KPMG
White Paper
Outsourcing
Hospital Medical Transcription Services with CBay
Systems, Ltd.
Monica
Tadak, RHIA, Manager
Caroline Rader, Associate
KPMG, LLP
Abstract
Quality
of medical documentation is critical to the success
of a healthcare facility due to external and internal
market forces found in healthcare today. External
forces such as government regulations and insurance
company documentation requirements continue to affect
the need for quality medical documentation. With the
onset of the Health Insurance Portability and Accountability
Act (HIPAA), the confidentiality of medical documentation
is critical in maintaining compliance with government
regulations. The growing trend of insurance companies
requiring documentation to support charges has a direct
effect on hospitals’ reimbursement. Internal
forces such as reductions in staffing levels, capital
expenditures, and a shortage of qualified medical
transcription applicants can hinder the hospitals’ ability to provide quality medical documentation,
which in turn can result in a decrease of overall
receivables. Outsourcing medical transcription services
is a growing trend in the health information management
industry that has been shown to be successful in managing
market forces.
Introduction
Identifying
the healthcare industry’s growing need for outsourcing
medical transcription services, CBay Systems, Ltd.
(CBay) invested resources capable of addressing the
needs of the hospital environment, as well as the
physician and clinic environments. The Annapolis,
Maryland based company provides medical transcription
services to large physician practices and hospitals
throughout the country. Service levels include all
medical specialties, as well as specific aspects of
documentation such as history and physical reports,
discharge summaries, operative and stat reports.
Products
offered by CBay include CBayScribe™, the TAeSeries®
and A+Network provided in a joint venture with Arrendale
Associates, Inc.[1] CBayScribe™ allows for physician
practices and clinics to have the same level of transcription
services typically found at larger hospitals. The
transcription and editing facilities utilized by CBay’s
larger client hospitals is also used to complete the
volume of transcription services for CBayScribe™’s
physician practices and clinics. Physicians can dictate
reports using hand held digital recorders, analog
phone lines, a personal digital assistant (i.e. PDA),
or a CBayScribe™ recorder, which allows for direct
dictation into a personal computer. Currently, CBay
is the only company to commercialize voice capture
and transcription document delivery from a PDA. The
CBay developed software, CBayPDAChart, allows for
the dictation and retrieval of documents from a PDA.
Documents can also be retrieved from a secure website,
which is password protected. Benefits of the CBayScribe™ service include the ability to dictate from a variety
of locations wherever the physician may be in the
clinical area, compliance with the proposed HIPAA
requirements, guaranteed twenty four hour turnaround
time, and quality of that received by larger hospitals.
The
TAeSeries® and A+Network products areis the most
widely utilized service that CBay offers. The combined
product allows for dictation, transcription, document
management, physician electronic signature and electronic
patient record storage. Users have the ability to
access secure Internet-based databases. The databases
are encrypted to meet the proposed HIPAA requirements.
Features of the TAeSeries™ and A+Network products
include triple encryption for HIPAA privacy compliance,
scalable system configurations based on the size of
the facility, and elimination of the need to purchase
or maintain hardware or software equipment for dictation,
transcription, or faxing. Healthcare facilities save
thousands by not having to maintain hardware and software.
CBay
supports a twenty-four hour, seven day a week operation
providing continuous transcription coverage and technical
support for all product offerings. Physician dictations
are typically captured by the use of a toll free number
that physicians can access from any phone. However,
CBay offers clients the flexibility to also dictate
from a personal hand-held device or existing hospital
dictation equipment. The voice data is transmitted
to India, where CBay certified medical transcriptionists
reside. The difference in time zones allows for the
turnaround times from dictation to transcription to
remain true to the facility contract. Every report
that is transcribed is quality checked by other staff
members, including physicians. CBay’s standard
quality policy is derived from the American Association
for Medical Transcription (AAMT) standard of a 98%
accuracy rating. To aid in facilitating this accuracy
rating, CBay has developed a training and certification
program for the domestic and off-shore transcriptionists.
The training program consists of medical transcription
practice and theory, which occurs in a six-month time
period. Transcription theory is modeled after the
AAMT standards, while medical terminology and practice
is taught by qualified physicians. Language specialists
are included in the training program to instruct English,
with an emphasis on American speech. At the conclusion
of the training program a certification examination
is conducted. Only certified transcriptionists are
allowed in live production of any CBay product. Workshops
are conducted regularly to provide continuing education.
CBay
products utilize a Windows® based software program
that enables dictated medical records to be transmitted
electronically to the client, routed by facsimile
or paper to carbon copied physicians, and remain available
indefinitely in a protected database. By tailoring
to the individual needs of the facility, CBay offers
clients the choice of having the database server at
the facility or it may be housed and maintained at
the A+Network ASP data center. Transcribed dictations
are batched and directed several times a day to a
dedicated printer at the client site. All electronic
transmissions are encrypted and provide an audit trail
which tracks all activity, including who has accessed
a transcribed report, which complies with proposed
HIPAA requirements. CBay also provides systems training
to facility staff and continued technical support.
