May 31, 2016

How Scribes Help Drive the 4 BPCI Models

The myriad changes to the healthcare system are delivering one, unified message: High-quality patient care can no longer come at an increasingly exorbitant cost. Medical care is becoming more organized and data driven, thanks to the increased use of data-management technologies such as EHRs, the extra hands provided by medical scribes to relieve administrative workload, and the implementation of several government initiatives and mandates.

The new Bundled Payment Care Improvement (BPCI) initiative seeks to capitalize on these changes by making Medicare spending more economical while maintaining and possibly improving the quality of patient care. To achieve these aims, BPCI has devised four models of care with different key focuses:

  • Acute care — Models 1 and 4
  • Post-acute treatment — Model 3
  • Both — Model 2

Meeting or exceeding the financial requirements of these care models and reaping the benefits of change requires good management and wise use of available resources. The use of certified medical scribes supports the key aims of these models, helping to drive efficiency while raising care quality within the four BPCI models of care.

Streamlining care in acute settings

The use of medical scribes can increase the efficiency of care, particularly in the ER. In care models 1, 2, and 4 of the BPCI, payments are awarded to healthcare providers in acute care settings. Using scribes has the advantage of alleviating the burdens of cumbersome, yet important documentation of patient encounters and details of treatment, diagnosis and history — all of which often need to be completed on the fly, particularly where patient status may change quickly, with multiple providers and departments involved. In this way, scribes provide a crucial support system for acute care providers that reallocates the physician’s time back to medical care, freeing them to focus on urgent medical issues and directing the care pathway. Put it this way: Would you rather your physicians wait for documentation to inform the next step, or that patients are moved through the care pathway and, potentially, discharged sooner? When you have documentation and care processes working in parallel instead of sequentially, the use of time and resources is optimized, helping to meet the budgeted bundles of payments.

Assistance that goes beyond acute care

This aspect of scribe utilization is particularly relevant for care models 2 and 3 of the BPCI, which deliver bundled payments to healthcare providers in both acute and post-acute settings (model 2) or post acute settings alone (model 3). Although the work is done in the hospital during the acute care encounter, the work that scribes do lives on, and can be used to enhance the efficiency and quality of treatment within a private practice or post-acute setting to assist physicians that are assigned to patients after discharge from the hospital. Not only do they relieve non-medical care burdens from the physicians providing ongoing care, but high-quality documentation also helps better direct those physicians in making medical decisions. If your hospital has provided high-quality care, why risk being financially penalized because the post-acute physician didn’t have all the necessary information, and the patient’s condition deteriorated?

Maximize gains from financial incentives

In care models 2 and 3 of the BPCI, payment method is based upon a comparison of the actual accumulated cost of a single episode of care against an estimated target care cost. Healthcare providers who achieve a collective cost below the designated target cost are then rewarded for keeping costs low by being allowed to keep the cost difference. On the other hand, if actual costs exceed the target cost, the healthcare provider then assumes the financial responsibility of paying back the difference in the costs to Medicare. The monetary reward for resourceful medical care and management and the risk of additional costs are the incentives that deter excesses in care while recognizing good practices. Scribes can readily integrate into this system of reward and risk avoidance and improve outcomes for the healthcare provider by increasing a physician’s time spent in optimizing the medical part of medical care while they focus on keeping medical records and billing procedures as organized and accurate as possible. In addition, transparency in clinical care via clear and precise documentation from the medical scribe could also help during the reconciliation phase in models 2 and 3 during which the extent of care is compared to predicted costs. All of this has the potential to drive down costs, elevate quality, and even increase revenue through reward.

Building a bridge to better communication and coordination

Medicare’s original fee-for-service method of payment fragmented treatment across different healthcare providers, individualizing each treatment service at the expense of a holistic approach to treating chronic conditions in particular. BPCI aims to change this by bundling payments for multiple services from several healthcare providers into a single episode of care, thereby incentivizing coordinated patient care strategies across healthcare settings. Similarly, scribes act as links between patient and physician or physician and billing personnel to coordinate medical care with medical documentation in real-time. They help physicians communicate more efficiently among providers and departments (e.g. laboratory and radiology, other specialists), helping to coordinate planning and maintain the flow of tasks. Additionally, the work scribes contribute is a crucial link between acute and non-acute settings, as detailed documentation of patient events within the acute care hospital can facilitate transitions and the determination of next steps. In short, complete coordination and communication are the keys to BPCI, and scribes have already embraced the model.