Medical Transcription: What’s in a Line?
As much as things change in the medical transcription industry, one thing seems to remain the same. Discussions, and confusion, over the definition of a “line” of transcription. For those of you who are relatively new to the industry, perhaps a bit of history will help.
There was a time when most MTs worked in-house in a hospital or doctor’s office and were paid hourly. Then the move came to work from home. At the same time, as we grew as an industry, production pay became a part of our world. Medical transcription is quite measurable, and in the beginning, there were many ways that was done. Sometimes it was a gross line (anything on a line is a line), sometimes it was total characters divided by a number to calculate a line (and that ranged anywhere from 45 to 80), and sometimes computer “byte” counts were used. Sometimes MTs were even paid by the page of transcription, or the minute of dictation. It was quite confusing, and there was no real way to do an accurate comparison, for customers or for the MT.
In the early 1990s, three organizations (what is now AHDI, MTIA, and AHIMA) came together to try to come up with some common definitions of things. Those discussions were quite fascinating as it became hard for the group to even agree on what a “minute” of dictation was. This meeting actually resulted in a document with a list of definitions for things like a line, character, and minute of dictation. AAMT (now AHDI) was the first organization to publish this, and so the definition of a line in the document became known as “The AAMT Line.” It was never intended to be a “standard” as none of the organizations involved are standards development organizations. What is WAS intended to do is provide some common understanding of the metrics in our industry. By around 1997, AAMT was hearing from the membership that this definition was causing problems for them. MTs who had previously been paid on a gross line were now being told that they had to be paid on a 65-character line because “AAMT says that’s what we have to do,” but there was no change in the compensation rates offered. The resultant decrease in pay was, of course, not something anyone was pleased about. The reality is there never was any such thing as an “AAMT line,” that’s just what the industry used. Even with that definition, its use was manipulated. Do those 65 characters include spaces? What about formatting codes? What about things like bolds and underlines? Even though the definition addressed those things, each user manipulated it to fit their needs. That’s not uncommon when you have a “definition” list and when you are in an industry with no real defined true standards. In 1998, the year I was AAMT President, the association formally removed its support for the document of definitions due to the misuse in the industry. And yet still today you will hear people reference “The AAMT line.”
A few years ago, MTIA brought forth the idea of the VBC as the answer to our industry issues. The VBC, or verifiable black character, simply meant that you only count those characters you can see, which means spaces were not counted. Once again, this certainly caused some uproar in the industry. The idea of a VBC is that you can measure it more accurately, there is no question about spaces and such. To their credit, the organization did issue a statement that this meant the old methods of billing and compensation would have to be addressed to account for the differences. And yet, even with this, I have already seen manipulations.
The real question for medical transcriptionists must be, in my opinion, how is your line defined? What is included in that line and is it verifiable for the MT? I do not believe anyone should work in a situation where it is unclear how they are compensated. Yet, today, I still meet MTs who aren’t really sure how their compensation is calculated. Who is responsible for that?
I have to say that I believe the only way we are truly empowered is by taking control ourselves. In job interviews, I believe that’s a two-way process, and each person has a choice to make. The employer or client is choosing the MT, and the MT is choosing the employer or client. The method for billing or compensation should be absolutely clear and transparent. Find out if spaces are counted. Ask about headers and footers. And what about things like bolds and underlines? Are they counted, and if so, does that mean each bolded character counts as two characters? Can you verify those counts on whatever system you are using?
I urge you to be sure that you have all of the information so you can make an informed decision. It’s easy to say “this place pays xxx cents per line and this one pays 2 cents more, so I will take position B.” Yet, if you don’t have a real understanding of the definitions that are used, you cannot make an informed comparison and decision. Don’t let that happen to you!
Now to the age-old question. What if a company doesn’t pay for spaces? I’ve heard some MTs say they simply won’t work for that company. In the end, that’s a personal choice. I’ve heard some MTs say if spaces aren’t paid for, then let’s notgivethemspacesanymore. In the end, of course, we can’t do that because ultimately it is the patient we serve. For me, frankly, it never mattered. I don’t care if you pay for spaces or not. What I DO care about is understand how things are calculated so that I can take that into consideration in asking for an appropriate rate of compensation. If I know that spaces take up 20-30% of a document and I’m not going to be paid for spaces, then I will expect that my line rate will be 20-30% higher than normal to account for that. It’s really that simple, and it is all about transparency.How about you? I will look forward to this discussion and your input!
