Inspiring Physicians and Improving Inspiring Physicians and Improving Inspiring Physicians and Improving Inspiring Physicians and Improving Performance in Primary CarePerformance in Primary CarePerformance in Primary CarePerformance in Primary Care

An Analysis of Using Scribes in Primary Care

BY: E RVIN G RUIAE RVIN G RUIAE RVIN G RUIAE RVIN G RUIA, M BA

D I R E C TO R O F B U S I N E S S D E V E L O P M E N T

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Maximize our financial health by effectively leveraging the value and engagement of our

providers through continuous innovation and individualized physician support.

JESSICA JESSICA JESSICA JESSICA SCHERLERSCHERLERSCHERLERSCHERLER----HYMANHYMANHYMANHYMAN

CLINIC MANAGER

WARRANWARRANWARRANWARRAN JOHNSON, JOHNSON, JOHNSON, JOHNSON, RN

CEO, SCRIBEX

Presentation ObjectivesPresentation ObjectivesPresentation ObjectivesPresentation Objectives

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Revisit Data From

GTFMC

• GTFMC has demonstrated a strong

revenue increase using medical scribes

(even though scribes have not been used

as a strategy to increase patient volume).

Review Case Studies

From Other Medical Scribe

Programs

• Case studies highlight how to

optimize the scribe resource

(improved physician satisfaction and

increased revenue).

Proven Models /

Projected Results

• Illustrate proven models for

implementing medical scribe

program with no risk/low risk.

Background Background Background Background

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What have we learned over a 3-year period?

Case Study of GTFMC – Family Practice with 3 MD’s using scribes

Pros

o There is a significant improvement in physician satisfaction (going home earlier/charts are more

complete)

o Charts more accurately reflect the level of care provided to the patient (24% increase in charge per

patient)

o Improvement in clinic revenue $524,517

o Improvement in clinic net income of $98,258

o Increase in visits/hour

o Physicians are leaving earlier (an est. 1 hour, 41 minutes earlier each day)

o Must have the right medical scribe services provider (match with culture)

Cons

o Some effort involved with coordinating the staffing matrix

o Some coaching required from provider to get the best results from the scribe

Typical Typical Typical Typical ChallengesChallengesChallengesChallenges

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Broad Challenges and Concerning Trends

• Flat or declining fee for service reimbursement

• Decrease in productive activity (face time with patients) due to an increase in administrative and

documentation requirements not yet fully delegated to physician extenders

• Poor patient throughput

• Lengthy patient wait times

• Financially under-producing

• Physician dissatisfaction

• Additional Meaningful Use 2 compliance requirements and penalties

o Auditors are looking for patient-specific narratives and not copied or overly-templated

documentation

3-Year Growth Data

GTFMC Impact

Patient Through-Put

Visits -4%

Days at the office -11%

Average patients / hour 2%

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GTFMC Impact

Revenue Growth*

Total Charges 20%

Work RVUs 8%

Charge per patient 24%

wRVU per visit 10%

Annual Clinic Gross

Revenue

$524,517

Annual Clinic Net Income $98,258

Why did revenue increase despite a decrease in patient through-put?o Increased chart value off-set the decrease in patient contact time.

How this growth occurredo GTFMC made 1 of 3 possible improvements

Implemented

1. Improved Chart Value

• Physician shifted focus from clerical tasks to direct patient care, which

allowed more care to be delivered. Scribe more accurately recorded the

care, supporting a higher chart level.

Not yet implemented / opportunities not yet realized

2. Increasing patient through-put by trading documentation time for patient

care time

3. Increasing patient through-put by shortening patient visits

Case Studies: Leveraged Scribes to Increase Patient ThroughCase Studies: Leveraged Scribes to Increase Patient ThroughCase Studies: Leveraged Scribes to Increase Patient ThroughCase Studies: Leveraged Scribes to Increase Patient Through----PutPutPutPut

Mountain View Medical Center – Family Practice Clinic

Action◦ Shortened patient visits by 5 minutes each and traded documentation time for time with patients

Result◦ Increased productivity ~36%,

◦ Increase YOY revenue ~22%

◦ 30% more time focused on the patient (not multi-tasking)

Allina Health – Cardiology Practice in Minneapolis, Minnesota

Action◦ Shortened patient visits by 9 minutes each

Result◦ Increased productivity >30%

◦ Increased revenue by >$300K per provider/year

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Projected Results Using Medical ScribesProjected Results Using Medical ScribesProjected Results Using Medical ScribesProjected Results Using Medical Scribes

Beginning

State

2009

Hybrid

2014

Future

State

(2014-2015)

6.37 6.69 7.69

3.00 1.00 1.00

9.37 7.69 8.69

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17.92 19.22 22.09

$191.76 $237.38 $237.38

N/A 18% 18%

$0.00 $179.21 $243.54

$3,436 $4,383 $5,000

$687,268 $876,648 $1,000,037

N/A $189,380 $312,769

Patient contact time

Hours documenting (est.)

