospitals, has agreed to pay $9.1 million to settle allegations that seven of its hospitals submitted false Medicare claims, U.S. Attorney Benjamin Wagner announced late Friday.

Here is more detail about the alleged offenses:
The hospitals include Community Hospital of San Bernardino, St. Bernadine Medical Center in San Bernardino and St. Elizabeth Community Hospital in Red Bluff.

The settlement also included allegations that O�Conner Hospital in San Jose, Seton Medical Center in Daly City and St. Joseph�s Hospital and Medical Center in Phoenix submitted inflated costs for their home health agencies and were overpaid. The agreement also resolves allegations that St. Joseph�s overstated how much was owed in disproportionate share funding for indigent patients.

CHW no longer owns O�Conner Hospital or Seton Medical Center.

The settlement resolves allegations that St. John�s Regional Medical Center in Oxnard was overpaid for treating a high percentage of patients with end-stage kidney disease for several years, including two when it was not eligible.

Note that while the amount of the payment assessed appears substantial, it will be made a very long time after the alleged bad behavior occurred:
All of the problems occurred in the 1990s. Federal investigators began looking into the matter in 2001, but it took years to compile evidence and reach a settlement. All of the hospitals had set aside money in a reserve account should they have to pay funds back to the government.

So if a hospital submits false claims to the US government, hospital leaders need not fear paying anything back for more than 10 years, according to this settlement.

By the way, this was not the first such settlement that Catholic Healthcare West has had to make:
In 1998, a whistleblower at Woodland Healthcare disclosed instances of alleged fraud by two medical groups affiliated with local Mercy hospitals, Woodland Clinic Medical Group and Medical Clinic of Sacramento.

Following an extensive investigation, former U.S. Attorney John Vincent announced a $10.25 million settlement in May 2001. The allegations included false claims to inflate reimbursement from Medicare, Medi-Cal and military health insurance programs.

Massachusetts General Hospital (Partners Healthcare)

Per the Boston Globe,
Massachusetts General Hospital has agreed to pay the federal government $1 million to settle potential violations of patient privacy laws, which occurred when an employee commuting to work lost patient records on the T�s Red Line two years ago.

Here is more detail about the alleged offenses:
Health information for 192 patients in Mass General�s Infectious Disease Associates outpatient practice was lost in the incident, including that of patients with HIV/AIDS. The documents included a patient schedule containing names and patient medical record numbers, as well as billing forms containing the name, birth date, medical record number, health insurer and policy number, diagnosis, and name of providers for 66 of those patients.

Note that Massachusetts General Hospital is not independent, but part of Partners Healthcare, which reported net patient service revenue of $1.5 billion in the most recent quarter, again per the Boston Globe. So this settlement amounted to about 0.00167% of the system's patient revenue.

So if a hospital engages in actions that violate the trust patients have that their information will be kept confidential, all hospital leaders have to fear is that their institution will eventually have to pay something much less than round-up error of their revenue, according to this settlement.

Summary

Again, the volume of participants in the ongoing march of legal settlements is a reminder of how pervasive bad behavior is in the US health care system. Remember that these settlements are in some sense the tip of the iceberg. They only indicate behavior that inspired legal action which was in turn was publicized. It is likely that for each behavior that eventually leads to a settlement, there are many behaviors that go unreported, or that cause no reaction.

It is interesting that sorts of bad behavior that formerly caused no official reaction are now leading to settlements. As noted above, there had been no recent legal actions against concentration of power in health care up to the United Regional Health Care System settlement.

However, like many of the settlements we have previously noted, the latest crop seem to have little deterrent power. The United Regional Health Care System settlement seemingly involved no monetary penalties whatsoever, only a promise of not to do it again. The Catholic Healthcare West settlement's monetary penalties were so delayed, occurring over 10 years after the actions in question, their deterrent power is highly questionable. The Massachusetts General Hospital (really the Partners Healthcare) monetary penalty was infinitesimal compared to the size of the institution's budget.

Furthermore, as in nearly every other case we have reported, no person who authorized, directed or implemented the actions in question had to pay any penalty, or suffer any negative consequence, or was even identified.

So while there seems to be some increased interest in addressing some kinds of bad behavior, like monopolistic practices, that heretofore generated no official reactions, regulatory authorities still seem loathe to even slap the wrists of the people whose aggregated actions are making our health care so expensive, so inaccessible, and probably of such mediocre quality.