Related posts:
- 7 Questions to Ask During a Medical Transcription Job Interview
- Medical Transcription and April Fool’s Day
- Medical Transcription: What Are You Passionate About?
- Medical Transcription: The Final Summit
- Medical Transcription – What is your Vision for the Future?
Tagged with: how to count a line of transcription • how to measure medical transcription • medical transcription • medical transcription technology
Filed under: Professional Development • Technology
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Kathy, thanks for the history lesson and for bringing to light an issue that plagues those of us in MT pay-for-production world. How in the heck are we paid? There are lines that qualify for bonus, there might be some that do not, voice recognition lines at a different rate, shift differentials, overtime (which at some employers means 1-1/2 times line count and sometimes 1-1/2 times the “lower of” several possible rates). We MTs by and large aren’t math wizards. For the life of me I can’t figure out how they calculate my pay, no matter how many times the payroll people try to explain it. Did work for a hospital that gave us a spreadsheet that explained it well, but don’t know of any employer who does that now. And our industry hasn’t had a salary survey in some time. My pay has decreased over time and I’m working just as much. ;-( Am I alone? Students ask me what they should charge for entry level. I have no frame of reference. Let’s bring this big secret out of the closet. Kathy, can you do a survey? Line base rate, bonus, differential for CMT, shift differential … other stuff I haven’t thought about?
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Kathy Reply:
May 28th, 2010 at 12:52 pm
Great points, Crystal. And it’s such a critical issue that it IS important for us to understand it. By the way, folks, IF you are an employee (not an IC), there is no magic formula for overtime pay. That is dictated by the US Department of Labor and they make it pretty simple. If we see in comments an interest in a a survey, sure, we could do one here. Just realize that the surveys we do here are pretty “unscientific,” although they do provide some really good insight into our community!
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I think this is the best article you have published yet, especially for new MTs! As a new graduate, I did not have an understanding of the differences in how a line is calculated. I was careful to ask about cpl pay and how I might be compensated with bonuses, shift differentials, or for CMT. I also did ask employers about how a line was calculated and if I was paid for headers/footers; however, as a new graduate I really had no idea what that information actually meant. I did not understand how much time I might be spending to enter demographics or anything else that MTs are often not compensated for. I had quite a few job offers after graduation last year and in retrospect I turned down jobs that actually paid more than the jobs I viewed as being better, simply based on how they calculated a line.
This is another trap we also fall into as we talk to each other MTs and compare our careers. I haven’t been working for too long yet, but the opinion I have formed at this point is that unless 2 MTs work on the same account, with the same supervisor and the same dictator, with lines being calculated the same, you really cannot compare one MT to the other. I remember getting very discouarged when I was barely hitting 110 lph on an 80% ESL account that was mostly op notes, and learning a friend was doing 200+ lph on a clinic notes account with 1 dictator. At that time, I was too new to understand I was comparing apples to watermelons! The same is true for pay.
I began my career working for a company that paid based on a 55 character VBC. Even being new to the industry, I know plenty of people who do not find that acceptable; however, they also offered an above-average cpl pay, bonuses, benefits, and shift/holiday/weekend pay differentials. I have learned pretty quickly that there is a lot more to the picture than meets the eye. I think that too often our industry, and often educators, is failing to make sure new MTs understand this.
Straight forward information like this is incredibly valuable as we find our way in this industry. Once again, fantastic article!
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Kathy Reply:
May 28th, 2010 at 4:02 pm
Thanks, Sarah. You are sure right about not comparing one MT to another! There are too many variables. I argued that case years ago when I managed in a hospital. Some MTs had purchased their own specialty word books, others had to use the department’s books, which meant getting up from their desk to get the book. Even something that simple made a difference in what someone could do in a day. And, by the way, if you’re doing an 80% EST account that is mostly OP notes, wow! For someone new to the field, that is pretty amazing!
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I love this! I used to work for a service on an account that paid 0.065 CPL and paid for spaces; I now work for a service on an account that pays 0.09 CPL and does NOT pay for spaces. Based on what my paychecks USED to be when I got paid for them vs. what my paychecks are NOW when I DON’T….I’m coming out ahead not getting paid for spaces!
There are definitely some variables that could make a difference. I currently don’t do op reports, for example, and those jobs always required a bit of research (more than what I do now). Also, I actually believe I have doctors who generally are far easier to understand (not that occasionally I don’t exclaim to the four walls of my office that I have just met the bain of my existence). All in all, it’s a tough call. I’ve almost always had accounts that paid for spaces, and for the most part they paid between 0.065 and 0.08 CPL. My paychecks on the account I have now are ALWAYS more than I have ever made before in a 2-week pay period. I also can take into account, of course, that I’m probably more familiar with my Instant Text and using it more often/more consistently and, of course, that helps to increase what I am able to get done (compared to in the past) in the same amount of time. I guess there are all sorts of variables you can consider, but I’m still making a better income now on an account that doesn’t pay for spaces!
