Going NuTS

The very technology that made it possible for me to work from home in my PJs is the same technology that is taking my job from me. 

If you’ve ever called customer service for just about any company, you’ve probably experienced language barrier issues with the person on the other end of the line.  We all know that the other person is not at the home office of said company, but rather on the other side of the world.  We all understand that it’s all about the dollar.  Someone in Pakistan or India will work for pennies on the dollar (and be very grateful for it), so our American companies send their work to those countries in order to save money. Thanks to the internet, working remotely means working from anywhere in the world.  

Sadly, this trend has been growing in healthcare as well. Probably the greatest area of this has been in the Health Information area, specifically, Medical Transcription.  If you’re not familiar with medical transcription, here’s a little speed course:  Your medical record is your health history, kept on file at the office/hospital/facility you choose.  The records are used to document many things.  Your personal history, your family history, your surgical history, your social history, physical examination, diagnostic testing, treatments prescribed, diagnoses, and plans for treatment.  These records are cumulative, and are referred to throughout your life, and are used to glean information when consultants or other ancillary services are needed.  Your medical record is a vital part of your health care picture.  Unknown by many, these records also serve as the tools for reimbursement.  Information from the records is translated into codes, which are then submitted to the insurance company.  The amount of reimbursement depends on these codes.  So, in essence, your personal finances are affected by your health records, as they determine the amount received by the provider.  The less your insurance pays, the more you are responsible to pay. 

A medical transcriptionist sits in front of a computer many hours a day, transcribing the spoken words of the providers into the healthcare records that make up your “chart”.  Nowadays there are no paper charts filed away in the dark basements of hospitals – rather they are stored within the bowels of data banks and computer systems, making them available at the click of a mouse.  When you visit your physician, or you are admitted to a medical facility, there is a documented record of that visit.  In the olden days, the doctors wrote this information in a paper chart, in their chicken-scratch handwriting.  Nowadays, he picks up a phone, or other electronic device, speaks into it, and dictates his words instead of writing them.  We MTs click a few buttons, and that recorded voice comes through our headphones, and we transcribe what he/she says.  We click a few more buttons, and BAM, it goes immediately into the electronic medical record at the hospital miles away from our desks at home.  We pour another cup of coffee, click a few buttons, and go on to the next patient. 

In the olden days, we were paid by the hour, as there was no real way to quantify how much work we did.  There are so many variables, the technology just didn’t exist to pay us based on performance.  But as technology evolved, it became easier to keep tabs of exactly how much work we did. An audit trail can show just about anything a manager would need to know about how we processed that report.  So the trend moved toward production-based pay.  This is good and bad.  The bad: We are not paid for any time our hands are not on the keyboard; i.e. no paid coffee breaks, bathroom breaks, etc.  The good:  We have the opportunity to make more money than we might have made with hourly pay.  Some MTs are very fast, others not as much.  As long as there is enough work for everyone, there is no limit to how much you can work within your shift.  If the backlog justifies it, overtime is available as well. 

I don’t remember the exact date, but either the late 90s or early 2000s, St. Mary’s sent the MTs home to work, with the proven notion that less distraction means more productive time.  This is now pretty much common practice among hospitals, and many clinics. 

To back up for a moment, in late 1997, I quit my day job in a busy orthopedic practice to do contract work from home, as well as my part-time work with St. Mary's.  Up until then, I had not bitten the bullet and gotten on the internet.  Once I started working from home, I wanted a connection with the outside world, so I got the internet, and joined several groups for MTs on line.  I started hearing the term “off-shoring” and “outsourcing”.  The natives were restless regarding some transcription agencies who were sending electronic voice files overseas…. Where labor is pennies on the ten-dollars in the USA.  We thought it would never fly.  There are too many risks with confidentiality (pre-HIPAA days), too much room for technical errors, etc. 

As the years have gone by, the rumbling noise in the distance has become the roar of thunder, moving ever closer, and nowadays, the way of American MTs is falling by the wayside.  It is a dying profession.

With each passing year, as technology recreates itself, and new capabilities are discovered, our industry has changed.  I started out on an IBM non-correcting Selectric typewriter.  Yep.  We’ve come a long way, baby!!! Voice recognition software has changed the landscape of our work, as well as point-and-click software you may have seen used in your physician’s office or in the emergency room. 

Over the past several years, our hospital has gone through two very significant mergers.  There are always good things about mergers, but the worst thing (that I can see) is the loss of autonomy within our own facility.  We’re not just our local hospital governed by our Board of Directors.  Many decisions are made on a corporate level,  rather than by our local administration. 

We were given the devastating news this week that corporate has decided to outsource our medical transcription department to a very large transcription agency.  We knew this was coming.  We just hoped that it would be later rather than sooner.  After the first merger, I made some phone calls and found that three out of the four hospitals I called were already outsourcing to a big monster company.  After the second merger, and the loss of even more autonomy, the nail in the coffin was placed.  Still, we thought (hoped and prayed) it would be years and years before the final pound of the hammer. In the spirit of ‘corporate standardization’, though, the change was inevitable, and the hammer has dropped.

