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.  

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