Blog Posts


The Value of an Integrated Scribe Program for Emergency and Hospitalist Service Lines

Posted on Thu, Jun 25, 2015
The Value of an Integrated Scribe Program for Emergency and Hospitalist Service Lines

Scribes improve the efficiency of both emergency and hospital medicine program. 
by Andy Mulvey, MD
Implementing a door-to-discharge model to manage patients from arrival to the emergency department until hospital discharge is becoming essential to the hospital-based healthcare delivery market.  Two critical challenges to the success of this strategy are recognized: the national, ongoing shortage of physicians both in hospitalist and emergency medicine; and the burden placed on these physicians by hospital electronic medical record (EMR) systems.  Efforts to maximize physician productivity will be crucial to reducing increased compensation and locum tenens physician utilization while allowing for ongoing organic growth.  Potential solutions to the recruiting challenge include better-aligned staffing models and more robust use of Advanced Practice Providers and scribes.  This article will focus on scribe solutions and the benefits they can bring to emergency medicine and hospitalists services. 
An integrated scribe program can have significant, direct impacts on revenue, overhead, and patient care quality.  Additional, indirect scribe benefits include improvements in patient satisfaction, charting compliance, physician recruitment, retention, and job satisfaction.  As with any component of our operational model, scribe programs must be developed, integrated, and managed correctly to ensure they have maximum impact on the providers and service lines they support. 
Hospital medicine scribes increase physician productivity through a combination of pre-rounding on patients and offloading the time-consuming EMR documentation from physician providers.  Use of scribes allows a typical hospitalist to increase their productivity by an additional 4-6 encounters per day (20-25% increase).  This results in a reduction of FTE requirements for the service as well as volume growth without added practice overhead.  Net gains in hospitalist service revenue are achieved through improved documentation and increases in the case mix index (CMI).  Finally, the patient length of stay (LOS) can be reduced by improvements in the efficiency of patient care activities and discharge planning.  This reduction in LOS in turn has a positive impact on hospital capacity and creates opportunities to drive facility revenue.  All of these scribe program benefits can be accomplished while improving HCAHPS, physician job satisfaction and client hospital relations.  A recent article published by Advocate Chicago Health Care highlights these results (Kreamer, “The economic impact of medical scribes in a hospitalist setting,” 2015).
Emergency medicine scribe programs are uniquely positioned to support providers in the often unpredictable and erratic environment of the emergency department (E.D.).  There is a great deal of industry data demonstrating the impact scribes have on physician productivity with average increases between 0.3 - 1.0 patient per hour staffed.  Improved productivity allows for higher patient-to-provider staffing ratios, reducing the total staffing cost per patient evaluated.  Documentation improvements, both E&M and procedural, result in higher revenue as the RVUs generated per patient increase.  From a patient care perspective, the most significant impact scribes have on the emergency department is seen in the ED metrics.  Scribes drive physician productivity and efficiency and, as a result, reduce door-to-provider, door-to-discharge, and decision-to-admit times.  This overall reduction in patient LOS is directly correlated to patient satisfaction and physical plant capacity for the emergency department. 
As we continue to progress through the healthcare era of the electronic medical record and significant physician workforce shortages, new approaches to staffing and management must be utilized.  Fully integrated scribe programs can provide added efficiencies, boost provider productivity, offsetting EMR and workforce challenges.   These benefits, along with improvements in physician job satisfaction, recruitment and retention, make the decision to consider a low-cost scribe solution an easy one.  Recognizing the emergence of the medical scribe industry, now is the time for healthcare leaders and administrators to investigate and adopt new scribe ‘best practices.’  This has the potential to further drive scribe program return on investment, not to mention the multitude of other, non-financial benefits of scribes.  

     Dr. Andy Mulvey is an active practicing emergency physician who balances the roles of business leader and practicing emergency physician.  Nearly sixteen years ago, Andy began his emergency medicine career in a private group and managed the growing practice as CEO for over ten years.  Andy serves as a regional medical director for EmCare. Past experience includes serving as a consultant and chief growth officer for ScribeAmerica. He has had the opportunity to interact with physician and healthcare leaders all over the country sharing his experience, methods for achieving clinical excellence and business expertise.  He earned his M.D. at Loyola University Stritch School of Medicine and completed his emergency medicine residency at Resurrection Medical Center in Chicago.  


EmCare’s Genesis Cup Honors Innovation, Creativity in Health Care

Posted on Sat, Apr 13, 2013

Medical Directors, EmCare Executives Recognized for “Making Health Care Work Better™”


EmCare’s Genesis Cup program was designed to recognize and celebrate the creativity and innovation of everyday physicians as part of the company’s never-ending pursuit to improve the delivery of patient care.

Each year, EmCare selects a Genesis Cup winner and runners-up to reward innovation and improvement in health care. The three honoree teams presented their prize-winning projects to their peers at EmCare’s 26th Annual Leadership Conference.

This year’s Genesis Cup contenders explored topics including the effectiveness of medical scribes, the improvement of trauma and blood transfusion services and a new emergency department optimization model.

Here’s a summary of the winners and runners-up.