Regarding refusing to work on an account that doesn’t pay for spaces, I will say that I know someone who has done that. She said, “If they aren’t going to pay for them, then I’m not going to include them [spaces] or I’m just not going to work on that account.” As Kathy says, in the end, it is really the patient who is the beneficiary of our transcription. I guess it is always up to us as individuals to “negotiate” our line rate with a company who would like us to transcribe for them, so we have the option to be pro-active from the outset.
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Kathy Reply:
May 28th, 2010 at 4:03 pm
Sherry, this is a great example of how it really doesn’t matter what’s counted IF you are compensated for the knowledge you have. Maybe we are having the wrong discussions in our profession. Perhaps we should stop talking about what “counts” and start talking about fair compensation for the knowledge that we have to do the job!
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This was a good article. I do think, however, that an industry-wide standard would be helpful for making comparisons, both for clients and for transcriptionists.
That said, in my mind the one sine qua non would be making sure that as expanders become more and more common, transcriptionists continue to be paid for the end result and not based on characters actually typed. I work on one account where the system indicates both how many lines were physically typed and how many lines were in the report. Obviously, the latter is always more. I certainly don’t want to lose the benefit of the effort I put into creating templates and using my expander to good effect, and I could see that as a potential danger. Or is it actually happening already?
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Kathy Reply:
May 28th, 2010 at 4:06 pm
Carla, you’re right that industry standards would be helpful for everyone concerned. I’ve always felt that using expanders, the knowledge it takes to use them and set things up, are a part of what I am paid for in the KNOWLEDGE I bring to the table. I haven’t heard of anyone not getting paid for that, although I’m sure there is a program out there that can track that. That’s another good point in discussions is you want to be sure you’re using the word “characters” and not “keystrokes.” I’ve seen agreements that said “keystrokes” and that always made me think that was way too vague.
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Kathy,
Thank you for this invaluable information. Even though I have such a passion for MT that I would work for free, it does help to see it written that we deserve to be paid.
Angie
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Kathy Reply:
May 28th, 2010 at 4:07 pm
Angie, passion is a good thing. Working for free is not! LOL In the end, it’s all about being sure that it’s fair for the knowledge you possess!
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Carla: I have actually used my microsoft program to figure out character count/65 = number of lines and always come out the same as the service’s counting system said I had. It made absolutely no difference whether I was physically typing those characters or whether they were “popped in” based on what I had put into my expander. I’m not even sure there is technology that can detect the difference! A black character is a black character, whether you typed it into your expander and then required it to print into your report OR whether you manually typed it in each and every time yourself. To me, that would almost equate with “them” being able to detect every website that you use for reference while you are logged on. I don’t believe that it is possible unless, of course, you are working at a work station in a facility where your work station is actually feeding into a mainframe computer, and then the facility can track every single thing you do on your work station. As an independent contractor working on my own computer from my home (or even a hotel room someplace that has internet service for their guests), “they” do not have the capability to know how many characters are PRINTED using an expander and how many are PRINTED when I actually plunk my fingers onto the keys. Once the work is downloaded to me, I’m truly independent…finish the job, upload it back to them, and I go onto the next job.
Now, I guess I’m not a true computer expert and it is possible that maybe some companies or systems DO have that ability, and if so I’d LOVE to know about it. As Kathy’s article mentioned before, most companies work on a fairly routine system where they determine the line count to be a certain number of characters, and at this point we have to be intelligent enough to ask so we know whether their line count includes spaces or if we aren’t compensated for them. That VBC, or verifiable black character, is the base of everything…and VBCs include every black character whether they were produced by an expander or were manually typed.
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Kathy Reply:
May 28th, 2010 at 4:10 pm
Sherry, your last paragraph makes exactly the point I’ve “preached” for many years. In the end, it IS about us knowing what to ask, and how to interpret that, to make the best decision for ourselves. Someone told me today she wished we would stop talking about what’s counted and start talking about how to be compensated for the knowledge it takes to do the job. I think however we do it, it IS about taking responsibility for ourselves and not just doing nothing and then blaming someone else when it goes wrong. New graduates also really need to understand this kind of thing as they move to that first job. I’ve always felt it was up to me to be sure I am compensated fairly, which means I get informed and I ask lots of questions.
