Outsourcing of Medical Transcription
Due to the increasing demand to document medical records, countries have started to outsource the services of medical transcription. In the United States, the medical transcription business is estimated to be worth US$10 to $25 billion annually and growing 15 percent each year. The main reason for outsourcing is stated to be the cost advantage due to cheap labor in developing countries, and their currency rates as compared to the U.S. dollar.
There is a volatile controversy on whether medical transcription work should be outsourced, mainly due to three reasons:
- The greater majority of MTs presently work from home offices rather than in hospitals, working off-site for "national" transcription services. It is predominantly those nationals located in the United States who are striving to outsource work to other-than-US-based transcriptionists. In outsourcing work to sometimes lesser-qualified and lower-paid non-US MTs, the nationals unfortunately can force US transcriptionists to accept lower rates, at the risk of losing business altogether to the cheaper outsourcing providers. In addition to the low line rates forced on US transcriptionists, US MTs are often paid as ICs (independent contractors); thus, the nationals save on employee insurance and benefits offered, etc. Unfortunately for the state of healthcare-related administrative costs in the United States, in outsourcing, the nationals still charge the hospitals the same rate as they did in the past for highly qualified US transcriptionists but subcontract the work to non-US MTs, keeping the difference as profit.
- There are concerns about patient privacy, with confidential reports going from the country where the patient is located (i.e. the US) to a country where the laws about privacy and patient confidentiality may not even exist, which was overcome as the Health Insurance Portability and Accountability Act (HIPAA) became mandatory for all the providers from the outsourced countries. Some of the countries that now outsource transcription work are the United States and Britain, with work outsourced to Philippines, India, SriLanka, Canada, Australia and Barbados.
- The quality of the finished transcriptions is a concern. Many outsourced transcriptionists simply do not have the requisite basic education to do the job with reasonable accuracy, as well as additional, occupation-specific training in medical transcription. Many foreign MTs who can speak English are not familiar with American expressions and/or the slang doctors often use, and can be unfamiliar with American names and places. An MT editor, certainly, is then responsible for all work transcribed from these countries and under these conditions. These outsourced transcriptionists often work for a fraction of what transcriptionists are paid in the United States, even with the US MTs daily accepting lower and lower rates. However, some firms choose to employ American transcriptionists as they believe the quality of work is better.
Among outsourcing countries, the Philippines has recently attracted increased amounts of MT outsourcing from the United States due to the fact that English is one of the official languages used in all government transactions in the country and the high literacy in the English language and perhaps the capability of average Filipino to understand American idioms, colloquialism, and slang used in medical transcription as compared to the Indians who are more familiar with British English, since they were a former colony of theirs. This is very concerning to the US MTs. HIPAA governs outsourcing of MT work. Stricter policies in compliance with HIPAA are implemented in such companies to enable security and confidentiality of work involved in such practices.
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