The Visible Black Character Debate Continues
My colleague and fellow blogger Julie Weight recently wrote
an article revisiting the visible black character (VBC) method of measurement recommended by the American Health Information Management Association (AHIMA) and the Medical Transcription Industry Association (MTIA). Julie’s comments came on the heels of the publication of an article entitled “
Buyer Be Aware” in
For The Record magazine’s online edition, which examines the current state of VBC adoption in the industry. The VBC method has been touted as an easily verifiable means of measuring transcription production. The question remains, though, of whether or not VBC is really any more impervious to manipulation than other counting methods.
From the standpoint of defining a unit of measure, there’s no question in my mind that VBC is a vast improvement over other counting methods. What you see is literally what you get. However, there’s more to measuring than simply defining a unit of measure. There’s also the question of determining what exactly is being measured, what instrument is being used to do the measuring, and an equivalent cost per unit.
The only foolproof way to verify a VBC count is to manually count visible characters in a report, which is not practical in the real world. In actual practice, VBC counting is done by software, with its inherent potential for manipulation. In order to ensure that clients can duplicate the character counting methodology used by a transcription provider, both parties would need to use the exact same software application in the exact same manner. This application would need to be supplied by a neutral third party, not by the service provider.
But even after ensuring that the measuring methodology can be exactly duplicated by both provider and client, there still remains the issue of agreeing on how much of the commodity being provided is subject to measurement and remuneration. In the case of medical transcription specifically, is the client paying for the information contained in document headers and footers? What about demographic information that may be automatically populated into the document by the transcription platform?
As if that weren’t enough, there’s yet one other issue to be resolved, and that is setting a cost per VBC that will result in the client paying and the provider receiving the same net compensation for the work being performed. I’m old enough to remember the 1970s when there was a push for the U.S. to begin converting to the metric system of measurement. Needless to say, much attention was focused on the issue of converting one unit of measure to another; if the speed limit is 65 mph, what’s that in kilometers per hour?
Likewise, if an MT service has been charging 12 cents for a 65-character line including spaces, what is an equivalent charge per visible black character? Obviously a conversion formula must be devised in order to set the baseline cost per unit, which is yet another opportunity for potential manipulation to occur. The process of determining an equivalent price per unit must be carried out in a totally transparent fashion in order for both client and provider to be satisfied that the cost of providing transcription remains the same even though the counting methodology has changed.
Not only is it important that there be transparency between service provider and client with regard to setting a price per VBC, the same is also true when it comes to setting compensation for transcriptionists. One of the primary reasons many MTs have been skeptical of the move to a VBC counting methodology is the fear that in the process their net compensation will be cut. This is particularly true if spaces have been included in the line count methodology MTs have been accustomed to using.
When all is said and done, the fact is that there’s no process that can’t be manipulated to one degree or another. I personally believe that the VBC unit of measure is a positive development, but by no means is it foolproof. Adopting a new unit of measure does not ensure honesty in the marketplace; only an unstinting commitment to ethical behavior on the part of all parties involved will do that.