outsourcing & clinical documentation -...

OUTSOURCING & CLINICAL DOCUMENTATION:Healthcare’s New World—a Strategic View

White Paper

Key Considerations in Outsourcing Transcription 3

Guide to Best Practices in the Transition to Outsourcing 5

M*Modal: The Choice for Outsource Partner 9

Record of Success 11

Take the Next Step 11

TABLE OF CONTENTS

KEY CONSIDERATIONS IN OUTSOURCING TRANSCRIPTION

Cost pressures are relentless. The CFO knows this better than anyone in today’s healthcare organiza-

tions. As the new world of value-based healthcare emerges, pursuing the twin objectives of reducing

cost and delivering higher quality care is imperative. The urgency—for some survival—is forcing

dramatic moves on all fronts.

These moves include strong interest in outsourcing costly internal functions. With the stakes so high,

CFOs continue to distinguish “core” vs. “context” activities. As business strategist Geoffrey Moore

defined the notion, activities which differentiate the organization in its market are “core” and merit

investment. All others are “context” and inhabit “the world of outsourcing.”1

Many CFOs are concluding that in-house transcription is not core. It is a logical candidate for

outsourcing to achieve savings. In-house departments incur not just direct labor costs but also

indirect overheads, volume fluctuations that cause under- or over-utilization of people, and ancillary

expenses. With EHR systems reducing transcription volumes, the cost/personnel equation is already

shifting even without intervention. Approaching this subject in a planned fashion is in order.

Outsourcing options range from overflow to partial to complete. Your organization is likely

outsourcing some work today and may use a sub-optimal set of legacy vendors of different

sizes and capabilities.

1 Geoffrey Moore, Living on the Fault Line, HarperBusiness, 2000, p. 32.

white paper / M*Modal / pg. 3

We mentioned the EHR. Transcription outsourcing must be included in the larger EHR strategy

discussion, because gaps in EHRs prevent them from being the universal documentation solution

often claimed.

Every patient has a unique story. Dictated narrative reports have long been the “gold standard”

for documenting complete and variable information. As one doctor put it, “One of the most helpful

lessons I’ve learned about being a physician is that we’re story tellers. We’re trying to capture the

patient’s full story.”

Yet we’ve created a crisis of capture around clinical narrative in the move to EHRs. Pursuing the

legitimate need for structured data, we have pushed a paradigm of template-based data entry at

the expense of rich narrative documentation. This model works for some information, but it can

be cumbersome, demanding behavior shifts and negatively impacting productivity. In addition to

constricting the physician’s ability to capture detail, EHRs frequently encourage such undesirable

behaviors as improper use of cut-and-paste and inclusion of standard text blocks that render the

record unusable.

Clearly an intelligent combination of EHR and speech recognition technology along with outsourced

services is needed to put you in control of savings, while also promoting EHR adoption and truly

meaningful use. This helps you optimize the overall investment.

The decision to outsource completely brings a significant human element into the equation.

Organizations considering this option frequently face concerns about:

• People losing jobs

• Public relations backlash in the community

• Physician perceptions of responsiveness and quality of documentation support

This paper offers guidance on dealing with these issues and implementing a cost-saving outsourcing

strategy successfully.


As the nation’s largest clinical documentation outsourcing company, M*Modal has helped an array of

healthcare organizations. We have distilled this accumulated knowledge into four key considerations

in pursuit of best practices in this area. These considerations establish a structured approach and

promote benefits across the organization.

Best Practice #1: Choose a vendor experienced with successful transitions to the outsourced transcription model

This advice may sound obvious, but many of the firms in this space

are small or have been created through merging disparate compa-

nies. Unlike M*Modal’s tested process they frequently lack a system-

atic approach to transitions and cannot adapt to individual needs. By

contrast, M*Modal becomes an extension of your department.

GUIDE TO BEST PRACTICES IN THE TRANSITION TO OUTSOURCING

FOR CFOS

• Lower cost structure

• Free resources such as system maintenance to invest in critical health IT initiatives and additional labor-saving tech-nologies, such as Computer-Assisted Coding

• Optimized revenue cycle from faster and higher quality documentation

• Retain physician documenta-tion choices while fostering EHR

strategy

FOR HDS (HEALTHCARE

DOCUMENTATION

SPECIALISTS)/MTS

• Potentially greater job security than if they remain in-house

• Opportunities for advance-ment that may not be avail-able in-house

• M*Modal HDS (Healthcare Documentation Specialists)/MTs have opportunities to move into management positions and Sr. Healthcare Documentation Analysts can apply their skills in other roles such as a career path to Coding

