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Practice Management - To scribe, or not to scribe, that is the question

November 18, 2015
Dr. Michael Murphy
From the November 2015 issue of HealthCare Business News magazine
It’s no secret that America’s health care system is evolving at a faster rate than ever before. This transformation is taking place in many forms: from EHRs, to more federal mandates, value-based purchasing, decreased reimbursements and the Affordable Care Act. The bottom line is this: hospitals and doctors are asked to do more with less.
A doctor’s traditional role is that of caregiver, not administrator or data entry specialist. Yet with each successive year, we’ve seen the average doctor, in both the hospital and office setting, saddled with more administrative responsibilities. A recent study pointed out that the No. 1 cause of work-related stress is administrative duties — surpassing work hours and pay. Hospitalists, for example, now need to administer and accurately document the answers to a 12-question survey for each patient before admitting them.
For many doctors, EHRs have become more of a curse than a blessing. Federal grant money has made many EHR companies overzealous in selling their systems despite obvious technical shortcomings and in some cases, steep learning curves. But even if EHRs are working well for a doctor, many other administrative tasks such as value-based purchasing, bundled payments, HCAHPS, ICD- 10, care coordination, and population health, are here to fill that time gap.
A Catch-22
Even though many hospitals may not like it, they are required to follow these mandates in order to remain compliant and not lose additional funding or reimbursements. As a result, a new obstacle arises when dealing with patients who are seemingly unaware of these added duties, and still expect immediate access, as well as 100 percent attention from their health care providers.
A patient might be taken aback by a doctor typing away at their EHR as they’re inputting medical decision-making. In that case, the patient might perceive the doctor as distracted, frazzled, or detached from their situation. That in turn will likely be reflected in the HCAHPS survey or Press Ganey results, which then continue to feed the cycle of pressure for doctors being told that their survey scores are low.
As we shift away from fee-for-service to bundled payments, the one who provides the best access and the most cost efficient care will win. However, for every new patient that is seen, an additional 12-15 minutes of documentation will be required. If a provider wants to provide better access to care and now see 40 patients per day instead of 30, an additional documentation burden of 150 minutes will occur. This unfortunate burden needs to be carefully analyzed and considered along with family time, risk, compliance and what revenues will actually be achieved.

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