Any corrections or modifications to previously transcribed
documents are handled at no charge to the client.
Supplies such as, paper and toner for the operation
of the printers at the client site are also provided
by CBay. Turnaround times are established at the industry
standard, but can be negotiated by the facility. Typical
turnaround times for high volume reports are shown
in Table 1. below:
Table
1. Average Turnaround Times for Transcribed Reports
|
Work
Type
|
Turnaround
Time |
| History
and Physical |
12
hours |
| Operative
Report |
12
hours |
| Discharge
Summary |
48
hours |
| Stat
Report |
Within
3 hours[2] |
| Emergency
Room Report |
12
hours |
Other
reports such as those received for cardiac catheterization,
progress notes, and clinical services have an average
turnaround time of twenty-four hours.
The
cost of services provided is based on a per line charge
with a cost typically below that of larger medical
transcription companies providing a similar service.
The cost of the service is based on a sixty-five character
net line of transcription, while competitors prices
are based on a gross line of transcription. CBay defines
a character as any number, symbol, letter or function
key necessary for the final document. When determining
the total number of lines transcribed all characters
are calculated and divided by sixty-five. However,
the italics, underscore, bold, shift key, and any
other formatting characters are not included in this
calculation. The initial software set up is performed
by CBay in collaboration with the facilities’ Information Technology Department and is included
in the negotiated price. Additional licensure fees
are assessed as needed. Importantly, when using the
ASP model the cost of hardware is also included into
the per line charge. In non-CBay supported environments,
hospitals are charged $300 - $400k for the dictation
system hardware including license fees, and $100 -
$200k annually for maintenance of the hardware itself.
A
document management software package which accompanies
the transcription service is also included in the
per line charge of the ASP model. The document management
system provides the Health Information Manager at
the facility with the tools necessary to monitor turnaround
time from the time of dictation through the time the
hard copy report is received. A unique and versatile
component of this system is a report writer, which
allows the Manager to customize various reports, such
as: all documents that were transcribed by the type
of report (e.g. discharge summary, operative report),
and the number of lines transcribed.
Review
of Hospitals - A Case Study
KPMG,
LLP (KPMG), an independent company that provides advisory
services to the healthcare industry, conducted studies
at two of CBay’s clients based in Central Florida.
Both hospitals report a positive business relationship,
significant cost savings from the sixty-five character
net line transcribed methodology and capital and software
integration costs, and excellent client service from
the transcription company by utilizing the TAeSeries® and A+Network ASP model. Neither hospital is utilizing
the electronic patient record service.
In
the first case study, KPMG interviewed Bayfront Medical
Center (Bayfront). Bayfront is a Level II trauma center
with 550 beds employing 450 board certified physicians.
Prior to the implementation of CBay’s services
in December of 2000, the Medical Center engaged a
large nationally recognized transcription vendor.
The search for a new vendor was prompted by poor customer
service and billing inconsistencies. The vendor contract
stated the hospital would be charged per line, based
on sixty-five characters. When prompted the vendor
was unable to justify the dollar amount charged for
transcription services. For example, the number of
lines billed could not be reconciled against the number
of lines transcribed. The Health Information Managers
at Bayfront indicated they are pleased with the prompt
customer service and faxing service that CBay provides,
as well as the ability to view the status of the reports.
Managers specified that the greatest benefit of CBay’s
service compared to the previous vendor, is the significant
cost savings. Since contracting with CBay, Bayfront
has realized an annual cost savings of approximately
$200k, which translates to a total savings of $600k
for the entire contract period. This significant cost
savings is attributed to the lower per line charge
when compared to the previous transcription services
vendor.
In
the second case study, an interview was conducted
with the Director of Health Information Management
(HIM) at St. Anthony’s Hospital (St. Anthony’s).
St. Anthony’s is a full service acute care hospital
with 415 beds that employs more than 500 board certified
physicians. St. Anthony’s had previously contracted
with the same vendor as Bayfront. The Hospital experienced
the same poor customer service and billing inconsistencies.
The previous vendor was also inconsistent with the
turnaround times on reports as negotiated in the vendor’s
contract. Since February 2001, St. Anthony’s
has utilized CBay’s transcription services. The
Director of HIM reported significant annual cost savings
of $120k, for a total savings of $360k for the entire
contract period. Additional savings have also been
realized due to the mailing service provided by CBay.
Without this service an additional part time employee
would be required to manage the mailing volume to
carbon copied physicians, costing the Hospital an
additional $8,250 (0.5 FTE) annually. The Director
also noted prompt customer service, as well as receiving
transcribed reports in a timely fashion, as presented
in the contract agreement.
The
report writer provided by CBay has assisted both facilities
in auditing the company’s billing methodologies.
