Using a scribe is optional within Winden’s group, and indeed six of its 23 physicians opt out of the program, although Winden says he has “converted a couple over.” Some truly don’t need the service. One doctor on staff is “fast anyway,” explains Winden. But then there’s the other extreme: “We have another physician who charts almost illegibly,” Winden says. “He has to have a scribe.”
Winden adds that new doctors who join the practice particularly benefit from the service of scribes, as they are more likely to accept a scribe as a legitimate assistant. Overall, Winden’s physicians welcome a scribe’s assistance because doing so allows them to feel and act like doctors rather than data-entry personnel.
Of course, employing a medical scribe is an investment, says Winden: “We want them to be committed for two years. It takes a while for them to get up to snuff. If they’re only here eight months or a year, it doesn’t really benefit them or us.”
Training a scribe can take up to three months, starting with a crash course with a health education expert in a hospital’s emergency department. After that, would-be scribes attend a three-day class. Finally, the apprentice shadows an experienced scribe for one month.
“We make reference cards for when they’re learning coding, documenting, and creating a complete note — cheat sheets,” explains Winden.
Working the numbers
In addition to assisting physicians, scribes can perform nonclinical duties that lighten the nursing staff’s workload. Scribes cost less per hour than registered nurses — at least 50 percent less. And because they’re in school and work part time, you needn’t provide benefits.
Still, how to cover the cost of your own scribe program? By cashing in on their efficiency. If your scribes are knowledgeable and hardworking, your physicians will see more patients in less time, your coding will be more accurate, and your patient work flow will improve. But how can you be sure of a return on your investment? Consider the following “composite” situation:
Let’s assume you see 40 patients per day five days a week for 48 weeks a year. According to Physicians Practice’s 2006 Fee Schedule Survey, the average reimbursement for a 99213 — established patient, midrange exam level — is roughly $50. Do the math for an annual gross income of $480,000. Then chop that number in half to account for overhead (that’s about the national average, according to a compensation survey published by Physicians Practice). Assume the scribe earns $15 an hour (a high estimate).
As you can see in Table A, you’ll need to see an additional 2.5 patients per day, on average, to break even after accounting for the cost of the scribe. After that, the scribe more than pays for himself. And if Winden is correct in his estimate that scribes boost a physician’s productivity by about 10 percent, then the physician described in Table A would be able to add four patients to her schedule each day — adding nearly $20,000 a year to the practice’s revenue, and that’s after paying the scribe. The more efficient your scribe(s), the more patients your physicians will be able to see.
What effect can a scribe have on raising your reimbursements? A well-trained scribe is more likely to accurately catch (and code) all of your work as you perform it and call it out. And as we’ve just seen, a scribe can save you time, allowing you to see more patients per day. Consider this hypothetical situation involving in-office procedures:
Let’s say you perform a 10160 (puncture aspiration of an abscess, hematoma, bulla, or cyst), which scores about double the rate of a regular visit ($106 vs. $50-ish), or you may perform a 12052 (layered closure of wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes) for $285. Coding for these procedures in conjunction with regular office visits, let’s say your average reimbursement jumps to $75 per encounter.
As you can see in Table B, you now have to add only two patients per day to break even. Notice how at three or four more patients a day your bottom line starts to fatten nicely.
