How to Derive Maximum Value from ED Scribes
In the fast-paced realm of the hospital Emergency Department (ED), the primary focus is on diagnosing and treating urgent patient conditions. The necessary evils of documenting, coding and billing are secondary but nonetheless very important to the success of the ED physician and hospital. Fortunately, hospital systems are designed to capture the workflow of the ED physicians, but it is up to the physician to supply the chart documentation in as much detail as possible to achieve maximum reimbursement for the work performed.
The use of scribes can be a benefit to the ED physician and the hospital, especially in times of high volume and for services requiring high acuity. A scribe accompanies the physician in his or her patient visits to record the information provided by the patient as well as to capture the information given by the physician about the patient’s diagnosis, additional diagnostic testing, or procedures for the patient. Often scribes are pre-med students, so they are intelligent, knowledgeable about medical terminology, and eager to begin working in the medical environment. This can be a great asset to the busy ED physician, provided the physician and scribe work as a team and communicate well.
Scribes remove the chore of documentation from the physician so that he or she can concentrate fully on the patient’s diagnosis and treatment. Improved documentation of the ED visit leads to better reimbursement. Chart notes must always be available to support the coding and billing submitted for the visit, and capturing as much detail as possible is essential to better coding and billing. Scribes can help the physician achieve more complete documentation, especially during times of high volume when the busy physician might forget to record routine steps in the patient’s care. The scribe provides a second set of eyes and can prompt the physician to complete sections of the chart that might have been overlooked.
Scribes are an added cost to the ED but by increasing efficiency they make it possible for the physician to see more patients, thus increasing the department’s revenue and covering the cost of the scribe service. Electronic Health Records (EHR) systems typically get in the way of the physician’s patient interaction, and have been found to slow down most ED physicians. Adding a scribe to the physician’s toolbox helps him or her regain productivity. Physicians who work in several facilities, each with a different EHR, can especially benefit from a scribe dedicated to each facility who will help navigate the flow of the ED modules.
Patients have noted increased satisfaction with the ED through the use of scribes. When the scribe handles the routine taking of notes, writing orders, and coordination of care, it allows the patient to receive more focused attention from the physician and thus reduces the time needed for the visit.
Because the scribe works in real-time with the physician to complete the patient’s chart recording, there is no delay in the finalization of the charts. The physician reviews his or her charts at the end of the shift and the process is complete, in contrast to a physician who must later dictate chart notes or transcribe data into the EHR. This affords a significant reduction in the department’s charge lag.
More thorough documentation will allow coders to apply the highest level of coding that is appropriate to the service. This will naturally lead to higher revenue for the same volume of services in the department. In addition, compliance will be improved so potential refunds due to chart audits will be minimized.
Cautions and Caveats
The use of scribes is not necessarily the answer for every physician or department. During times of low volume, the physician might be as productive alone and the cost of the scribe is not justified by throughput. However, other benefits might accrue that justify the use of scribes regardless of efficiency gains; this is for each facility and physician to work out.
Some have reported that physician performance is decreased when working with a scribe. Usually this is because physician and scribe have not yet gelled into a team. The more time spent working together, the better the relationship will work. Similarly, good communication is critical in order for documentation to be improved. Gaps in communication and understanding can lead to a degradation of documentation.
The turnover rate for scribes is typically rather high, as the pre-med students experience changes in their programs and time constraints. This necessitates re-training more often than anyone would like. Using a scribe service bureau puts the burden on the agency to handle hiring and training, while an in-house scribe program should assign a ‘lead scribe’ or manager who will take on this task.
While many benefits may be gained by using scribes in the ED, the costs and benefits must be weighed and monitored in each situation. Generally, physician efficiency and department workflow can be improved and this leads to higher patient satisfaction. More thorough documentation enables a higher level of coding and billing while enhancing compliance. More timely completion of records improves patient care and reduces the lag in billing for services, which can improve overall revenue.
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