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I just read back my last post and I sure sound like a know it all. I’m sorry I sounded so dynamic and sure of myself–at this point, I’d like to be proven wrong so I can learn something about all this that I don’t really know. Sorry, Carla. It almost sounded like I was picking on you because it was addressed with your name specifically. I’m sorry. I’m pretty sure I have my facts straight, but I didn’t mean to come across like I think I did after I re-read that post! grrr
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Of course back in the day before word processors, computers and certainly before AAMT, BOS, etc, being paid by the line in an 8-hour work day would have yielded very low paychecks. Any time the doctor corrected himself, you had to start over the retype the whole report. There were no text expanders, everything had to be typed.
Over the years I’ve transcribed (40 come June 16) I have certainly been made aware that the doctors hate to part with their money to pay transcriptionists. It’s a miracle I have the job I do, because many physicians now do their own putting information into the patient’s chart, often while you are sitting there.
The MT companies pay just as little as they dare so they will make money for the owners/managers. I think that’s why so many of them hire newbies because they will work for the lowest pay they offer and not quibble about it. It’s us oldsters who feel that after 40 years of doing every conceivable type of report there is both in hospital and out that we are worth more than 7 cents or even 8 cents a line.
But I have to say that finally I feel I am being paid fairly, albeit no compensation for CMT, in fact I think I’m probably the only one who even has that. But then of the services I did work for, only one ever paid more for having the CMT.
Speaking of the math, when you produce the required quota for most the MT companies out there it equates to about $10.00 an hour. And while some companies do offer incentive money for producing more, many do not. I believe that the reason behind the myriad methods of line counting is to afford the highest profits for the MT company, that’s the bottom line.
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Kathy Reply:
May 28th, 2010 at 4:14 pm
Oh boy, Gwen, I remember those days! My first days of transcription were done on a selectric typewriter, with carbon paper, and each carbon copy was on a different color paper. Remember having all those bottles of “white out” in different colors on your desk? I am SOOO glad those days are over!
I think, too, that employers are as varied as MTs are. There is no “one size fits all” in our world. There are good and bad in both groups. In the end, it is about finding the right fit for YOU and what you’re looking for in a work situation. Find what you love, find a place you love, and do awesome work. I’m glad you have that where you are now.
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This might sound really strange, but do you know the two types of people (and I don’t want to be too general here, but I think you will see my point) that have been my best “bosses”?
The first is the woman who has been a secretary, transcriptionist, or typist in the past. She is aware of what we do and has some realistic expectations as to how long things will take to complete, etc.
The second is the MUCH older gentleman who was raised during a time when women were just treated much differently. Although they realize that we are “there” to take care of their transcription/typing needs, they act like they are truly GRATEFUL that we are there and that they can TRUST US TO USE OUR BRAINS!
That “in-between group” are the ones I have problems with. It generally encompasses women of all ages and levels in business, but the one thing that they lack is what we have an abundance of, and that is “office experience.” The rest of this group is made up of the younger and/or middle-aged men who just want to exercise their power. These are the ones who truly have no idea of what it takes to get out all the work for all the people we are working for. Sometimes, one man will think he is the ONLY person we are working for! These people can drive you nuts and just might, unless someone is able to wise them up before it happens to you. Yes, while all bosses don’t come from the same mold, I think they pretty much fit into 1 of those 3 groups.
I could get into paragraph after paragraph of what I think our dictators should go through before they would be allowed to pick up that recording device the very first time, but you’ve probably already said most of it before yourself! Oh, well…it’s something to hope for and strive for. Keeps everyone on their toes! Just give me a few of those nice old-school doctors who appreciate everything I do, and if you deliver them along with my coffee and chocolates, nobody will get hurt!
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Kathy: You know the problem with getting paid what we are worth? It’s a judgment call! It involves things like “merit raises,” and for the most part they don’t exist anymore because too many places are unionized. My last job working in a facility was doing transcription at a local hospital. Virtually everyone in the hospital was a union member (of course, that didn’t include management…I don’t know, I guess maybe the docs weren’t union, but the nurses were!) At any rate, when work got low in our department, I was the hospital employee/member of the union who had the least seniority IN THE ENTIRE HOSPITAL, so I lost my job! I’m not even talking about seniority in my DEPARTMENT…I truly mean I had the least seniority of every union member in the union in the hospital! There was a girl in our department who had less seniority IN THE DEPARTMENT than I did, but she had 2 months more seniority total within the union!
