Hate Dealing With an EHR? Use a Scribe and Profits Increase

Will You Earn More Using a Scribe?

Practice management consultant Cheryl Toth says that paper charts took a physician 2 minutes to complete per patient.^[4] EHR documentation requires an average of 3.5 minutes per patient to complete, a 1.5-minute increase.

An extra 1.5 minutes may not seem like much, but it adds up. Assuming that the average patient visit is 15 minutes, it means that you could see 11.2 fewer patients per week, Toth notes, assuming a patient load of about 110 patients per week.^[4]

If your average reimbursement is $86 per visit, and you see 11.2 fewer patients a week, you potentially lose $963 per week or $3852.80 per month, she says.^[4] The use of a scribe allows a physician to see an additional patient per hour during an 8-hour clinic, Toth says, adding that this is a conservative estimate.^[4]

The increase in productivity is about the same for primary care, she says. That means the ability to see a minimum of 8 more patients a day.

Toth figures that with 3.5 clinics per week, 28 additional patients can be seen.^[4] (Many KarenZupko clients are surgical specialists who divide their time between outpatient clinics and hospital work.) She assumes a 40%-60% mix of new and established patients. She uses CPT code 99203 (for a level 3 new patient office visit, the Medicare reimbursement for which was $102.95 in 2011, when her calculations were made) and CPT code 99213 (for an established patient visit -- a $68.97 reimbursement in 2011).

Based on these assumptions, Toth calculates that the gross potential revenue per week from being able to see 1 additional patient per hour is $660.50.^[4] The gross potential revenue per month is about $2642.

Of course, you must then deduct to cost of a scribe to get net revenue gain. If you've been using a transcription service that a scribe renders unnecessary, the cost of that must be deducted from the cost of the scribe to get the true cost.

Hourly rates for scribes vary from $10 to $25 an hour, Toth says.^[4] She thinks $20-$25 an hour for a scribe whom you personally hire to join your staff is more realistic. Add in the cost of benefits -- which typically adds 25% to the hourly wage -- and the cost of a scribe averages $28.12 per hour, she figures.

Total it up, and here's one scenario of how the profits stack up:

Gross potential reimbursement per week for seeing 1 additional patient per hour is $660.50.^[4] Toth assumes that transcription is outsourced at $15 per hour, and a transcriptionist works 25 hours per week per physician. It comes to $375 a week per physician. That's money you save; add it back in. Now deduct the cost of the scribe, whom Toth assumes works 28 hours a week for an average rate of $28.12 an hour. The net potential revenue gain with a scribe is $248.14 a week.

"The average doctor using a scribe can see at least 1 more patient an hour," asserts Asfer Shariff of Physicians Angels. "One more patient covers the cost of a scribe and saves the doctor up to 2 hours of typing a day."

Other experts contend that seeing an extra patient every 3 hours is the typical break-even point for scribe use. Different assumptions about the cost of scribes, who range today from $14 to $23 an hour if subcontracted from a scribe vendor rather than hired independently by a practice, account for these variations.

ScribeAmerica's Michael Murphy estimates that you need 2-3 additional patients a day to break even, but he too contends that seeing an extra patient an hour is easily achievable. "Our practices are going from 3 patients an hour to 4, or 4 to 5," he says. "If you're seeing another 8 patients a day, you're budget-positive a significant amount of money."

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Cite this: Hate Dealing With an EHR? Use a Scribe and Profits Increase - Medscape - Feb 27, 2014.