Genesis Cup Winner: “Are Scribes Worth It?” (pictured)

A study gauging the pros and cons of employing medical scribes has earned The Genesis Cup award for 2013.  The scribe project was produced by Dr. Tanveer Gaibi, medical director for Northwest Hospital in Randallstown, Md., Dr. Michael Hochberg, medical director for Saint Peter’s University Hospital in New Brunswick, N.J., Dr. Daria Starosta, EmCare director of practice development, and Mark Switaj, EmCare client administrator. Their landmark project, titled “Are Scribes Worth It?,” concluded that scribe programs can greatly assist higher acuity E.D.s that are experiencing long patient stays, reduce the incidence of patients leaving without treatment, and expedite data entry into challenging electronic medical record (E.M.R.) systems.  Some scribe programs can even pay for themselves.

Genesis Cup Runner-Up: “E.D. Optimization Model”

A new Emergency Department (E.D.) Optimization Model earned a Genesis Cup runner-up recognition for Andy Mulvey, M.D. and Richele Wright, M.S.N, F.N.P, B.C. Dr. Mulvey and Wright developed the new operational plan implemented at Community Hospital South (CHS) in Indianapolis. Their program improved overall quality of care and quality metrics while also building an increase in E.D. patient volume.  All of this occurred during a major rollout of a new electronic medical record (E.M.R.) system.

Inside of six months during 2012, Mulvey, Wright and others used the award-winning model to reduce Left Without Being Seen rates from 3.8 percent to 0.24 percent. The average Length of Stay fell from 351 minutes to 281 minutes. And the E.D. volume grew to more than 42,000 visits, with a roughly 25% increase in total patient visits since 2011.

Genesis Cup Runner-Up: “Lean Processes to Improve E.D. Trauma Care”

The effective implementation of Lean processes to improve both emergency trauma care and urgent blood release has earned Genesis Cup honors for a medical director from John Peter Smith Hospital (JPS) in Fort Worth, Tex. The second 2013 Genesis Cup runner-up is Carrie de Moor, M.D., F.A.C.E.P., who acts as EmCare’s emergency medical director for JPS.

Dr. de Moor came up with a new, Lean system for urgent blood release. Under the new JPS guidelines, patients receive urgent blood off of clinical appearance and vital signs rather than the previous required lab results. The new clinical appearance/vital signs criteria are determined by the treating physician and include:

  • Systolic blood pressure of less than 90 (indicating hemorrhagic shock)
  • Acute ischemic electrocardiogram (E.K.G.) changes or chest pain due to anemia
  • Any other clinical appearance suggesting that the patient’s current illness, traumatic or medical, may result in imminent death without immediate transfusion.

By changing the way urgent blood is requested, Dr. de Moor and JPS saw some impressive year-to-year improvements, including:
  • 2,784 fewer units of P.R.B.C.s transfused
  • 2,200 fewer units of F.F.P. transfused
  • Overall savings of $945,035 for the hospital
  • Decline in blood utilization occurring along with increase in volume from 100,000 patients per year to more than 120,000 patients per year in the same time span.

Dr. de Moor also used Lean process improvements to improve care for trauma patients at JPS. The new, Lean program Dr. de Moor designed is mechanism-based, activated internally and mimics trauma activation flow. The implementation of the new trauma model had a dramatic impact:

  • The average time to Level 3 Trauma Activation/Consult fell from two hours five minutes to one hour and 20 minutes.
  • An hour and a half of average patient wait time was eliminated
  • The trauma area now processes 2.125 patients in the time it previously took to process one patient.

Genesis Cup Runner-Up: Enticing the Best Performance from Physicians

Timothy R. Jones, M.D., associate director at Baylor All Saints Medical Center in Fort Worth, TX, earned Genesis Cup accolades for his submission, “Enticing Best Performance from Physicians.”

“Physicians are naturally hard workers,” says Dr. Jones. “Every physician thinks he or she is above average, that they all bring their ‘A-Game’ to each shift, but the truth is that most physicians are anonymous in terms of hospital data, and anonymity can create inertia.  By empowering physicians with detailed, unblinded monthly performance data that reveals how each physician in a group performs compares to the average and to his/her named peers, performance in all measured metrics improves across the board.  It’s direct feedback physicians can use to improve their practice, and they love it.”

Dr. Jones examined Relative Value Units (RVU) generated per hour, patients seen per hour, RVUs generated per patient, Press-Ganey scores, and coding trends for level 3, 4, 5, and critical care charts over a 13- month period within his ED group.  The results were dramatic.

  • RVU/hr (physician) increase – 27.2%
  • RVU/hr (midlevel) increase – 29.1%
  • Patients/hr (physician) increase – 14.7%
  • Patients/hr (midlevel) increase – 16.7%
  • RVU/pt (physician) increase – 10.2%
  • RVU/pt (midlevel) increase – 11.4%
  • Net Charges increase – 28.6%
  • Collections increase – 19.0%

“Knowledge really is power,” says Dr. Jones. “By simply empowering physicians and midlevels with unblinded performance data, a healthy sense of competition is established and practice excellence becomes the status quo.”

“Three clear winners emerge,” concludes Dr. Jones.  ”The physician with increased take-home pay and a true understanding of his/her practice pattern, the group with increased revenue and, most importantly, the patient who is met by a physician primed to optimize the customer experience.”

In addition to recognizing the inventor/innovator, The Genesis Cup recognizes those involved in the initiative, including the emergency department, radiology department, hospitalist team, anesthesia team and the regional office in supporting such endeavors.