Sharon Carter
MANAGED CARE May 1997. ©1997 Stezzi Communications

Streamlining your practice's office dictation may not rank number one on the HMOs' wish lists. But since when do managed care physicians have money to toss out the window?

Sharon Carter

Everyone wants to cut medical office costs these days, but not everyone stops to consider the money they may be squandering through poorly managed office dictation. "Every payday most of us have overtime," says Lee Johnson, head of the transcription department for a large Houston group practice, "yet almost every week we also have to send work out to a service. In direct expenses, this costs the practice hundreds of dollars a month. And that's not counting indirect costs, like long-distance phone calls.

"If the doctors followed our suggestions," adds Johnson, "we could probably cut out most, if not all, of that extra expense."

Denver secretary Susan Hanson offers a cautionary example from her experience. "A doctor dictated a letter to a 'Dr. Hoylake,' and he always wants letters out the day they are dictated. I looked in the county directory, then in the state directory. No Dr. Hoylake.

"I then went looking for the chart, but had to give up my search after 20 or 30 minutes. (The physician had left it in his car.) To make a long story short, it took me about an hour — made up in overtime — and six phone calls, most of them long-distance, to get the out-of-state address that had been right in front of the doctor while he was dictating."

In Texas, a transcription service's average charge is 10 cents a line, or about $3 a page, while a medical practice with more than two doctors usually generates at least 30 to 70 pages a week in transcription.

"There's also a charge if I pick up and deliver the work," says Alice Martinez, a freelance transcriber in Dallas who charges $3 a page. "I don't have benefits, of course, but I make a pretty good living."

How much of the expense of transcription could be eliminated if physicians followed sound dictation guidelines?

"Hey, don't suggest that!" jokes Martinez, who goes on to venture a serious reply: "Probably 80 to 90 percent."

Here, then, are 10 ways suggested by secretaries and professional transcribers for controlling the cost of transcribing your dictation:

1. Slow down the speedsters. "One of the doctors in our office dictates like a runaway train," says Oklahoma secretary Paula Pell. "It may save him a few minutes, but we can type three pages of anyone else's in the time it takes us to do one of his. That's because with his we're endlessly stopping and backing up to understand what he is saying. We have overtime almost always when he's here. When he's away, we don't."

2. Find out if it matters in what sequence patient information is given. In some computers, blanks to be filled in come up in a certain order — for example, date, patient's name, doctor's name, chart number. If these bits of information are given randomly, the typist has to stop and back up, or jump ahead and then back up. A whole day of this can waste a surprising amount of time.

3. If the patient's name is difficult or unusual, spell it. "If we have to go off our working screen and into the main computer to look up the spelling of a name, it takes between three and 10 minutes," reports a Dallas transcriber. "It's not unusual for us to waste an hour a day doing this." (Check on how employees are dictating. Secretaries say nurses are more likely than doctors to mumble names, or not to spell them.)

4. Share vital information. If you have an address for the recipient of a letter, give it to the typist. If you don't have an address but know the town, give that. This can save time and needless phone calls, often long-distance calls.

5. Be distinct where numbers are concerned. In rapid speech it's almost impossible to distinguish "16" from "60," so make an extra effort to be clear. Correcting an error or filling in a blank can waste a typist's time — or your own.

6. Don't waste words. Some doctors and nurses are notoriously verbose. See if offenders in your practice can be gently introduced to the charms of brevity.

7. Keep background noise down. Even when the dictation itself is good, background noise that sounds like an orgy, a construction site or a combination of the two can necessitate a lot of stopping and backing up.

8. Don't hold the microphone too close. This is one of the most common mistakes. Play back a sample of your dictation. If there seem to be frequent bursts of static, you're probably holding the microphone too close to your mouth. This can create a recording that is literally painful to the transcriber's ears — as well as making your words hard to decipher.

9. Eliminate unnecessary copies. "We call one of our physicians Dr. CC because of all the extra copies he requests," reports one transcriber. "I don't know why he does it. None of the other doctors do. By the time we have looked up all those addresses and printed the envelope labels, getting a one-page letter of his ready can take half an hour."

10. Arrange substitute dictations where appropriate. If someone in your practice has a thick, hard-to-understand accent, see if someone else can take over his or her dictation on an ongoing basis — perhaps for a bit extra in pay. If such a substitution can be made without giving offense, it can save time — and therefore money.

If you follow these 10 suggestions, you'll go a long way toward making sure you're not wasting money on transcriptions.

The author has 12 years' experience as a medical transcriber, and now works as an administrative assistant in a Dallas oncology practice.

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