If you’re like most practices, your number one goal is to provide the highest quality eye care for your patients. But staying profitable—which usually means seeing as many patients as possible—is a close second.
Unfortunately, those two goals are often at odds. A schedule packed with patients means more revenue but less—and lower quality—physician-patient face time. The more time a physician spends on documentation and navigating electronic medical records, the less time he or she spends interacting and forming relationships with patients.
Scribes: Best of Both Worlds
What if there was a way to get the best of both worlds: a busy, productive practice and a higher level of patient care? There is, and they’re called scribes. Here’s how they work:
In the most profitable practices, each employee works to his or her highest level of competency. For a physician, that means performing billable exams—not charting. By delegating documentation to a scribe, the physician becomes more productive. Instead of the physician stopping the exam to document as they go, the exam and the documentation happen simultaneously. That means shorter appointments. Shorter appointments mean more appointments. And more appointments mean more revenue.
A scribe can also enhance the quality of physician-patient interactions, leading to higher patient satisfaction. Patient satisfaction is one way to measure quality of care, and it is gaining significance as we transition to value-based reimbursement. Higher patient satisfaction leads to more referrals, better ratings on websites like healthgrades.com, and a reduction in patient turnover.
“Using a scribe allows the physician to give the patient his or her full attention—the EHR is no longer a distraction,” says Raemarie Jimenez, CPC, CPC-I, CPMA, CANPC, CRHC, of AAPC, a professional association that is currently developing a scribe certification. “A lot of providers are using scribes so that they can focus on the patient. In a lot of instances providers are spending so much time on documentation that they don’t feel like they’re having a genuine face-to-face encounter,” she explains.
Scribes can also be very helpful for physicians who routinely see older patients. Senior patients are often hard of hearing, and many supplement by lip reading. If the doctor is turned away and looking at the computer, communication is more difficult.
Three Ways Scribes Work
At the core, a scribe is someone who specializes in what physicians dislike the most—documentation. But there are multiple ways that a practice can incorporate a scribe:
Use a scribe solely for data entry.
The scribe either follows a single physician or stays in a single exam room all day, writing down each patient’s medical history and documenting the entire appointment, as well as any resulting treatment decisions. “This is typically an entry-level position for med students or those interested in attaining a job in other medical fields,” notes Jimenez. “For someone brand new to the medical field, scribing is a fantastic way to get used to medicine and get a better understanding of what aspect of medicine they’d like to pursue,” she says.
Train a clinical tech to scribe.
A scribe-technician conducts all portions of the visit that a tech normally would, including patient history and pre-testing. When the physician arrives, the tech puts their scribe hat on. Practices should tread carefully, says Jimenez. “Using a clinical staff member to both interact with the patient and document is a compliance risk,” she warns.
Go all in with Scribe 2.0 (aka The Super-Tech).
A super-tech is a jack-of-all-trades. He or she is a clinical tech who not only scribes, but stays with the patient throughout the entire visit (instead of with a particular physician or exam room). But wait, there’s more: the super-tech is also an optician—not a master optician, but someone who can do easy cases and leave more complex ones to the ABOM.
The super-tech system may also be an opportunity for career advancement for your techs. They’ll learn new skills that make them more valuable and flexible while benefiting your practice at the same time. Win-win!
If you choose to train a current staff member to scribe, you should avoid…
Clinical knowledge is essential for a competent scribe, so you can’t just pull in a non-clinical employee. If your front desk person decides he or she’d rather scribe, that’s fine. But they’ll need to go through the full scribe training process.
The highest and best use of providers like PAs and NPs is independently seeing other patients. Using them as scribes is counterproductive.
Scribes: More than Just Documentation
A scribe’s core duty is to capture accurate and detailed documentation of the patient encounter in real time (such as in an exam room). But scribes can have other duties as well, all aiming to free up a physician’s billable time. Jane Shuman, MSM, COT, COE, OCS, CMSS, OSC and Mary Pat Johnson, COMT, CPC, COE, CPMA shared the following duties during their session at the 2018 ASCRS∙ASOA Annual Meeting. A scribe can:
- Assist physician in navigating the EHR. A physician who has less facility with computers might struggle to complete these forms as quickly or as accurately as a capable scribe.
- Respond to messages, including queries from coders.
- Locate information for review, such as diagnostic images, lab results, and previous notes.
- Enter information into the electronic health record.
- Research information requested by the provider.
- Assist patients by clarifying and ensuring they understand any instructions of next steps that the provider has directed.
There are also a few things that a scribe can’t (or shouldn’t) do:
- Scribes should never make diagnoses, decisions, or treatment suggestions beyond what the provider directs. If a patient or family member assumes that the scribe has a clinical role (and they don’t), the scribe should correct them right away.
- They should not conduct any diagnostic testing, or perform any portion of the exam, including the history interview, unless they are licensed to do so (a scribe-technician, for example).
- Scribes should not enter orders. A scribe may draft orders, but the physicians must review, authenticate them, and submit them.
Interested in adding a scribe to your practice? Stay tuned for our next post, which will explain the how-tos, pros, and cons of working with scribes.