Scribe Hiring How-Tos for Your Eye Care Practice

Is your practice ready to take on a scribe? In our last post, we talked about how a scribe could improve your practice and how to incorporate an ophthalmology scribe into your operations. If you missed it, read it here.

Before you commit to hiring a scribe, take a close look at your practice’s financials and your local market. The data varies but average salary for a scribe is nearly $33,000 (not including bonuses), according to payscale.com. The bottom 10 percent of scribes made $22,328, and the top 10 percent averaged $39,060. You’ll also need to do a cost-benefit analysis, determining how many additional patients it will take you to cover the scribe’s salary, and the scribe’s anticipated impact on your practice’s revenue.

And don’t forget: for a scribe to be worth the investment, your physicians must be on board. Many physicians find it difficult to delegate—they see it as giving up control. For scribing to benefit a practice, the physician must be confident in the scribe’s abilities and be willing to give up some control.

How to Hire an Ophthalmic Scribe

If you decide that a scribe is right for your practice (and you’ve decided against training a current staff member to scribe) you’ll need to hire one. You can hire a scribe from a scribe service, post your own ad online, or hire someone right off the street—seriously. The scribe industry is unregulated, and there are no universally accepted standards for scribes. A few organizations offer a scribe certification, including AAPC, ACMSS, and JCAHPO. A certification is a good indicator of a candidate’s commitment to the job and a minimum level of skill. Beyond that, seek out a candidate with the following skills, recommends AHIMA:

• Knowledge of basic anatomy and medical terminology.
• Working knowledge of EHR, forms, and templates.
• Awareness of the essential elements of documentation, including what’s required for quality reporting.
• Basic coding knowledge.
• Familiarity with HIPAA compliance.
• An understanding of the roles and responsibilities of medical personnel.
• Ability to multitask.
• Good mobility.
• Typing skills.
• Legible handwriting.

The Flip Side

Not every physician subscribes to the scribe model—some see scribes as a double-edged sword. On the one hand, they’re a workaround for clunky, non-intuitive EHRs, but on the other hand, they’re a workaround for clunky, non-intuitive EHRs. Huh?

Here’s the rub: by using scribes, physicians are essentially avoiding the EHR. As a result, physicians become indifferent to the EHR’s usability. Out of sight, out of mind, right? But physicians’ indifference means less market pressure on EHR companies to improve their products—to create user-friendly EHRs that enhance a practice’s workflow, rather than disrupt it. Less incentive to innovate means you’re stuck with the same sub-par EHR that necessitated a scribe in the first place. It’s a vicious cycle.

“Some providers get boxed in using a specific tool that doesn’t really make sense from a clinical flow standpoint. They’re forced to fill things out and check boxes that don’t really matter,” laments Raemarie Jimenez, CPC, CPC-I, CPMA, CANPC, CRHC, of AAPC. “They feel that their only answer is to use a scribe, but the only clear alternative is either a better product, or a better implementation where the provider has more say so,” she continues.

Some physicians also worry about inserting a non-clinical staff member into the exam room, or how a third party will affect the physician-patient relationship. They worry that discomfort with a “stranger” in the exam room could cause a patient withhold important information. But “most patients are used to having someone else in the room. Nurses and CNAs routinely accompany patients,” notes Jimenez. The patient always has the right to refuse the presence of additional staff in the exam room—give them the option, she recommends.

Scribe Compliance

A scribe can have both a positive and negative effect on compliance. First and foremost, a scribe can further a practice’s clinical documentation improvement (CDI) program. “Good record keeping isn’t just right, it’s the law,” says Sharon Alamalhodaei, who spoke about scribe ethics and compliance at ASCRS.  Jimenez agrees. “Sometimes, because they are forced to see patients so quickly, providers may not document a pertinent finding or other information. Because the scribe’s sole focus is on documentation, the result is more through and accurate records,” she reports. More complete documentation results in better charge capture and more accurate coding and billing. Additionally, scribes are a witness to informed consent.

On the other hand, scribes can also be a compliance risk. If you’re planning to train a clinical staff member to scribe, watch out: using an employee in a dual role can be a compliance hot spot. “The biggest compliance issue that we see is that providers are using clinical staff for two purposes: to interact and to document,” Jimenez says. “That’s the biggest misuse of scribes. Medicare has been very clear that a scribe is an extension of the provider from a documentation standpoint only, not from a clinical standpoint,” she explains.

Plus, there’s the ever-present opportunity for fraud and abuse. There have been reports of scribes documenting activities or services that haven’t actually been performed, such as smoking cessation counseling. And if you already have compliance problems, your scribe could be your next whistleblower. A scribe may report any compliance problem he or she witnesses.