Questions lead to more questions on the topic. If states start the trend, how does that affect the remote work force in medical transcription? How would MTs react to mandatory credentialing in the industry?

The Association for Healthcare Documentation Integrity's (AHDI) Director of Credentialing and Education, Kim Buchanan, CMT, AHDI-F, joked in an e-mail that "we're always talking about mandatory credentialing." Buchanan and the others interviewed agreed that the buzz around the topic of mandatory credentialing of MTs has increased lately. ADVANCE takes a look at where the idea stands and what questions remain up in the air.

Are Credentialed MTs Better?

No one could say for sure. AHDI has employers looking at quality scores between credentialed and non-credentialed MTs, Buchanan noted, but it's hard to get a handle on whether or not a brand new MT armed with a registered medical transcriptionist (RMT) credential is any better than a 25-year veteran with no credential.

The comparison often gets made between those with credentials and those without. "At this point, a [certified medical transcriptionist (CMT) credential] is not a guarantee that you're going to get a quality product or that it's going to be substantially better overall than from non-CMTs," explained Jay Vance, CMT, president and CEO of Vance Digital, Columbia, MO.

Who Would Need a Credential?

Would it be just new MTs, or everyone in the industry? Buchanan guesses it would have to be everyone. The credential AHDI is targeting for mandatory credentialing is the RMT credential, which is the entry-level credential. No one's really sure at this point how the credentialing would be policed or if, indeed, everyone would be required to have a credential.

What If Only One State Goes for It?

The way AHDI envisions mandatory credentialing right now involves a state-by-state plan, rather than going to the federal level. Each state has sunrise evaluation forms where industries can plead their cases for mandatory credentialing. AHDI representatives from Illinois and Pennsylvania filled out sunrise forms already, and Washington representatives are busy completing their sunrise evaluation for a June deadline (read about PA's experiences online at www.advanceweb.com/him).

Buchanan surmises that at least one state will bite, but that might cause confusion. Buchanan said the best way to do it, if a state were to approve mandatory certification of MTs, would be to have all work for that state's hospitals done by certified MTs, no matter where those MTs might be based.

That would mean full disclosure of contracts with outsourcing partners, and it could become very complex and intensive. "[If] you said any health care documents in the state of Washington have to be produced by certified individuals, I think outsourcing nationally could be called into question," Buchanan said. "We may end up seeing Washington hospitals bring their dictation either back in house or at least more local because they would have more control over it."

Will It Affect the Work Force Shortage?

That's a point of contention. Vance sees mandatory credentialing as exacerbating "an already critical labor shortage in the medical transcription field, at least in the short term." He isn't opposed to credentialing in the least (he's a CMT himself), but doesn't see how the details of requiring certification could pan out.

Dave Woodrow, vice president of business development with DSG Inc., a Jacksonville, FL-based medical transcription service organization (MTSO), agreed that credentialing would be a plus for the industry. However, it would seriously cramp an already pinched labor market, even with the work lost as MTs study for the exam. "It would decimate the work force," Woodrow predicted. "People don't want work going offshore? Well, the reason it's going offshore is because there are not enough MTs here. If you said all of a sudden, well, only [RMTs] can do it, you'd see it go offshore faster."

Buchanan had a different take. With facilities really starting to ramp up use of speech recognition, no one has clear numbers on how many open positions exist in the transcription field. "Honestly I think the work force shortage is shrinking anyway, and I really think that when this happens, when not just anybody can claim to be an MT and when the positions are fewer and employers are pickier, if you will, only the cream of the crop will stay employed," Buchanan said.

Who Picks Up the Bill?

If mandatory credentialing was approved, it would likely fall on individual MTs. MTSOs expressed initial concern about having to foot the bill, Buchanan noted. "We've all accepted that individuals need to be accountable for it," Buchanan said.

Woodrow explained that service organizations are already operating under tight budgets, and having MTs pay for their own credentials also seems like a difficult choice, as maintaining the credential can be pricey. "We have a work force that is not in a position to be traveling around the country to various conferences, and certainly the income is not something that gives them a lot of spare dollars to invest, frankly, in that credentialing."

In addition to paying for exams and continuing education, MTs would likely have to foot the bill for licensing fees in the individual states, Buchanan said. In Pennsylvania, those fees would run $2,105 per license every 2 years, according to the 2006 sunrise evaluation letter from the state.

Will MTs Embrace It?

Some are all for it, and some are vehemently against it. Woodrow noted he sees about half of MTs in favor of mandatory credentialing. Vance said he hears from MTs who don't see any real incentive to garner a credential. Still, more people are taking credentialing exams than ever before, possibly because of the economy, Buchanan explained. "Some people are all for it and have jumped on board, and others are still really fearful of how it would impact them," she said.

Where Does This Stand Now?

AHDI is still working on a state-by-state basis to advocate for mandatory credentialing. Those interested in rallying for the cause can view documents pertaining to mandatory credentialing on the AHDI Web site (www.ahdionline.org), so each state isn't reinventing the wheel. Pennsylvania denied the request to issue mandatory certification, citing costs and a minimal benefit to patients.

As mentioned above, AHDI is amassing numbers on qualitybetween credentialed and non-credentialed MTs and hopes to use those numbers to show that credentialing increases efficiency in health care. The American Recovery and Reinvestment Act might help the cause if a solid case can be made for credentialing increasing efficiency, Buchanan explained.

The bottom line is-at least in the eyes of those interviewed-that credentialing is a good thing for the industry, but many obstacles exist in requiring it. It's no sure bet that employers would pay more for credentialed MTs. Advocacy efforts for mandatory credentialing take a great deal of time, and generating enthusiasm for the idea isn't always easy. "I think manpower and enthusiasm are our biggest obstacles," Buchanan said.

Lynn Jusinski is an associate editor withADVANCE.