The Many (Many) Benefits of Virtual Medical Scribes – Physicians Angels
A true cost-benefit analysis is an area that doctors and hospital executives struggle to understand when it comes to using scribes. First, it helps to understand what the most expensive recurring cost in healthcare is for labor: doctors, physician assistants, and nurse practitioners.
According to data we have collected for our own internal studies – which were subsequently confirmed by Michael E. Porter and Thomas H. Lee in a Harvard Business Review article titled, “The Strategy That Will Fix Healthcare” – a doctor’s cost per minute runs up to $4 minute. This drops to $1 per minute for NPs/PAs. So, to speak of cost-benefit ratios, we first have to know what is the cost for a medical facility’s doctor per minute of work. Hold in mind the thought of $240 per hour: the cost of 1 hour of a doctor’s time.
Would you pay $240 per hour to have someone type and click information into an electronic medical record? Of course not. So then why would you take your most expensive group of employees and make them into data entry staff?
And what happens during the time that the doctors are typing? If they type in front of a patient, that is akin to texting during a conversation.
Studies report that patients perceive doctors, who are typing while they are talking, as not listening to them. If the doctor types their notes after the encounter, then the next patient has to wait longer to be seen (lowering patient satisfaction scores) – or less patients are being scheduled, which means less revenue (confirmed by multiple studies), unless each patient is billed more (also confirmed – EMR’s allow upcoding, but no real improvement in patient care or health outcomes).
So the current status quo with EMRs is thus: Expensive EMR deployments, doctor’s time poorly utilized, less patients seen, more expensive patient encounters, longer wait times to be seen, increasing patient dissatisfaction, and higher physician burnout.
Breaking Down the Data and the Day:
The minimum amount of time that it takes a physician to process his or her portion of the patient encounter in an EMR is 4 minutes, with most charting taking 12 minutes, and complex patient cases taking up to 20 minutes. So at $4 per minute, a physician can cost $16 to $80 per minute just to type up a single patient encounter.
The cost of a Physicians Angels’ Virtual Medical Scribes cost $14 per hour. Onsite scribes are more expensive ($18 to $26 per hour, and have several drawbacks associated with absenteeism, turnover, and overhead costs). The average doctor using a scribe can easily see one more patient per hour. This means that seeing just one new patient covers the cost of a scribe and saves the doctor over 2 hours of typing each clinic day.
The average doctor can then either take the time savings or have more time for other activities (research, publishing, management), or they can see more patients in the same number of hours. Considering the halo effect of each extra patient encounter, this translates into extra lab tests, radiologic studies, or surgeries. Not only the small clinic, but the big health systems stand to gain a tremendous amount of ancillary revenue from using medical scribes.
By fractionating and specializing work, a combination of doctor/scribe can be more productive than a doctor alone. This is Adam Smith’s division of labor argument that many in healthcare don’t fully understand or trust yet. Many clinic directors and hospital directors only see another person being hired as a liability, not realizing that the EMR is no different from a CT scan or EKG machine. The EMR is a data acquisition device. You don’t see the radiologist or cardiologist operating the CT or EKG. They have technicians, thus allowing their mental energies to be devoted to the interpretation of data and management of the patient. A medical scribe is an EMR technician, in other words.
Some doctors claim they already use a scribe. In fact, they have assigned an existing medical assistant or nurse to “scribe” for them. This is something my ENT group tried, and it was a costly mess. Pulling a staff person off of existing responsibilities and patient care, and then asking them to work as a scribe means that other work piles up. Having a patient care provider, like an MA or nurse, work as an EMR data entry clerk is not a productive use of their training or time neither.
What healthcare groups nationwide deploying EMRs have experienced, without fail, is a reduction in the number of patients seen per office day, along with an increase in wait time. The cause is doctors acting as EMR data entry clerks for large portions of the day, instead of seeing patients.
Instead of hiring medical scribes, the response in healthcare has been to hire more doctors, NPs, PAs, and extend office hours. Medical groups have increased their most expensive labor costs to see the same number of patients they saw pre-EMR. They can achieve the same results with a low cost medical scribe, instead.
We have to keep in mind that the EMR is the ultimate aggregator of data for doctors to use. But by asking doctors to be their own data entry clerks expends their energy incorrectly. It also results in doctors developing poor data entry behaviors, reducing the quality of the patient data – which threatens the ultimate quality and purpose of the EMR, not to mention the patient’s care.