247 Scribes in an Academic Emergency Department Lead to Increased Charges and Decreased Down Coding

The Productivity Requirements of Implementing a Medical Scribe Program

BACKGROUND

Economic analyses of medical scribes have been limited to individual, specialty-specific clinics.

OBJECTIVE

To determine the number of additional patient visits various specialties would need to recover the costs of implementing scribes in their practice at 1 year.

DESIGN

Modeling study based on 2015 data from the Centers for Medicare & Medicaid Services (CMS) and National Ambulatory Medical Care Survey. Scribe costs were based on literature review and a third-party contractor model. Revenue was calculated from direct visit billing, CPT (Current Procedural Terminology) billing, and data from the National Ambulatory Medical Care Survey.

DATA SOURCES

2015 data from CMS and the National Ambulatory Medical Care Survey.

TARGET POPULATION

Health care providers.

TIME HORIZON

1 year.

PERSPECTIVE

Office-based clinic.

OUTCOME MEASURES

The number of additional patient visits a physician must have to recover the costs of a scribe program at 1 year.

RESULTS OF BASE-CASE ANALYSIS

An average of 1.34 additional new patient visits per day (295 per year) were required to recover scribe costs (range, 0.89 [cardiology] to 1.80 [orthopedic surgery] new patient visits per day). For returning patients, an average of 2.15 additional visits per day (472 per year) were required (range, 1.65 [cardiology] to 2.78 [orthopedic surgery] returning visits per day). The addition of 2 new patient (or 3 returning) visits per day was profitable for all specialties.

RESULTS OF SENSITIVITY ANALYSIS

Results were not sensitive to most inputs, with the exception of hourly scribe cost and inclusion of CPT revenue.

LIMITATION

Use of Medicare data and failure to account for indirect costs, downstream revenue, or changes in documentation quality.

CONCLUSION

For all specialties, modest increases in productivity due to scribes may allow physicians to see more patients and offset scribe costs, making scribe programs revenue-neutral.

PRIMARY FUNDING SOURCE

University of Chicago Medicine's Center for Healthcare Delivery Science and Innovation and the Bucksbaum Institute.

The emergence of new data work occupations in healthcare: The case of medical scribes

PURPOSE

Increasing demand for more and better documentation as well as digitalization of healthcare entail shifts in competencies and roles of healthcare occupations and professions. As a result of this data-centric technological development, new kinds of work and occupations emerge of which medical scribes are an example. To investigate and provide a case of an emergent occupation focused on 'data work', we describe the emergence, growth and stabilization of medical scribes, outline their history and provide a literature overview.

METHOD

We conducted a review of the literature on medical scribes in academic journals until 2017. These publications are categorized according to the country of study, medical specialization, method, focus, attitude to the use of medical scribes, and the reasons given for the use of medical scribes. We outline the history of the emergence of medical scribes and provide a summary of the existing research publications on medical scribes.

FINDINGS

We identified 60 papers of which a majority are based on cases from the USA; conducted in emergency departments; based on quantitative methods; focus on economic feasibility and satisfaction; are positive towards the use of medical scribes; and link the use of medical scribes to the implementation of electronic health records (EHR). There is a distinct lack of research on medical scribes themselves and their interaction with physicians, patients, and EHR.

CONCLUSIONS

Medical scribes have emerged as a new data-work occupation as a response to increased demands for documentation and digitalization through EHRs. Research on medical scribes has hitherto focused on efficiency and economic feasibility of scribes, and there is a need to look into the interaction of medical scribes with physicians and patients as well as look at opportunities for redesign of EHR. More generally, there is a need to look beyond the most prominent professions such as physicians and nurses in discussions of digitization and datafication of healthcare, and investigate how new and previous tasks are (re)distributed between occupations and professions.