Know what number jumped out at me soon after I started my orthopedic surgery practice in 2007? Not the usual suspects like staffing costs, malpractice insurance premiums or surgical supply bills. No, it was our medical transcription fees. Each of the 30 physicians in our group was spending an average of $30,000 per year on transcription.

My personal wake-up call came when I noticed that my transcriptionist collected more for an office consult for an ACL repair (CPT 99243) than I did. I was reimbursed $176 for the visit. She charged us $88.62 to type a 2-page letter and a 3-page addendum. I received $87.38. At a nickel a word, she was making more than I was. There's got to be a better way, I remember thinking.

My partners didn't realize — and didn't seem to mind — that we were paying such exorbitant transcription fees (see "Transcription Costs by Physician"). I tried to re-negotiate our contract with our transcriptionist. For example, I suggested that she no longer charge us by the line when she was using a single keystroke to insert a spiel or an addendum — especially on an office consultation, when only 20% of the note is dictated and the other 80% is templated. She balked, saying she had a family to feed (seriously).

Something had to give. No, make that someone had to go. That would be my transcriptionist, who actually had the audacity to tell me that I "talk too much" and that I "should focus on surgery and let her take care of the dictation" when I suggested that her fees were getting out of hand. Talk too much? Then let me make this brief: You're fired!

I began thinking about how to streamline my transcription process, cut costs and still ensure optimal patient record keeping. I eventually discovered speech-enabled medical transcription. I speak normally into a microphone and seconds later my words appear on my desktop monitor. It took me 6 weeks to master most of the software's shortcuts. For example, when I say, "insert normal right knee," the program recognizes these words and pastes the paragraph I've stored into the note.

I talk, it types
Besides being more efficient, voice recognition software is also an economical choice. Between 2007 and 2010, my per-patient cost for transcription decreased from $11.68 to $1.17. My per-line charge is down from 65 ? to 19 ?, or 2.2 ? per word.

The initial cost outlay was reasonable: $1,550 to license the software, $300 for a noise-canceling microphone and $250 for a Bluetooth headset. There's also a one-time fee for initial setup and annual maintenance and site license fees. You may want to upgrade your computer, as the speed of your computer may affect the speed of the transcription. The software paid for itself in 6 months.

You'll be speaking your notes in no time. It takes 5 minutes to install the software and 30 minutes to train and read aloud with pre-written scripts before you're ready to go. The software is designed to recognize word associations (the frequency of words that occur with other words). You don't speak deliberately — word by word by word. You teach the program how you speak. Regardless of whether you have a deep voice or a high voice or speak with an accent, the software "learns" your voice, intonation and preferences. Speak normally. Once you get the hang of it, the accuracy is amazing.

Starting to dictate is easy. Open a word processing file. Make sure your text insertion point is at the start of the document and simply start talking. As you talk, text displays on the screen.

You'll soon be creating voice-command shortcuts and spiels for those cases that you perform again and again. To create a shortcut, dictate a phrase, paragraph or letter, highlight the text and say "make that a shortcut." A pop-up box opens that lets you name the shortcut. Next time you can use it without re-dictating by saying "insert left distal radius fracture." You can make changes easily to each patient note to individualize it.

Benefits of better (and faster) notes
We're able to see more patents because we're spending less time (and money) on transcription. I've also noticed that structured data lends itself to more efficient coding and billing and better documentation.

An often-overlooked benefit of voice recognition software is how quickly you'll get reports to your patients' primary care physicians and physical therapists. I can literally complete the note before a patient leaves my office, right click and sign it, click on the fax button and the note is sent. Be-fore, it would sometimes take a week before the patient's primary care physician would receive a faxed report from me. Now it's 10 minutes after I saw his patient.

As you might imagine, my ability to gain referrals has gone through the roof. Referring physicians appreciate that you're responsive not only to their needs, but to their patient's needs as well.