The ROI of Medical Scribes

June 4, 2014

Medical scribes can increase efficiency and the quality of chart documentation. Here's how to calculate your ROI if you choose to use scribes in your practice.

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 Muletick@gmail.com.