The monster company has guaranteed jobs for us, with a six-month transition package guaranteeing current wages and benefits, which is the only good thing about this.  It sucks on SO many levels, but the transition package is better than unemployment.  Once the six months is up, the party is over, and we are left to sink.  There is no swimming.  The company is horrible, and I have never read anything good about it.  The name is Nuance (if you want to look it up yourself).  The official name of the company is Nuance Transcription Services, but the current employees (who hate it) and former employees call it NuTS. I've been following this company, and the employees who hate it, for three years.  My feelings about this company are not sour grapes just because I'm losing MY job.  The despicable way this company runs their business and treats their workers is well documented, and my notes go back several years. The information I could give you wouldn’t really make sense to you, but bottom line is, there are a great many MTs who can’t even make minimum wage.  One of my co-workers worked for them a while and said she will never work for them again.  Based on my research, I won’t be working for them after the six-month period, either.   

Our projected go-live date with the agency is slated for late November, then we have the six-month transition period.  This gives us a little under a year to find other work.  The youngest one of us is in her early 40s.  The rest of us are well into our 50s, some of us approaching the big 6-0.  Between the six of us who are losing our jobs, there are over 120 years of service to St. Mary’s.  Probably closer to 130 years.  To be very clear – this is not a St. Mary’s decision.  They fought for us.  It is a corporate decision.  But, sadly, St. Mary’s will suffer, and if you are a patient there, the integrity of your healthcare record will suffer. (So be diligent in requesting copies of your reports, or accessing the patient portal to make sure your records are as accurate as you possibly can.)  It is not only a sad day for my peeps and myself, it is a sad day for our beloved hospital, and our community.  The goal of this monster company is to make it so horrible that the American MT can’t work under those conditions.  As one American MT quits, that job is given to a non-English-speaking “transcriptionist” in India. The company has created 3,000 new jobs for Indian MTs – so they are at the ready when we are dropping like flies.  Why pay me a DESPICABLE 6 cents for one line (after the six month transition period to a NuTS employee) when they can pay an Indian MT 1 cent for 50 lines?  And they are happy to get it.  They just want to feed their babies the same as we do.  It’s all about the dollar.  I understand receipts are down, Obamacare will soon have reimbursements at the Medicaid level, etc., etc.  Times are tough.  I get that costs need to be cut wherever they can. But IMO, selling out to foreigners is an abomination, (in any industry.)  Especially to people who cannot produce adequate, quality work, for such an important product:  Your healthcare records!!! 

It has been such a pleasure working for a hospital that values our work, and recognizes the contribution we make to the total package of patient care.  They know that our loyalty to our facility, our doctors, our patients, and each other, is a very valuable asset – something that money can’t buy.  Our local management is upset about this, but like us, knew it was a reality at some point.  At least we are able to leave with the knowledge and dignity that our local management cares about us - even though corporate only sees a bunch of numbers on a spreadsheet.

I am heartbroken at the thoughts of leaving my little work family of MTs, which also includes our supervisor.  Even though she will stay on at the hospital to manage the incoming reports, she is one of us.  She is taking this very hard, and is as devastated as we are.  I love these women.  Three of them I’ve worked with since 1992.  Though not a full-time employee there since 1992, I have stayed on the payroll all these years, with only a few years that I haven’t worked there in some capacity, whether it was p.r.n., part-time, or full-time.  These are my peeps.  We love each other.  We coordinate our schedules to cover for each other whenever needed.  We pray for each other.  We laugh together, and cry together. We rejoice at the weddings of our children, the births of our grandbabies, and we mourn at the loss of friends, family, and pets.  We are family.  We love our hospital and our patients. We love our doctors.  (Well, most of them… lol…)  We know what needs to be done, and we do it. We have been through so much together. Advancement of technology, implementation of the electronic medical record, and strategizing to make our department pretty much run itself.  A well-oiled machine, if you will.  We are heartbroken. 

Losing a job you love, with a company you love, with people you love is devastating.  The collateral effects are as well.  My grandchildren stay with me after school and during the summer.  One co-worker’s mom has Alzheimer’s, and with this job she is able to keep her home and be with her during the day.  

Not to mention the financial part of it.  Why do we work?  Because we like to eat and live indoors, and be able to pay our bills.  Oddly, (well, not really), I am at peace with that.  My faith tells me that God will bear me through yet another pothole in this road of life.  Every one of us MTs have fought battles – HUGE battles – and faced many challenges that have shaken us to the core within the past five years.  Yet our faith has sustained and strengthened us.  I have absolutely no idea where we will go from here.  Any of us.  We all know we will not be able to work for the monster company.  But we all know that God will sustain us – in some way.  I am sick about the whole thing, but I am not panicking about my future.  If you’ve read my Facebook posts lately where I’ve shared my daily devotional readings – now perhaps they make more sense.  :-)  It is truly a God thing to be given the words of reassurance that these readings have given me.  Perhaps my future will be very bleak, and I’ll find myself and my three kitties living in a refrigerator box under a bridge.  Perhaps as time goes by (and my goodness, does it fly by these days!!!)…. Perhaps as time goes by I will find myself more anxious and closer to hitting the panic button.  I don’t know.  But for right now, this moment, for this day – this week that just passed – I am thankful for a peaceful heart. From you, my friends, I would ask a prayer, a good thought  – for myself and my co-workers.  We’d sure appreciate it.