What's a scribe? Simplistically, a scribe is anyone that enters information into the patient's record on behalf of a provider. Most practices use scribes already by this definition; they just don't call them scribes.
My dermatologist Dr. K uses LPNs as scribes in a remarkably efficient way. Scribing is a good 75 percent of their work, I would estimate. The medical assistant brings me into the exam room, collects and enters my vitals, meds, and pertinent recent medical history. Dr. K comes in, checks me out from head-to-toe, and dictates the pertinent findings, which the LPN enters into my record. When an excision is needed (ah, the joys of being freckled and fair-skinned), the LPN records what implements of destruction will be used. Dr. K goes into the next exam room to see another patient with her other LPN while my medical assistant prepares the surgical tray. Dr. K returns, excises the lesion, and goes on to her next patient while my LPN finishes up.
The whole process is remarkably smooth, patient-focused, and unrushed. And Dr. K has not entered a thing into my record.
I will use this example to demonstrate how to determine if Dr. K is losing money having someone else do her documentation.
What's the return on investment (ROI)?
It's simple to calculate:
• Step One: Calculate the incremental cost
If the scribe makes $20/hour, wages will be $160 for an eight-hour day. Add on the cost of benefits — including taxes, vacations, and retirement plan — 20 percent to 23 percent. I will use 20 percent in this example, so I would add $32 (20 percent of the $160 in daily wages) and arrive at a daily cost of $192.
Hourly Wage x Hours Worked = Wages
Wages x Benefits percent = Benefits Cost
Wages + Benefits Cost = Your Cost
• Step Two: Calculate the incremental revenues
This requires determining how many more patients the provider can see in a given period of time by using a scribe. Let's say Dr. K can see eight more established office patients a day (though I suspect her improved productivity lets her see twice that many). Multiply that figure by your average reimbursement (not charge) for your typical office follow-up patient. If Dr. K's typical follow-up patient is billed as a 99213, and she gets $73.08 on average for a 99213, we have everything we need to calculate our incremental revenues.
Eight extra patients/day x $73.08 reimbursement/patient = $584.64 in incremental revenue.
• Step Three: Calculate the return on investment
In our example, the daily incremental revenues and costs were $584.64 and $192.00, respectively, so the ROI is a positive $392.64 per day. Annualized over 240 work days in a year, the ROI is $94,233.60 — that's bottom line profit.
This calculation does not consider the impact on patient care or the accuracy of documentation, both of which must be considered. I like the use of scribes, though, given my experience as a patient. Using a scribe enabled Dr. K to focus her attention on me and not her computer screen. She is a "better" doctor, I perceive, and patient perceptions of quality increasingly matter to payers.
Two additional bonuses, one for the practice and one for me: 1) The practice easily meets all its meaningful use, PQRS, and other quality measures; and 2) I can get a same-week appointment with Dr. K, down from a four- to six-week wait just a few years ago. Yes, patient access has improved lockstep with patient satisfaction.
Your documentation requirements will continue to increase, it's an unfortunate truth. And I think scribes will give doctors an opportunity to practice medicine more, while reducing their administrative burdens.
Lucien W. Roberts, III, MHA, FACMPE, is assistant administrator of Gastrointestinal Specialists, Inc., a 21-provider practice in Central Virginia. In his spare time, he is a writer, speaker, and consultant. For the past twenty years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, and billing/collections. He may be reached at [email protected].