The ability to produce reports to include the actual
numbers of lines transcribed by work type and/or individual
report was mentioned as a positive attribute by Managers
of both sites. Neither Manager reported changes to
current operations in order to successfully implement
CBay’s transcription services and document management
software. The format and options of both computer
applications are similar, therefore eliminating the
need for timely instruction. CBay was able to customize
screens, dictation templates, and reports to ease
the transition. The value added options that CBay
brought to each Hospital has improved the overall
workflow. Any concerns and issues of each Hospital
are addressed during weekly scheduled telephone meetings
between CBay and the Hospital. During the weekly meeting,
communication logs prepared by Hospital staff members
are reviewed with the dedicated CBay account representative.
Both Hospitals have experienced prompt action and
appreciate the ability to access CBay staff regularly.
Other Managers in the HIM Department also complimented
the transcription service.
At
both facilities, the transcribed reports are available
on-line and accessible by designated staff members.
This is especially helpful to the coding staff who
need access to the medical document. Coding managers
interviewed indicated improved process flow and increases
in productivity.
Evaluating
the Results
To
measure the results of the transcription services
provided by CBay, KPMG reviewed turnaround reports,
sample transcribed reports, and interviewed medical
transcription staff at each of the Hospitals involved
in the case study. A review of the average turnaround
time reports provided by CBay for each Hospital confirmed
that the turnaround times were in compliance with
the contract. In some instances, the turnaround times
were less than the time expected, per the contract.
When
CBay’s services were compared to other competitors’ product information published on the Internet, the
CBay product and benefits match and/or exceed that
of larger transcription service companies. Table 2.
below illustrates the comparison of CBay to other
vendors marketing similar services:
Table
2. Vendor Comparison Table
|
Transcrip-tion
Services Vendor
|
Pricing
Methodo-logy |
Turnaround
Times |
HIPAA
Compliant |
Windows®
based software |
Report
Writer |
Faxed
Reports to Physician Office |
Mailing
of Reports to Physician Office |
| CBay |
Per
65 character net line transcribed |
Industry
standard |
Yes |
Yes |
Yes
|
Yes |
Yes |
| Competitor
A1 |
Per
65 character gross line transcribed |
Industry
standard |
No |
No |
No |
Yes |
No |
| Competitor
B2 |
Per
65 character net line transcribed |
Based
on where transcription is performed (e.g. USA
or India) |
Yes |
Yes |
Yes |
No |
No |
1 Competitor A: Previous vendor at case study hospitals.
2 Competitor B: Competing vendor in similar markets,
utilizing international transcriptionists.
A
comparison of reports from CBay and the previous vendor
revealed that both reports were of the same magnitude
and format. This was due to the customizations made
by CBay to ease the transition into a new software
system. The greatest benefit provided by CBay to the
Hospitals over other competitors is the lower price
per line transcribed and the ability to audit the
billing methodology.
KPMG
found that each Hospital realized significant cost
savings due to the lower cost of the service provided,
when compared to the previous vendor contracted at
each Hospital. Prior billings were compared to those
received from CBay. The annual cost savings for both
hospitals is $320k or $960k total savings for the
three-year contract period. Significant savings of
approximately $300-$400k were also realized since
neither Hospital was required to purchase dictation
hardware when CBay’s services were implemented.
KPMG
also found that any changes made to the daily operations
of the Hospitals due to the implementation of the
CBay TAeSeries™ and A+Network services yielded
positive results. Hospital management and staff were
pleased with the turnaround in receiving reports,
the availability of reports for coding and filing,
prompt customer service, and the overall quality of
transcribed reports.
Conclusion
Today
more than 154 physician practices and hospitals utilize
CBay’s and A+Network’s transcription services
and software products. The company continues to enhance
the software application’s functionality and
further advance itself in the medical transcription
industry, such as complying with the upcoming HIPAA
guidelines. CBay’s commitment to the confidentiality
of medical documentation together with the ability
to provide prompt customer service at a cost lower
than competitors will advance the company’s standing
in the industry. Future services planned for CBay
include value added product lines to address coding,
claims processing, billing and receivables management.
The continued joint venture with Arrendale Associates,
Inc. will provide the foundation for these services.
The A+Network is capable of and will be valuable in
providing the technology platform that will allow
for tracking a patient encounter from the time of
patient registration to the final receipt of payment
from the insurance payor. CBay Systems, Ltd. looks
forward to providing the healthcare industry with
an “end to end” solution.
Additional
information on the products available from CBay Systems,
Ltd. can be found on the company’s websites,
www.cbaysystems.com and www.cbayscribe.com. Company
information for Arrendale Associates, Inc. can be
accessed at www.aaita.com.
--------------------------------------------------------------------------------
[1]
Arrendale Associates, Inc. (AAI) is a company, which
specializes in providing document management software
and services to hospitals. AAI and CBay have joined
forces to market electronic document creation and
distribution software to hospitals.
[2]
Stat reports that require immediate transcription
are considered on an individual basis and can be routed
as needed directly to a transcriptionist for immediate
turnaround.