Thus, in recent years, health care leaders, like leaders of financial service companies, seem to have impunity,  Up to now, they have been able to preside over all sorts of bad behaviors that help support their exorbitant remuneration without fearing any personal penalties.  As Charles Ferguson, the director of Inside Job, said when accepting his Academy Award last night, per MarketWatch,
Forgive me, I must start by pointing out that three years after a horrific financial crisis caused by fraud, not a single financial executive has gone to jail � and that�s wrong

After a slow-motion health care train wreck over the last 30 years, hardly any health care executives have even had to pay a fine, much less go to jail.

So I repeat, and repeat, and repeat: we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.

"Give yourself something to work toward - constantly." ~ Mary Kay Ash
What are you constantly working towards to live your dreams?

The Japanese Congress and the Global Health Forum

This week,  I traveled to Japan as part of a 'US-Japan health care policy dialogue' a partnership between the Center for Strategic and International Studies (CSIS), a Washington-based foreign policy institute, and the Health and Global Policy Institute (HGPI), based in Tokyo.  This collaboration between American and Japanese experts focused on critical areas of innovation and reform in the health sectors of both Japan and the United States - initially payment systems and healthcare IT.  Over the next 6 months, we'll complete an analysis with actionable policy recommendations.

As part of the effort, I provided testimony to the Japanese Congress (Diet) and joined an all day Global Health Forum organized by the Health and Global Policy Institute (HGPI), a leading Japanese think tank.

The Congressional experience was interesting.  Japan has the longest lifespan of any country in the world, has comprehensive healthcare coverage for all citizens, and has very low healthcare costs - less than half the US expenditure per person per year.   It's challenging to highlight lessons learned from the US which has highly variable quality, high cost, and 40 million uninsured.

Luckily, the Japanese agreed that Healthcare IT is to be embraced for quality/safety/efficiency, cost reduction, and job creation.

I described the US Healthcare IT program as guided by 5 goals

*Improving quality, safety, efficiency, and reducing health disparities
*Engage patients and families in their health care
*Improve care coordination
*Improve population and public health
*Ensure adequate privacy and security protections for personal health information

achieved with 5 tactics

* Policy (Health Information Technology Policy Committee)
Certification and Standards (Health Information Technology Standards Committee)
Privacy and Security Tiger Team
Regional Extension Centers and Health Information Exchanges ($2 billion)
Incentives to adopt and achieve �Meaningful Use of Electronic Health Records� ($21 billion)

The Japanese legislators asked great questions about the role of genomics, the role of telemedicine, and the potential for job creation.   I remain optimistic that the Japanese will consider their own healthcare IT stimulus program.

The all day Global Health Forum included several important key points:

In Japan over the past 50 years, the economy has shifted from agricultural to industrial, from rural to urban, and from communities bonded together to often impersonal cities without support systems of the family and friends.   Many Japanese die alone and do not have the eldercare they need.

25% of Japanese are over 65 and over the next 50 years, the problem will get worse, such that 2 working age individuals will be paying for the care of 1 retirement age individual.   The Japanese birth rate is 1.3, so the Japanese population will fall rapidly over the next 50 years, reducing the workforce and tax base.   Immigration is very limited in Japan, so diminishing Japanese and limited foreign workers with result in a crisis of public funding for healthcare .    The Japanese will try to balance cost, quality, and healthcare access with available funds, but even now there is gap between the funds received from workers and the funds paid out to pay for the care of the elderly.

IT can provide some mitigation of the problem.   Japan has one of the best wired and wireless networks in the world.   These can be leveraged to create virtual communities/social networks of carers as well as support homecare including telemedicine and remote monitoring.   IT can provide data for population health and care coordination.

At present Japan has many policies which discourage the use of the public internet for healthcare, data exchange, and homecare. Changing policy/regulation and providing incentives to move care to the home is an important next step.  Focusing on wellness and day to day life rather than just treatment of disease is also an important tactic.    Japan describes this as a transition from "medical policymaking"  to a "health policymaking".

The session on healthcare IT included my presentation, a presentation from Dr. Akiyama of Tokyo University, and a presentation from Intel.

Many of themes in Japanese society apply to the US.   Our aging baby boomers will require more care than the Medicare system can afford.    Secretary Sebelius has said that 1/3 of US healthcare is redundant and unnecessary.      I look forward to continued exchange of ideas between the US and Japanese.  We are meeting again this July at CSIS in Washington.

