Scribes for the Win!

Medical scribes have become an integral part of the medical landscape.  By 2019, there will be 100,000 medical scribes, roughly 1 for every 9 physicians.

As our country has moved into the era of EMRs, we are still in the process of learning how to effectively use this new technology. Putting aside interoperability and all the other ‘baggage’ that comes with implementation of EMRs in the first place, let’s focus for a second on how this has drastically changed the workflow for providers.

In the past, you could walk into your doctor’s office expecting his or her undivided attention. Let’s go as far as to say that they actually looked at you while speaking and listened to your entire story without pausing to type in between. That type of doctor’s visit no longer exists in 2019.

With the creation of the HITECH Act in 2009 to improve quality of care and increase care coordination (among other goals), computerized documentation and physician order entry became part of every medical encounter. What did this mean for the doctor-patient relationship? It meant that now when you walk into your doctor’s office, you are lucky if they look up at you from their screen. On the provider’s end, the patient encounter now involved administrative tasks taking away from valuable face time with their patients.

And… cue scribes!

Medical scribes document the verbal communication from the doctor-patient interaction in real time at the point of care while (under the supervision of the provider). [1] The ideal scribes are college students or graduates pursuing medicine or another track in health care with knowledge of medical terminology and the ability to type. FAST. Scribes are put through a rigorous training and they must also be able to adapt to the environment in which they work in, whether this be an ambulatory setting or the emergency department.

Having worked as a scribe in both outpatient and emergency departments during my transition to graduate school, I noticed two outcomes across the board: increased physician productivity and satisfaction. This consequently translated into higher levels of patient satisfaction. For instance, in the ED, the providers I worked with were able to see more patients per hour without worrying about documentation other than putting orders in. Not only did this improve door-to-doc and door-to-discharge times, it allowed the provider to focus completely on examining the patient without the cloud of documentation hanging over them. That was my job. Although this was my job, I was also able to reap additional benefits in the form of witnessing medical conditions managed in real time, note the consequences of improper documentation on the administrative end, and the impact of meaningful use in the age of value-based payments.

Scribes can now also assist in the referral management process through ReferWell’s partnership with ScribeAmerica. With care coordination playing an important role in patient satisfaction, scribes will now be able to help book referrals at the point of care for patients. Specifically, 40 percent of patients report specialist referrals as the most important factor in their overall satisfaction. For providers, this means one more administrative duty that can be delegated to the scribe and increase the amount of time focusing on the patients.

Two of the main reasons that relative value units (RVU’s) are lost in the system are 1) deficient charting and 2) non-billable or incomplete charts. Scribes address the deficiency in charting by assuring that all the necessary elements of the encounter are accounted for, as opposed to the physician trying to recall items afterwards. This solves the issue of charts being overlooked and ultimately reducing the number of incomplete charts, leading to less medical and legal challenges later [2]. There is increased revenue for the same volume of services (reduced leakage) and additionally “compliance is improved so potential refunds due to chart audits will be minimized” [3].

Overall, medical scribes have improved physician productivity, improved physician lifestyle, and increased reimbursements for hospitals. With proper training, scribes have been able to include data in patient charts that is often missing, which provides a more thorough patient note. In addition, they serve as an extra hand to help with simple non-clinical duties at the workplace. Although there are still some hesitations in hiring scribes as far as the cost and training, the majority would agree that it is a win-win; and at the end of the day a happy provider results in a happy patient.

[1] American College of Medical Scribe Specialists. (2016). Medical scribe definitions. American College of Medical Scribe Specialists. Retrieved from https://theacmss.org/specialistcertification/scribe-definitions/

[2] Healthcare Administrative Partners. (2016). How to derive maximum value from ED scribes. Healthcare Administrative Partners. Retrieved from http://www.hapusa.com/clinical-specialties/emergency-medicine/scribes-can-help-improve-emergency-department-revenue/

[3] Strafford, J. (2012). Can scribes help improve your practice productivity?. AAPC Client Services. Retrieved from http://www.aapcps.com/news-articles/ProductiveScribes.aspx

 

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