• Many experience upside

income potential

FOR TRANSCRIPTION

DEPARTMENT

• Methodology to successfully and gracefully migrate department to complete outsourcing

• Cost reductions and/or improvements to quality and TAT measures

• Ability to handle more work, more flexibly

• Contribute proactively to organizational strategy rather than appear resistant to change

BENEFITS OF A STRUCTURED APPROACH


Best Practice #2: Pursue a proven methodology for transitioning

This is not an ad hoc effort. The delicate balance of people, cost and quality demands an organized,

proven process rather than the hasty or cookie-cutter approach often taken. Points to keep in

mind include:

• The status quo can rarely be fully maintained. While there will be pressure to leave intact all

transcriptionists and their work routines, this is rarely possible or even desirable. In fact, in most

cases a prime driver for full outsourcing is that the in-house team is not adhering to consistent

turnaround time or achieving desired quality standards.

• Opportunities abound to satisfy long-run objectives through proper transition planning. Moving

some physicians to self-editing speech recognition and implementing clinical documentation

improvement efforts are two moves that can feed your longer term strategy.

EXAMPLE: THE M*MODAL TRANSITION METHODOLOGY

M*Modal is proactive from both the management and transcriptionist perspectives, engaging with

HR, the CFO, and Department staff from the beginning. In the case of complete outsourcing, we will

frequently “re-badge” the in-house transcription staff, making it our own. This offers a clear path to

savings while preserving employment for most.

MANAGEMENT PROCESS

The M*Modal process is holistic and designed to shepherd customers throughout the phases:

• Pre-Decision. M*Modal Human Resources provides pre-decision consultation with the custom-

er’s leadership to outline the HDS/MT recruitment and transition process. You know what to

expect before you decide, and critical issues, such as unionized employees and benefits, can

be addressed.

• Implementation Planning. M*Modal follows a formal project management approach with dedi-

cated resources and a project plan. Project team calls are held to set a timeline for announce-

ment, job offers, paperwork completion, equipment ordering and training to insure that go-live

targets are met. Details such as HDS/MT experience, skills and more are collected and maintained

by HR to help formulate the right offers.


• Implementation. Most important, M*Modal assigns you a Customer Relationship Manager

(CRM) and Healthcare Documentation Services Manager. Their jobs are to satisfy customers by

leveraging resources across M*Modal as required to address needs. Customers consistently cite

this approach as a significant benefit. A weekly quality audit is performed on all transitioned HDS/

MT for the first four weeks of employment, with the expectation of 99.6 accuracy. All receive the

M*Modal National Quality Program requirements.

• Ongoing Reporting. M*Modal’s Performance Monitor portal (Fig. 1) lets administrators view

meaningful data and metrics to track performance, provide management reports and obtain data

required by The Joint Commission. Turn-around time, work-type and dictator statistics, quality

indicators, and much more are included—often more than currently available.

HEALTHCARE DOCUMENTATION SPECIALIST (HDS)/MEDICAL TRANSCRIPTIONIST (MT)

TRANSITION PROCESS

As a company that manages thousands of transcriptionists daily, M*Modal understands the impact of

the outsource decision on individuals and follows a process designed to handle the transcription staff

migration in a smooth, speedy, fair and sensitive fashion. M*Modal’s transition package includes:

• Employment offers to all facility-employed HDS/MT, waiving the professional

courtesy test; however, a background check is performed

• Benefits effective the first of the month following the date of employment with us

• Honoring the years of service. For those with the facility longer than 2 years, this policy allows

them to accrue PTO at our highest rate; three-year veterans join our 401k fully vested

• Primary assignment of work on the facility’s account when possible

• Flexible work schedules that meet the needs of the employee and the customer

• M*Modal supplies a full equipment package at no charge to the employee,

along with 24x7 technical support assistance

• Opportunity to get additional education to move into a Coding Services career

Fig. 1: Performance Monitor Portal


Best Practice #3: Consider your outsource partner’s enablement teamThe transition methodology described here is only as good as the people implementing it. They

are crucial to realization of the projected cost savings as well as the maintenance of high quality

standards. A firm such as M*Modal brings people with deep experience serving hospitals of all

sizes, clinics, radiology departments and many more care settings. The Customer Relationship Manager dedicated to your organization will be carefully selected from our ranks, and these

CRMs are supported by a Customer Care Region Vice President and a highly effective operations, IT

and leadership organization. Customers frequently reference the value of the M*Modal people as the

difference in an effective transition.

