September 01, 2015
Are Medical Scribes Cost-Effective?

Research has shown that using medical scribes confers a laundry list of benefits. Patient satisfaction increases where scribes are used, for a start. Physicians, too, experience an increase in job satisfaction, according to a report in the Annals of Family Medicine — not to mention the time savings they report. One physician says he can now review 15 to 20 scribe-produced charts in under half an hour, whereas the same workload used to require 2 hours at the end of each day, just to update charts.

These are all great results, and goals worth pursuing in your practice, department or facility. Also consider that physicians who work with scribes are able see, on average, one additional patient per hour, and that scribe-produced documentation is typically so thorough that higher levels of visit, diagnostic and procedural coding can be achieved, thus resulting in more revenue. What could this mean for you? Let’s take a look at the economic case for using scribes.

What the literature shows

Research into the economics of scribes is painting a favorable picture:

  • $2500 saved per patient — A prospective, controlled study compared standard visits (20-minute follow-up and 40-minute new patient) to a scribe system (15-minute follow-up and 30-minute new patient) in a cardiology clinic. Physician productivity, patient satisfaction, physician–patient interaction, and revenue were measured. The economic result: Direct and indirect revenue combined resulted in $2,500 more per patient with scribes. “Using scribes in a cardiology clinic is feasible, produces improvements in physician–patient interaction, and results in large increases in physician productivity and system cardiovascular revenue,” the authors concluded.
  • $12,000 per patient — A study conducted from 2012 to 2014 evaluated the use of medical scribes with a hospitalist group working across two hospitals, to determine if cost savings could be sustainably achieved. Each scribe was trained on workflow, productivity, and creating accurate, inpatient-specific documentation. At the end of the study, the Case Mix Index (CMI) at each had increased by 0.26 and 0.28. To put that in perspective, a change in CMI of 0.1 typically translates to a loss or gain of about $4,500 per patient. Compared with the whole hospital, teams with medical scribes put up even larger increases, indicating the addition of medical scribes made the difference. “Medical scribes as well as hospitalists are historically viewed as a line-item expense in the inpatient setting,” writes the author. “On the contrary, the data demonstrated that the introduction of medical scribes resulted in markedly improved revenues for hospitals. Since an increase of 0.1 in CMI results in an increase in revenue of approximately $4,500 per patient, at the end of this study, both hospitals gained approximately $12,000 per patient.”

Translating to practice

Let’s say a primary care physician’s average revenue per patient visit is about $80, seeing an average of 15 patients per day. A retrospective data analysis found that an additional 0.8 patients per hour are seen where scribes are part of the care team. So, if a physician can see even five patients more in a day, that’s an extra $400 per day. Over a typical 22-day working month, that translates to additional revenue of $8,800 each month, or $105,000 annually. And that doesn’t even take into account the additional revenue that could come from better coding and, therefore, charge capture.

Viewpoint article in the Journal of the American Medical Association argued that the use of scribes is a temporary fix, at best, for the shortcomings of electronic health records. Worse, the authors claim, the “increasing use of medical scribers to record patient data will impede the development of electronic health record management systems” to have better usability, more efficient data entry and improved record exchangeability.

The question is: If and until that happens, can you afford to wait?