Maintaining the status quo won't be good enough for vendors in the fiercely competitive medical transcription services market, according to KLAS.

The company's new report, "Transcription Services: Steady Demand in a Volatile Market," includes performance ratings for 15 medical transcription service organizations (MTSOs), and the field looks different from KLAS' June 2008 report.

The top-rated vendor last year, Transcend, has dropped to fifth place despite a steady performance score. Newly rated Webmedx and Precyse Solutions take the top two spots in the 2009 report, followed by Encompass and TransTech, both of which saw significant improvement in their performance scores.

"The shakeup in vendor rankings this year illustrates how competitive the MTSO market is and that vendors have to always be looking to improve the service they offer providers," said Graham Triggs, KLAS' director of financial and services research and author of the report. "Sixty-two percent of respondents in this study have switched MTSOs at least once – suggesting that every vendor is vulnerable if performance starts to wane."

The report also compares provider experiences using onshore and offshore transcription services. An increasing number of providers are sending transcription work offshore – 43 percent of respondents did so in 2009, up from 35 percent in 2008. Offshoring is attractive for those charged with reducing costs, but less popular with those who have to deal with the issues of offshoring, such as reduced quality.

Despite the increase in offshore transcription work, onshore services continue to get higher marks for overall quality and turnaround time. The top five MTSOs in the KLAS report do their work predominantly onshore.

The 15 MTSOs rated in the report are Acusis, CBay, DTS America, Encompass, Focus, Heartland, MedQuist, Precyse Solutions, Spheris, SPi, Sten-Tel, Superior Global, Transcend, TransTech and Webmedx.