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Worried about meeting MU requirements? Wanting to enhance efficiency and improve customer service? Want to be home at a reasonable hour? Consider the use of scribes in your office to capture data. Scribes can be a valuable asset to any medical practice. This presentation will explore how Kansas City Bone & Joint Clinic utilizes scribes to enhance technology and provide accurate documentation. We will describe the benefits of using scribes, including documentation, efficiency and legal protection. We will also discuss how we believe utilizing scribes alongside the EHR technology enhances patient and provider satisfaction. If you saw our presentation in Orlando, you will gain new insights. Hilary Bias, Systems Administrator, Kansas City Bone & Joint Clinic Amy Roberts, Assistant Systems Administrator, Kansas City Bone & Joint Clinic
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Scribes: How Much is Your Time Worth?
Kansas City Bone & Joint Clinic, A Division of Signature Medical Group of KC, PA
“A trained medical information manager who specializes in charting physician-patient encounters in real-time during medical exams.” – (Wikipedia)
“An unlicensed individual hired to enter information into the EHR at the direction of a physician or licensed independent practitioner.” (Joint Commission)
What is a Medical Scribe?
Evolution of the Scribe- Our Office
Our office began with court reporters and secretaries 35+ years ago
Chart notes were transcribed and put in the paper chart
Scribes worked for one provider 40+ hours
Scribes replaced transcription
Evolution of the Scribe- Enter EMR
2005 beginning of EMR Brought forth a new
workflow Opened opportunities for
a new breed of scribes Scribe only when provider
in clinic, no extra time needed to transcribe
Can work with any provider
Timely, accurate documentation
Helps the EHR note look more like a dictated note
Legal liability Fully engaged with the patient Quality of life for the
physicians Patient and physician
satisfaction increases
What’s the Benefit?
“In a four month study, involving 6 community clinics….36% of patients said they were more satisfied with their office visit. In addition, 9 our of 10 patients participating in the project said they were not concerned about another person being in the room during their medical visit.” (Beaulieu,
2012)
Extra person in the room?
Allow therapy, diagnostic tests, DME supplies, Rx, etc. to be ordered/e-scribed before patient leaves room
Our response to MU stage 2- in a minute Truly the “Dr’s. Assistant”
Injections Casting Getting printed documentation, i.e..
Prescriptions Emergencies
Your Right Hand
“The ‘scribe’ does not act independently in E&M services, surgical and other such encounters, but documents the physicians dictation and or activities during the visit. The physician who receives payment for the services is expected to be the person delivering the services and creating the record, which is simply ‘scribed’ by another person.”
* Cahaba Government Benefit Administration LLC
Is it Legal?
Charge Capture
Billing “A well trained scribe is
more likely to accurately catch (and code) all of your work as you perform it and call it out.” (Grace, S. pg 4)
Scribes are not coders, but can work with coders to learn correct terminology, and required documentation.
Charge Capture
Scribes can help catch insurance specific needs
“….That's a great idea, say billing experts, but scribes should take no clinical role in patient visits.”
Orthopedic Coder’s Pink Sheet , October 2013
Let’s talk Money Spent
Transcription costs in the US run $0.13 - $0.16, out of the country $0.10- $0.12 per 65 character line
2 page note = $10.00 Follow up patient = $3 .00-5.00 Average 40 patient day with 15 new patients =
$225.00 MU requirements will only increase volume of
documentation Dragon= $1800 per license + hardware
Show Me the Money
Scribes average $13.00-$17.00 (hourly rate not including benefits) depending
on degree, experience, location Easily Increase patient volume Average patient value? Even adding a few more
patients a week could pay for your scribe
What is physician hourly rate? How much is the physicians
time worth?
Scribes will help you with MU Color coordination of custom templates
Blue for Meaningful use, Green for Total Joint protocol Obsterm is clicked and note looks pretty
The Attestation….
Plan The detrimental effects of tobacco use on wound and bone healing were discussed with the patient. I recommend smoking cessation during the healing period. I have also encouraged the patient to continue with a consistent weight loss program, including diet and exercise, to prevent deterioration of their joints as well as from an overall health standpoint.
CCDA requires specific information Can be generated during the visit but is time
consuming Most portals will automatically generate when note
signed. Scribes vital to ensure data is ‘Meaningful’
Meds administered counts towards MU measure new HTML template or you can use new MEL code
on custom forms.
CPS 12 and beyond
Greater documentation required Greater number of codes
Great time to get a scribe!
ICD- 10
Scribes can document the individual patient data, not a generic statement
Meaningful use terms met, but each note has patient specific recommendation
EMR notes don’t have to all look the same and a scribe can be instrumental.
Coders warn against ‘cookie cutter’ notes, and auditors look for this.
Copy and Paste- No way!
Meaningful Use Stage 2- the saga continues…. Stage 2 is making providers move away from
dictation Structured data will be required More required data collection CPOE requiring licensed healthcare
provider
Meaningful Use, Not Meaningful Waste
Disclosure Statement
I attest that I performed the duties of a scribe for this encounter, in the presence of the dictating physician. Jane Doe, M.S, ATC/L
I attest that I performed all the work during this encounter and that the scribe only recorded my findings. John Doe, M.D.
Documentation must include•Who performed the service•Who recorded the service•Qualifications of each person•Signature and date for both the physician and scribe
What is your practice? How else can you use them? Good fit for Dr. and scribe Like technology Ability to think on their feet “..must be meticulous and
document what the doctor said, not putting their own impressions”
How to find your scribe?
The physician needs to learn to speak out loud during exams and with recommendations
Scribe needs to learn the templates, or build them to be efficient with the specific provider
Learn physicians routine, workflow, expectations The Physician and Scribe need to mesh Have to pay attention and not get caught up in
what is happening, especially true in urgent type settings. Listen and enter what he is saying.
Training the Doctor and Scribe
More examples
More videos: http://youtu.be/RRMq7E5nvVAandhttp://youtu.be/m9z8Zl2SWzs
Wikipedia definition of Medical Scribe. Retrieved Dec. 30, 2012 from http://en.wikipedia.org/wiki/Medical_scribe
Grace, Shirley (2007, April 1) Strategy: Could You Use a Scribe? Physician’s Practice. Retrieved Aug. 28th, 2012 from http://www.physicianspractice.com
Beaulieu, Debra (2012, April 4) EHR scribes improve patient, physician satisfaction Fierce Practice Management. Retrieved Dec. 30, 2012 from http://www.fiercepracticemanagement.com/story/ehr-scribes-improve-patient-physician-satisfaction/2012-04-04
References
THANK YOU
Amy Roberts, Assistant System Administrator (Former Scribe)
[email protected] Hilary Bias, System Administrator
