Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. The 10-15% increase in clinic productivity associated with the utilization of medical scribes is adequate to offset the costs of the program for all Medicare-billing provider types.

2. The model was found to be sensitive to CPT revenue, suggesting that providers relying heavily on procedures/surgeries for revenue may find it more difficult to recoup the cost of training a scribe when only considering direct visit billing.

Evidence Rating Level: 3 (Average)

Study Rundown:

Difficult-to-navigate electronic health records systems are a large contributor to workplace dissatisfaction and physician burnout. Medical scribes can alleviate this issue by streamlining the documentation process and helping physicians spend more time face-to-face with patients. While previous studies in specialties such as family medicine and emergency medicine have shown that integration of scribes can increase productivity and thus revenue, these findings were difficult to generalize and did not account for the difficulties in training new scribes. This modeling study was designed to evaluate the magnitude of productivity increases necessary to offset the costs of hiring scribes via a third-party contractor across over 30 provider types. After including technology, onboarding, and turnover costs in the economic analysis, the mean annual revenue that would need to be generated to break even was found to be just shy of $48,000, which roughly corresponded to 300 new visits or 475 returning visits per year. Procedural and surgical specialties such as orthopedics and otolaryngology had lower E/M codes on average and required a greater number of visits, while office-based specialties such as cardiology and geriatrics required significantly fewer. Although there may be substantial variation both between specialties and between providers within a single specialty, these results suggest that the introduction of scribes to the clinic workflow is generally cost-effective and may positively influence provider satisfaction.

In-Depth [economic analysis]:

This modeling study drew 2015 data from the Centers for Medicare & Medicaid Services (CMS) and National Ambulatory Medical Care Survey in order to calculate the costs and additional revenue associated with implementation of a scribe program. Major costs included a $3000 program initialization fee, a $400 onboarding fee per scribe, and a $25 hourly rate per scribe; assuming roughly 1.5 new hires per year, the mean annual cost per scribe was $47,594 (standard deviation, $301.02). On the revenue side, direct visit billing was approximated using evaluation and management level-of-service codes (E/M 1-5) for all outpatient visits, and billing for laboratory and radiological testing was estimated using specialty-specific data on CPT codes. The groupings in the databases did not completely align with the prespecified provider subtypes in this study, so some extrapolation was performed (i.e. internal medicine data for geriatrics). After factoring in the percentage of visits at each reimbursement rate for each individual specialty and disregarding any revenue from downstream procedures/operations, the average number of additional visits needed to recover costs across all specialties was determined to be 295 per year (1.34 per day) for new patients and 472 per year (2.15 per day) for returning patients. Cardiology had the highest average bill per patient, requiring only an additional 195 visits/year (0.89 per day) for new patients or 364 visits/year (1.65 per day) for returning patients. In contrast, orthopedic surgery had the lowest, needing an additional 395 new visits/year (1.80 per day) or 612 returning visits/year (2.78 per day). These results were not sensitive to changes in scribe turnover rate but were sensitive to changes in hourly pay rate as well as CPT revenue; increasing pay by $5/hour resulted in an 18% increase in the number of additional visits necessary to recover costs, and discarding CPT revenue entirely resulted in a required productivity increase of nearly 30%.

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