An Analysis of Physician Productivity and Self-Sustaining Revenue Generation in a Free-Standing Emergency Department Medical Scribe Model

Abstract

Objectives. A free-standing emergency department (FSED) is a facility that provides comprehensive emergency medical care similar to a traditional emergency department but is not attached to a hospital campus. Medical scribes are increasingly likely to work in free-standing emergency departments. The purpose of this study was to retrospectively investigate the benefits of a scribe program in an FSED.Methods. A retrospective, Institutional Review Board-approved analysis from December 1, 2013, to February 1, 2015, of free-standing emergency department medical data was extracted to determine if scribed charts resulted in increased revenue and improved throughput.Results. When scribes are present in the FSED there is a small, but statistically significant, decrease in time from patient arrival to provider by 2.74 minutes. Scribed charts collected $4.69 more per chart and resulted in an increase in productivity. Incremental cost effectiveness ratios resulted in proven cost-utility with a net-positive effect.Conclusion. While there are some gains in terms of operational metrics and provider productivity with the addition of scribes to a free-standing emergency department, there is a net-positive financial impact of scribes. Implementing a scribe program at a FSED is cost-effective and justified from both an operational and a financial analysis.

Medical Scribes in the Emergency Department: The Scribes’ Point of View

“…9-11 Benefits have been demonstrated in improvements to patient throughput; documentation; patient outcomes; hospital billing and revenue; resident training; and provider, consultant, and patient satisfaction. 6,12,13 Although not every study demonstrated that scribes provided a significant benefit in terms of the study's primary outcome (eg, length of stay), no study reported inferior outcomes associated with the use of scribes.…”

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

“…While we were not able to identify a "gold-standard" approach for scribe training (eg, a generally agreed-upon competency model), there are some commonalities across different training programs offered by commercial scribing companies 20,24,25,[41][42][43][44][45][46][47][48][49][50][51][52] or by HCOs. 19,22,38,44,45,[53][54][55][56][57][58][59][60][61] Most of the training programs described in the literature are divided into 2 phases: an initial didactic phase and an applied, "hands-on" phase. In the didactic phase, written or online tutorials, 45,53,62,63 quizzes, 56 and clinical simulations 20,25,40,42,44,46,47,54,57,58,62 are used to teach the trainee on clinical procedures, Healthcare Insurance Portability and Accountability Act compliance, medical terminologies, documentation structure, billing and coding processes, and use of clinical inf...…”

“…Medical scribes in the United States are commonly managed by commercial scribing companies as subcontractors, 20,24,25,38,41-47, 49-52,65,70 even though some are directly employed by HCOs. 19,22,38,44,45,[53][54][55][56][57][58][59][60][61]71 Within an HCO, a scribe is assigned either to an individual provider (the "one-to-one" model) 50 or to a group of providers (the "one-to-many" model), 25 or is available as part of a pooled resource assigned dynamically based on matched schedules (the "many-to-many" model). 49 Use of these management models varies to a great extent depending on the preference of the HCO or of the scribing company.…”

“…Sources of data of scribe-produced draft documentation Besides capturing information during clinical encounter, scribes also record data from the provider when the patient is not present; for example, in the emergency department setting, scribes often record emergency department course, disposition, and re-evaluation discussions typically taking place outside the exam room. 53,54,59,61,77,81 Often, scribes also draw on data from existing patient charts, such as lab test results, radiology and pathology reports, problem list, current medications, and summaries of past clinic visits and hospitalizations. 42,65,78 Scribes may also utilize data obtained from outside records at the provider's request, such as faxes or paper forms that the patient brought to the clinic.…”