Fig. 2: M*Modal Care Team

REGION VICE

PRESIDENT

HEALTHCARE DOCUMENTATION

SERVICES MANAGER & PERFORMANCE

COACH

HEALTHCARE DOCUMENTATION SPECIALISTS AND SR. HEALTHCARE

DOCUMENTATION ANALYSTS

HUMAN RESOURCE EXECUTIVE

CUSTOMER RELATIONSHIP

MANAGER

Best Practice #4: Communicate the right message clearly.Outsourcing can be an uncomfortable step to communicate. Organizations may face complaints to

local media, online posts and pressure from other affected constituencies. In response, experience

shows it is best to explain outsourcing not just as a necessary cost-cutting exercise, but rather as

part of the need to address the major demands facing all healthcare organizations today to improve

and coordinate care efficiently. It is also advantageous to be proactive post-implementation.

Communicating success metrics from the outsourcing can go a long way to setting the context and

countering general complaints and allegations.


M*MODAL: THE CHOICE FOR OUTSOURCE PARTNER

M*Modal knows clinical documentation.

As one of the largest and most experienced transcription services providers, we have been delivering

transcription services for over 40 years. M*Modal offers an experienced workforce of over 5,500 U.S.-

based and global transcriptionists and speech editors who turn 200 million minutes of dictation (more

than 2 billion lines) into quality documents each year. Such scalability addresses the needs and growth

of a wide range of organizations.

“Our quality first philosophy within transcription services produces clinical documentation accuracy

with speed, quality and performance monitoring. M*Modal’s robust cloud-based technologies range

from transcription and speech recognition-based platforms to CDI applications and dedicated imag-

ing reporting solutions.”

Unlike other systems, M*Modal has a single architecture with one speech recognition and one Natural

Language Understanding technology. This enables a seamless experience and more complete docu-

mentation by providing dynamic feedback and closed-loop workflows all throughout the documenta-

tion process—instead of after the fact.


The M*Modal Fluency platform and clinical documentation services capture the patient story and

transform unstructured data into encoded clinical documentation, regardless of the source—whether

it’s front-end speech/EMR, transcription services or self-edits. Our cloud-based platform is always

connected, compatible with virtualized systems, and accessible anywhere. This integrated approach

enables you to preserve the richness of each patient encounter and enhance care delivery, while

promoting higher efficiency and accuracy.

In addition to transcription services we provide expert coding staffing, education and consulting

services. M*Modal Coding Services credentialed coding staff has been serving healthcare organiza-

tions for nearly 20 years.

M*Modal has over 3,850 hospitals, clinics and practices and more than 200,000 physicians as

customers. M*Modal’s mix of technology and service offerings is designed for healthcare today and

tomorrow—helping you to improve physician adoption, deliver higher quality documentation, and

promote better, more meaningful patient care.

Fig. 3: M*Modal Clinical Documentation Solutions

A UNIFIED PORTFOLIO

M*Modal Fluency workflow solutions promote collaboration and proactive CDI through integrated real-time insights

M*Modal Coding Services provides one stop for all of your coding needs—staffing, auditing, and education

M*Modal Transcription Services deliver world-class transcription service quality, data security and confidentiality


RECORD OF SUCCESSM*Modal’s success in transitioning to outsourcing shows up in the numbers:

TAKE THE NEXT STEPThe outsourcing decision is difficult and it is important to consider some key

factors when investigating this option:

• Choose a vendor who has experience managing through this transition

• Define a clear methodology for transitioning

• Take the long view—consider your outsource partner’s people

• Communicate, Communicate, Communicate

If you are considering a move to outsourced transcription, M*Modal can help.

We invite you to consult with M*Modal as you assess and analyze your options,

the implications for your own organization and the benefits of a structured

transition approach.

99.6


WORLD HEADQUARTERS: 5000 Meridian Boulevard, Suite 200 + Franklin, TN 37067 mmodal.com + [email protected] + 866-542-7253 © 2014 MModal IP LLC. All rights reserved.

M*Modal is a leading healthcare technology provider of advanced clinical documentation solutions,

enabling hospitals and physicians to enrich the content of patient electronic health records (EHR)

for improved healthcare and comprehensive billing integrity. As one of the largest clinical transcrip-

tion service providers in the U.S., with a global network of medical editors, M*Modal also provides

advanced cloud-based Speech Understanding™ and Natural Language Understanding technologies

and data analytics that enable physicians and clinicians to include the context of their patient narratives

into electronic health records in a single step, further enhancing their productivity and the cost-saving

efficiency and quality of patient care at the point of care. M*Modal has been recognized as one of

the fastest growing technology companies in North America, placing in the top third of Deloitte’s

Technology Fast 500 for 2012. For more information, please visit mmodal.com, Twitter, Facebook and

YouTube.

ABOUT M*MODAL

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