One of the challenges that is impacting nearly every urologist is need to improve the efficiency of our practices. In the past we had the luxury of low patient volumes and fat, juicy profit margins.
Today, it is the reverse: large patient volumes and razor thin profit margins. As a result, in order to maintain our incomes we are motivated to improve the efficiency of our practices. One of the most effective methods to enhance the efficiency of my practice is to make use of a scribe. A scribe is person who shadows a physician and takes notes either in the chart, or better yet, on the computer thus freeing the doctor to have more eyeball to eyeball contact with the patient.
How does the scribe work? The scribe interacts with a new patient after the doctor introduces him\herself to the patient. The scribe then takes the history of the present illness, records the past medical history and the review of systems. The scribe then presents the HOPI to the physician and then accompanies the physician into the room. At this point the doctor may ask a few additional questions or probe any aspects of the HOPI that are not clear or need a more in-depth questioning. The doctor conducts the physical exam and the scribe then records the positive findings in the chart or the EMR. At this juncture the doctor can have a discussion with the patient regarding the diagnosis and the plan of management with the patient and the scribe records the doctor’s plan of action. The doctor can then answer any questions the patient may have and the scribe can give the chart or the computer to the nurse who will make the necessary arrangements for any lab tests, studies or surgeries, provide the patient with sample medications and written instructions for the use of the medications, provide pertinent educational materials, and make the follow up appointments. While the nurse is taking care of one patient, the scribe has moved to the next patient, staying one patient ahead of the physician.
Advantages of the scribe. Most of all the scribe improves the efficiency of the practice. You are now able to be eyeball to eyeball with the patient and focus on communicating with the patient instead of writing or using the computer. As a result of using the scribe I am able to see 5-6 additional patients each full day in the office. Also, my coding has moved from the previous Level 2-3, to Level 4-5 as the scribe is more thorough conducting the review of systems, past medical history, and recording the fine nuances of the physical exam that I often neglected to document such as a neurologic and dermatologic examination.
How does a physician find a scribe? My first scribe was a college graduate and was in the gap year between college and medical school. She was taking courses to improve her MCAT scores and worked in my office for a year before entering medical school. Another scribe I had was a lady who worked as a transcriptionist but was replaced by an electronic medical record and wanted to stay in the medical field. The scribe does not need to have a medical background. You are looking for someone with people skills and the ability to communicate with patients in a sensitive and compassionate fashion. The cost of a scribe is roughly $10-$15\hour. I would recommend starting at the lower end and move up as he\she becomes trained.
The disadvantages of having a scribe are cost, time to train the scribe and the changing of habits from you do the writing in the chart or working the computers to allowing someone else to do it for you. In the beginning, this can be frustrating but when you see how efficient you become, you will enjoy the luxury of having a scribe. As a matter of fact when the scribe is absent or on vacation and I have to use the computer, I realize how invaluable she is and how effective the technique is to enhance my practice.
Getting started. First decide if you need a scribe. If patients need to wait more than 4-6 weeks to make an appointment for a routine visit, then you have a back log of patients and a scribe will help you reduce that backlog. If your last patient is scheduled at 4 or 4:30 and you aren’t finished with patients until 5:30 or 6:00 then a scribe will help improve the efficiency of the practice. If the majority of your codes are Level 3 or less, then you can improve your productivity by having a scribe. Finally, if you are considering a move to an EMR but are technophobic, then a scribe might be a natural segue to implementing the EMR.
Summary:
Few of us can increase reimbursements or make large cuts in overhead without impacting quality of care and patient satisfaction. However, all of us kind find ways to improve our efficiency and our productivity. A scribe may be just what the practice management advisor ordered. Try it. You’ll like it!
As always, I’m interested in hearing from my colleagues about new and novel practice management ideas that you may be using and that you would like to share with your fellow urologists. Let me hear from you: neilbaum@hotmail.com
