Michele, you have described very well the pitfalls of offshore outsourcing. I totally agree.However the reality of our business is very sobering.All of what you describe are trumped by one thing - price.The providers are counting their nickels; most of the time their first and sometimesthe only question we are asked by a prospective client is " how much".All medium and large companies have their delivery stations offshore. They pay the billers 80 cents per hour offshore; in USA they will have to pay at least 20 times that much.Athena Health, E Clinical Works, MTBC are just some of the companies that charge 3% or less, and give out their software for free to boot.How long do you think you will survive, with US wages you have to either pay or earn yourself?Have you ever tried calling your bank, your telephone company or even Google? Guess where the telephone is being answered.I would love to keep the jobs here, as an American, I just can't collect enough money from the Providers to make it a possibility.That said, your ace in the hole is your customer service, there are still some providers who will pay for superior customer service, that they would not get offshore or a bigger company. But such paying Providers are very small in numbers and they are dwindling fast, as they get more under pressure to make a profit.
All of what you describe are trumped by one thing - price.