Food Allergic? Be Our Guest.

Congratulations to Disney for being given the FAAN (Food Allergy and Anyphalaxis Network)Corporate Leadership Award. Disney was honored for "its commitment to food allergy awareness, education and management."

Tom Staggs, chairman of Walt Disney Parks and Resorts accepted the award saying, "Our parks in the U.S. alone accommodated well over 400,000 special dietary requests from guests last year."

Fantastic! No wonder Disney feels like "the most magical place on earth". They really try to make everyone feel special; like an honored guest.

I hope to see other resorts, parks and restaurants rise to the challenge as well. Everyone should be able to eat safely every where.

Campbells Soup and several individuals were also honored at the Hollywood gala.

A huge thank you to all the winners. your efforts are much appreciated.

Sunday, February 27, 2011

Medical transcription outsourcing: Support services that help enhance performance

In the current scenario the healthcare industry is facing numerous challenges, which has tested the ability of this sector to provide quality services while still remaining profitable. There has been a burgeoning need for healthcare services given the aging population and increasingly stressful lifestyles. The healthcare sector also faces challenges like eroding profit margins and escalating regulatory norms. In such an increasingly challenging environment it has become imperative for healthcare facilities to concentrate maximum time, capital and resources on their core business while outsourcing their non-core activities.

Medical transcription, the process of creating patient medical records from the dictation provided by healthcare professionals of the patient encounter is one such activity. Though medical transcription is an important contributor to healthcare facility's operations in several aspects like clinical decision-making, risk management and the receivables management, it is not a part of the core business of the healthcare facility. Outsourcing medical transcription has been proven to be an efficient solution to the documentation needs of the healthcare facility. In fact outsourced medical transcription services help healthcare facilities perform better in an increasingly challenging environment.

Due to the sensitive nature of healthcare services, outsourcing medical transcription has had some bad press and there have been some apprehensions regarding the wisdom of outsourcing. Given below are some of the myths against outsourcing medical transcription:

The healthcare process is too complex for any of the support services to be outsourced: It is true that the healthcare process is complicated and any service associated with healthcare needs to be able to understand the unique requirements of the healthcare sector to be able to provide quality services. The concerns of the healthcare facilities in this regard can be mitigated by sourcing a medical transcription service provider who has the relevant experience.

The cost savings from outsourcing medical transcription are not substantial and the decision to outsource cannot be justified: Outsourcing medical transcription to the right medical transcription service provider can result in substantial savings on both direct and indirect costs. To ensure that there are actual savings on cost, it is important to check on the billing method used by the medical transcription service provider.

The process of outsourcing is too tedious: The process of outsourcing medical transcription can be made easy by clearly enumerating the desired outcomes from the outsourcing decision. Having these desired outcomes in mind helps in the process of evaluation

The healthcare facility loses control over all aspects of the outsourced activity: The fear of losing control over the outsourced process can be mitigated by sourcing a medical transcription service provider with proven credentials and by establishing clear channels of communication to enable two-way interaction.

While outsourcing medical transcription it is important for healthcare facilities to source outsourcing partners who not only provide support for their current needs but also have the capability to provide services for future requirements.

TransDyne, a leader in the outsourced medical transcription industry provides medical transcription services that help save on money, time and efforts. TransDyne has used its extensive experience in information technology and their considerable experience in having served the needs of some of the leaders in the healthcare industry to provide immaculate medical transcription solutions. Some of the salient features of outsourced medical transcription solutions from TransDyne are:

  • Experience in serving the needs of various healthcare facilities backed by references
  • Offers free trial for a limited period
  • Has trained medical transcriptionists in specialties enabling them to be domain specialists in that specialty.
  • Provides medical transcription services with an accuracy of above 99% combining the expertise of the medical transcriptionists and a rigorous quality assurance process
  • Offers services with a reasonable and fair price using a measurable, verifiable, definable, consistent, fair and honest billing method.
  • Meets the turnaround time expectations of healthcare professionals
  • Allow healthcare professionals to retain their preferred mode of dictation
  • Offers flexible options for document delivery
  • Provides HL7 interface for EMR/EHR adoption
  • Uses technology that is easy to use
  • Has customer service channels for easy communication and resolution of issues

To avail complete medical transcription services from TransDyne, click here


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