Doctor Patient Relations

How to Use Scribes to Add 2 Exams Per Day

By Ken Krivacic, OD, MBA

Dec. 12, 2018

Scribes can offset the task of inputting data into practice management software for doctors, freeing up the doctor’s attention to focus on the patient. In the process, the doctor may find more accurate information recorded in the EHR, enhanced patient care and greater practice efficiency.

Along with the recording and inputting of patient data, employees trained as scribes often can supplement their work with other tasks in the practice.

My practice currently has six scribes for three doctors, or two scribes per doctor. They are paid between $13 to $17 per hour depending on experience, knowledge and time with the practice.

The scribe will greet the patient in the reception area, perform case histories and all preliminary testing, scribe in the exam room, pull contact lenses when needed and escort the patient to the contact lens room, when needed. They also perform call backs for those patients we want to follow-up on by e-mail, text or phone. They are also responsible for sending and receiving correspondence from other doctor offices.

In addition, our scribes maintain the exam rooms by cleaning and restocking eye drops, and other medications, that are both used in the exam room and sold to patients.

Add Two Extra Exam Slots Per Day
We started using scribes 8-10 years ago when we started getting very busy (a full daily schedule) and were looking for a way to be more efficient. Using a scribe has made me faster in doing an eye exam, so that we have been able to add an extra full exam for our morning and afternoon schedules, or two extra exams per day. The scribes also make me more personable with patients, as I can talk to them face-to-face as opposed to trying to type and talk at the same time.

The two extra exam slots, which our scribes have helped us make available, results in extra revenue for the practice, and helps justify the investment we have in the scribes. So, let’s do the math:
Cost: (est $15/hr x 40 hrs/wk x 4 wks) = $4,800 per month in two scribes salary
Revenue: (est $365/exam x2ex/dayx20days/mt) = $14,600 per month
COGs (Cost of Goods): est 30% of revenue = $14,600 x 0.30 = $4,380
Net gain per month: $14,600 – $4,800 – $4,380 = $5,420
Net gain per year: $65,040

In this example, the revenue gains are tremendous, and the entire practice benefits. Keep in mind there are variables. Is the scribe going to perform perfectly from day one? More than likely not – they need training, they will be slow in the beginning and they may make the occasional mistake that could cost the practice. In the long run, the benefits outweigh the drawbacks. Also keep in mind that our use of scribes was an evolving process. We did not decide one day to add two scribes per doctor. Like most other processes, we started slow and had one scribe per doctor first. Once we got comfortable with the system we added a second scribe.

Scribes Can Also Serve as Techs
Our scribes are both scribes and techs. They will start with the patient after the front desk has checked them in and will run all the preliminary testing (patient history, acuities, autorefraction, photos, etc.). Once finished, they will alert me to come in the exam room and will sit and scribe as I perform the refraction, externals, internals and make recommendations. They input the patient information into our EHR system as I call out what I want recorded.

Prior to having a scribe I would have to input the data myself, which slowed down the process by a few minutes. If you are seeing 10-12 patients in a morning, and save three minutes per patient, that frees up enough time to add an additional exam.

Boost Accuracy of Patient Data
Another advantage of having a scribe in the exam room is they can make sure everything was entered in the chart. They are a second set of eyes and ears, and they can make sure we keep as detailed records as possible. Examples of this might be not providing proper codes or the correct codes for a diagnosis and procedure. The scribe will question me as to the use of certain codes. They are also great about making sure prescription information is transferred to the proper department, so the optician does not have to come back into the clinic to request the Rx.

Train Your Scribes
Since we all have our own ways of conducting an exam, and working with patients, we need to train our scribes in how our system and processes work. Even if they were already scribing at another practice, they need to be trained in how we manage a patient through our exam process. This is usually done by our current scribes training the new hire, and having them shadow our current scribes for about a week before they see a patient on their own.

As with any other job position, there is continual training for all scribes, especially if we see a variation in how a certain test or procedure is being performed. These special sessions are usually done during our weekly staff meetings where we set aside time to work with our scribes.

Not Everyone Makes a Good Scribe
The scribing job requires that the employee be somewhat detailed-oriented, but also someone who can blend in and sit back and enter data into an EHR system. The less interaction during that part of the exam, the smoother and faster the exam flows. If you have someone who is more extroverted, and they want to interact with the patient more, it slows the whole process down, which would be counterproductive, as one of the reasons for using a scribe is to speed the process up.

 

 

Ken Krivacic, OD, MBA, owns Las Colinas Vision Center in Irving, Texas. To contact him: kkrivacic@aol.com.

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