When unions were first created, they truly served a wonderful purpose. However, they have grown too big, very cumbersome, and they now seem to protect people who have managed to gain seniority but take advantage of the fact that they can kind of relax their pace while others with less seniority will have to work harder have to pick up the slack. If unions stopped being there, and workers’ ability to keep their jobs reverted back to their bosses being satisfied with their performance, and raises were based upon performance (which, of course, is a reflection of their skills on top of their knowledge), then I think there would also be a higher quality of work being done because it would be important to do your best if you ever want to get a raise or a promotion.
In a strange way, this also brings up (for me at least) the topic of “verbatim accounts.” If you are told that you are to “type what you hear being said,” then all these docs need to do is to hire people off the street with a decent command of the English language, toss in good grammar and punctuation skills, maybe some exposure to medical terminology (to help with spelling) and the ability to type at a reasonable speed. To me, it says, “I don’t care how much time and money you spent on education, I don’t care how long you’ve been doing this, and I don’t even care what grammar books or other reference books say is right! Turn off your brain and put your fingers and ears in gear and just type what I say! And if you think I have made a mistake, remember who YOU are and who I AM and then just keep it to yourself!”
I definitely think we should be paid for what we bring to the table. While I know we aren’t doctors, we certainly work hand in hand WITH them. If they say something that is suspect, it could be a matter of diction, but if we type what we THINK they said and it’s WRONG, it could affect patient care in a very critical, possibly even terminal, way. We HAVE taken our time and our money to educate ourselves to the point where we are no longer “simple typists.” Gosh, I hate verbatim accounts!
Well, I wrote a book again…possibly on more than 1 topic. Sorry!
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Another lively discussion spawned Kathy. Thanks. My argument to my employer (a large MTSO) is that instead of counting lines, they need to count the number of flags and notes we put with a report to save the dictator and/or facility from having a job rejected by reimbursement agencies and from impacting patient care. It’s a given that we will fix the grammar and spelling, but knowing what SHOULD be in the document is where we shine. The orthopedists are notorious for left/right confusion. May not seem like much, but if a left knee is documented as having an implant, when you go to do the “other”knee there will be reimbursement nightmare. I think that is a far better way to assess our true value. The flag that says “check drug dosage,” “Patient indicates heart murmur in ROS but physical exam says no murmur,” “demographics indicate 50-year-old male but you indicated female.” I have actually been mildly reprimanded for doing too many of these because the doctor was getting “a complex,” although the facility said that every one was appropriate. This is what happens when you have the health record function assigned the IT and administrative “overhead” departments and removed from risk management. Our true value-added is our knowledge of what the report contains or should contain, not how to format it. Thanks for the thought-provoking discussion.
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I worked for a large MTSO previously and totally agree with you, Crystal. No matter how many QA marker were “appropriate”, we would get dinged by our supervisors if our QA utilization wasn’t below a certain percentage of our total documents completed. It’s pretty much a case of damned if you do and damned if you don’t. When the reason for the marker is to question the validity of something the dictator said, it shouldn’t count against you–it is in the best interest of the patient and facility! And all of this is another reason why we take specialized training and why MTSOs and hospitals themselves aren’t generally able to just “hire people off the street.”
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I think it is one of the best written articles regarding compensation for MT work. It is a subject that has so many intrepretations that one can really get lost arriving at the right price. It is tempting to throw up your hands and accept what is offered! Thanks
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Kathy Reply:
June 5th, 2010 at 3:57 pm
Thank you, Renee! I appreciate your comments and participation. I think it’s good to talk about some of the “hard stuff” so that we have a real understanding of things and can make informed decisions.
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Kathy, since what is considered a line seems to have been covered in these discussions, I think it would be very informative if MT’s would share how much per line they are charging or getting paid. I have heard it all across the board. I’ve heard it sometimes depends on the state, north or south, etc. Could anyone comment on how many cents per line they are making/charging, etc? Where I live in the south, the standard seems to be gross (contractor, not subcontractor)approximately 12-13 cents per line. How does that compare to others?
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Kathy Reply:
September 4th, 2010 at 9:47 am
Dusty I think we have a couple of challenges with talking about line rates. In any “gathering” of people, there are federal laws that prohibit anything that could be perceived as “price fixing.” I know that’s not your intent there, just trying to explain why that is. I think things DO vary depending on where you live. I’ve seen contractors get anywhere from 10-15 CPL, depending on both where they live and what kind of work. Years ago I was able to land a hospital account at 19, but I’m afraid many of those days are gone now.
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