By Michael R. Kauka

Price per line quotes for medical transcription remind of Babylon -- confusion. As a manager of a transcription company I dislike all the different line counting methods. They simply make it difficult to compare proposals and services. But since the 'line' is the most common way of quoting a price, the following will help explain the differences and provides valuable guidelines on how to make a decision.

Value, Not Just Price
When considering a proposal, you should focus on features such as accuracy, turn-around time, EMR capabilities (such as integration with your existing or planned technologies), technological expertise, and support. Price is, of course, important as well. The fact that one vendor uses a different line count method from another vendor is not dishonest. The reason for the difference is most likely technical.

Counting Methods
When technology entered the transcription industry a number of tools were available for typing such as simple word processors to sophisticated applications as Microsoft Word or WordPerfect. Each of these programs had some ability to count lines, but none of them did it the same. Medical-transcription-billing confusion was born.

Example: The Beginning Of Price-Per-Line Confusion
Recently I quoted a potential client a straight line price of 10 cents (see below for definition). In my opinion, straight lines are one of the easiest and fairest price-per-line counting methods because it is based on the popular Microsoft Word's line counting tool -- and Word is available in almost any office.
Another medical transcription company, bidding on the same opportunity, quoted 9 cents. Sounds cheaper, right? But upon comparing our bottom line price (the cost of all transcribed reports in a given billing period) to that of the competitor, the potential client found that our proposal was actually lower than the competing bidder. The prospective customer was, understandably, confused. It turned out that we do not count lines without characters -- our competitor did.

Is It Cheating?
Most transcription companies are honest. Granted, many want to sound cheaper than they actually are, others just do not have the technology to count accurately. In the above example, our technology allows us to delete empty character lines from the count. Our competitor relies on MS Word, an application that does not have the feature of ignoring empty lines.

Don't Worry : Price Per Line Isn't Everything
Before I explain the different counting methods, let me repeat: if you're looking at several proposal do not just focus on price. There is so much more to consider: accuracy, TAT, customer support, time-saving technologies, EMR compliance, HIPAA ... and on and on. However, understanding the definition of the line quoted in a proposal will make it easier to calculate the value of such features.

NOTE: MS WORD below identifies the count you should see if you open a document in Microsoft® Word and look at the numbers in the Line Count tool (under the Tools menu).

Common Line Count Methods In Medical Transcription

1. Gross Character:  Any letter, number, symbol or function key necessary for the final appearance and content of a document, including the space bar, carriage return, underscore, bold, and any character contained within a macro, header or footer.
   MS WORD: Displays only a limited count of this: ‘Characters with spaces’, ignoring bold, italics, etc.
2. Net Character: Printed characters only. Includes headers and footers.
   Rule Of Thumb: To convert to Gross Characters multiply Net Characters by 1.2.
   MS WORD: ‘Characters without spaces’, probably the most accurate number MS Word's line count tool delivers.
3. Net Line, aka Character Line: A defined line length that includes a pre-determined number of gross characters (55, 60, 65, 70, 75, etc.). May or may not includes headers and footers.
   MS WORD: Not available. It has to be calculated, for example:
   Number of '65 Character Lines' = Total Number of Gross Characters / 65
   Note: Most vendors do not like to use it because ignores formatted characters (see (1.).
4. Nominal Line, aka Straight Line: Any printed line that has one or more characters. May or may not include headers and footers.
   Rule Of Thumb: To convert Gross Lines to Net Lines multiply Gross Lines by .70 – if [!] the document format complies to the standard format, see below).
   MS WORD: ‘Lines’ minus empty lines (which must be done by hand in MS Word).
5. Gross Line, (aka, misleadingly, Straight Line): Many companies use the term Straight Line, when they should use the term Gross Line. Every line within a MS Word file, including the ones without characters.
   MS WORD: ‘Lines’ – it is the only count that requires no additional action in MS Word and is therefore used the most.
6. Keystroke: Each stroke of a key is counted - including the space bar, carriage return, underscore, bold, etc.
   Note: macros become an issue here - technically, if a macro requires three keystrokes, then for billing purposes, only three keystrokes should be billed.
   MS WORD: Not available.
7. Recorded Minute: One recorded minute of dictation.
   Rule Of Thumb: On average one minute is equal to 777 gross characters / 932 net characters for clinical records (including ER) and an average of 782 gross characters / 938 net characters for physician practices. But despite the above averages, dictation speeds of authors vary so greatly that this counting method is rarely used.

How To Compare Prices
In order to be able to compare pricing by different vendors do the following:

1. Take about 20 reports you have on file -- select different authors and report types. Format these reports as: US Letter. Margins top and bottom: 1 inch. Margins left and right: 1.25. Font: Times New Roman, 12 point, single line spacing.
2. Now ask the proposing medical transcription vendor for an exact definition of their line counting method.
3. Apply this method to all reports.
4. Sum up all the line counts of your reports and multiply by the quoted price.
5. Repeat for each vendor.

Don't Forget About Normals & Macros
This refers to content that is identical or similar for each report typed for a particular physician or group of physicians. The transcriptionist typically stores this information (such as a paragraph) in a Macro and merely hits a couple of keys to insert it into the report. You should consider asking your vendor for a discount for such content.

Hopefully this will help clear most of the confusion and make it easier to compare apples to apples ... and make a smart decision in choosing your next patient documentation vendor.

Michael Kauka is the CEO of Avaz Group LLC, a veteran provider of medical transcription services and technology. Questions or comments? .