Total hours in office

# patient/per day

Avg. charge/per patient

Less cost of scribe

Net Daily Revenue*

Achieved by shortening visits and

trading an hour of documentation

time to see more patients

Future State ImpactIncreased Revenue by $1,563.84 per day

Time in Office: December by 41 minutes per day

Achieved by

improving

chart quality

Annual Revenue Per

Provider*

Net Increase Per Provider*

* per provider

Net revenue inc./per patient

Proven Models Proven Models Proven Models Proven Models –––– Projected ResultsProjected ResultsProjected ResultsProjected Results

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High Performance

Description• Clinic negotiates contract on provider’s behalf as a

benefit for providers

• Provider pays for service

• No performance metrics

• Service often selected to improve provider lifestyle

Cost• Break even = adding 1.37 patients per day

Description

Case Study• ______________ Clinic

• Provider agrees to meet basic requirements, which

will more than cover the cost of the service

• Clinic pays for the service, knowing if the

performance metrics are met, it will generate

additional net income for the clinic

• If performance expectations are not met, physicians

agree they will pay for the service

Advantages• Very high adoption rate

• Clinic predicts revenue and cost

• Highest increase in provider performance

Advantages• Providers are committed to service

• Moderate improvement in provider performance

Model 1 Moderate PerformanceModel 2

Case Study• Oregon ___________

GTFMCModel 3

Low Risk

Disadvantages• Predictive performance levels difficult to achieve

Cost• Cost passed to provider

Disadvantages• Program requires clear administrative

communication and metrics tracking

Description• Clinic negotiates contract on provider’s

behalf as a benefit for providers

• No performance metrics

• Service selected to improve lifestyle

• GTFMC pays for service

• Fee caps are established with vendor

Advantages• Providers are committed to service

• Moderate improvement in provider

performance

Moderate Risk

Disadvantages• Service pays for itself because quality

of charts have improved; however If

provider decreases volume or take days

off, then revenue is impacted

Cost• Clinic pays; chart quality covers cost

Clinic Pays Low Risk Provider Pays Clinic Pays

Case Study• GTFMC

Maximizing Success FactorsMaximizing Success FactorsMaximizing Success FactorsMaximizing Success Factors

Agreement Incorporates Elements Designed to Optimize Success – No Risk Approach

• Providers adapts workflow to optimize use of scribe

• Add 1 hour of patient contact time per clinic day (same visits/hr), increase visits/hr to ___ (Define) or provider pays for the scribe

• Maintain current number of clinic days or add more

• Maintain current 4 same day appointments per provider

• Schedule enough patients to off-set no-shows

• The physician has patient wait times of > ___ days (Define)

• If provider does not meet performance criteria, the cost of the service is shifted to the provider or the service is terminated.

• Providers has 4 months to show significant change in productivity and clinic financial improvement

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Barriers to Achieving Success

• Provider adheres to old behaviors and does not adopt work flow to optimize success

• Provider removes their hands from the keyboard (in clinic to focus on patient)

• Discontinue dictation services

• Coach the scribe daily on individual preferences

• Clinic must add agreed-upon number of patients to current schedule

o likely 3 or more to create a buffer and ensure service cost is consistently covered

Behaviors to Adopt

Provider signs

Performance

Agreement

Provider Value and ResponsibilityProvider Value and ResponsibilityProvider Value and ResponsibilityProvider Value and Responsibility

Value Ask

Quality Charting 1. Call out findings to scribe

Higher Compensation 2. Review and edit scribe notes and order entry

Shorter work day 3. Adapt current workflow to optimize scribe resource

More satisfying patient encounter – not

multitasking

4. Coach scribe to learn their preferences

Patients are more satisfied when the focus is on

them

5. Complete periodic performance surveys

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We can better leverage our providers’ time, while improving patient care and

physician satisfaction, while increasing clinic revenue and physician compensation