Monthly PCMH/HH Webinar. The Use of Scribes in the Patient Centered Medical Home

Transcription

1 Monthly PCMH/HH Webinar The Use of Scribes in the Patient Centered Medical Home Wednesday, March 26, :30AM & 4:30PM Tel , ID: #

2 Important Webinar Notes To minimize background noise, all lines have been muted To UNMUTE line and talk, press *7 To MUTE line, press *6 To ask questions or share comments: Via Chat: Type your question or comment into the Chat box on the lower left-hand side of the screen To speak via Webinar: Use Raise your Hand function, we ll call on you to speak Via Phone: UNMUTE (*7) Please state your name and practice team when speaking This call is being recorded Tel , ID: # *7 to UNMUTE, *6 to MUTE

3 PCMH / HH Core Expectations 1. Demonstrated leadership 2. Team-based approach 3. Population risk-stratification and management 4. Practice-integrated care management 5. Enhanced access to care 6. Behavioral-physical health integration 7. Inclusion of patients & families 8. Connection to community 9. Commitment to waste reduction 10. Patient-centered HIT Tel , ID: # *7 to UNMUTE, *6 to MUTE

4 Webinar Objectives Explore how the scribe model is implemented and utilized to enhance team-based care and improve access The Wright Center for Primary Care Courtney Dempsey Terri Lacey Learn about what is working from PCMH/HH colleagues Best practice sharing from PCMH/HH practices Review important updates/information Tel , ID: # * 6 to MUTE, *7 to UNMUTE

5 The Use of Scribes in the Primary Care Setting Courtney Dempsey, BS, Medical Scribe Terri Lacey, Vice President Clinical Operations

6 Unlocking and Aligning Human Talent and Work Capacity

7 Unlocking Capacity: Provider Team SCRIBE

8 Objectives Understand the use of scribes and how they can enhance a team-based approach to care as well as access. Understand what is involved in scribe training and recruitment. Learn how to get- buy-in from providers to use scribes. Describe who would benefit from a scribe. Explore the financial side of using scribes.

9 But Isn t Automation Suppose to Help? In most industries, automation leads to increased efficiency, even employee layoffs. In health care, it seems, the computer has created the need for an extra human in the exam room.

10 Growing Popularity of Scribes Five years ago, only 10 percent of hospitals and doctors offices used electronic health records. But now the adoption rate is nearly 70 percent, thanks to tens of billions of dollars of federal incentive payments.

11 Transcriptionist vs. Scribe Medical transcriptionists are not new. Since the 1960s, physicians have dictated their notes into a tape recorder and given them to transcriptionists to convert into written reports, interpreting medical terminology and abbreviations as they worked. The notes appeared on paper charts hours, sometimes even days, later. Scribes simply speed up the process, entering data as it is gathered so that records can be viewed and assessed instantly.

12 Attributes of a Scribe Computer and Typing Skills Knowledge of Medical Terminology Self-Motivation Adaptability Intelligence Punctuality Attention to Detail Responsible Professional Capable of working in a high stress environment

13 Training Medical scribes are trained medical paraprofessionals who provide medical documentation services for physicians, physician s assistants, nurse practitioners or other providers. Many scribes are university students who want to pursue careers in medicine, but some have chosen medical documentation specialist as their full-time career.

14 Role of the Scribe The medical scribe performs many tasks in the emergency room, clinic or hospital. Under the physician s close direction the scribe will usually witness the patient interview and physical exam, and create a medical record for the patient based on the interaction.

15 Impact on Workflow Medical scribes synthesize and enter this complex information into the electronic medical record. Scribes are also fundamental to workflow in the clinical setting, following up on lab results, facilitating specialist consultation, assuring the radiological procedures and results are obtained in a timely manner.

16 Impact on Satisfaction Making physicians into secretaries is not a winning proposition, (Dr. Christine Sinsky), a primary care physician at Medical Associates Clinic and Health Plans, in Dubuque, Iowa, who also researches physician dissatisfaction. Dr. Sinsky, who was an author of the article in Health Affairs, has visited more than 50 primary care practices over the past five years, in the course of studying ways to stem high rates of physician burnout. She has found that physicians who use scribes are more satisfied with their work and choice of careers.

17 A study published jointly in October by the American Medical Association and RAND Corporation found that electronic health records were a major contributor to physician dissatisfaction, as doctors negotiate between talking to and examining the patient, and the constant demands of the computer. A recent article in the journal Health Affairs concluded that two-thirds of a primary care physician s day was spent on clerical work that could be done by someone else; among the recommended solutions was the hiring of scribes.

18 Triple Win The patients get undivided attention from the physicians, The scribes are continuously learning while making an important contribution, and the physician gets the satisfaction of doing the work they went into medicine for in the first place.

19 Privacy Implications Some physicians are concerned about the privacy implications of introducing a third person to the examining room. According to one study of scribes in clinical settings, roughly 10 percent of patients were uncomfortable with having the scribe present.

20 Cost The cost of hiring a scribe, borne largely by the physicians themselves, is also a concern. Companies typically charge $20 to $25 per hour for scribes, who in turn are paid $8 to $16 per hour. Yet physicians who use scribes say they come out even, or ahead, financially, as they can see up to four extra patients a day.

21 Time-Driven Activity-Based Costing Estimating the cost per time unit of capacity Estimating the unit of time for activities Deriving cost-driver rates Analyzing and reporting costs Updating the new model A Robert S. Kaplan and Steven R. Anderson. (2004). Time-Driven Activity-Based Costing. Harvard Business Review Reprints, 1-10.

22 Time Based Primary Care Visit Process Map Example w/o a Scribe

23 Time Based Primary Care Visit Process Map Example with a Scribe

24 Time-Driven Activity Based Costing Function Position Time on Min. Per Min. Rate Cost Schedule Appoint Scheduler 3 $0.25 $0.75 Check-In Front Office Staff 4 $0.25 $1.00 Room Patient MA 8 $0.26 $2.08 Documentation MA 3 $0.26 $0.78 Physician Eval Doc 13 $1.89 $24.57 Documentation Doc 10 $1.89 $18.90 POC Testing MA 6 $0.26 $1.56 Check-Out Front Office Staff 4 $0.25 $1.00 Total Visit Cost $50.64

25 Time-Driven Activity Based Costing Function Position Time on Min. Per Min. Rate Cost Schedule Appoint Scheduler 3 $0.25 $0.75 Check-In Front Office Staff 4 $0.25 $1.00 Room Patient MA 8 $0.26 $2.08 Documentation MA 3 $0.26 $0.78 Physician Eval Doc 12 $1.89 $22.68 Documentation Scribe 10 $0.26 $2.60 POC Testing MA 6 $0.26 $1.56 Check-Out Front Office Staff 4 $0.25 $1.00 Total Visit Cost $32.45

26 Dr. David Reuben, a geriatrician at the University of California, Los Angeles, uses physician partners, who do the work of scribes, with expanded responsibilities such as scheduling appointments, filling out test requisitions and completing the checkout process. Preliminary results from a six-month study Dr. Reuben conducted of geriatricians and general internists suggest that the physicians saved an average of three minutes per visit by using the scribes. Just as important, the physician partners or scribes dramatically reduced the amount of work for the doctor to do at the end of the day. And a vast majority of patients said they thought the assistants helped the visit run smoothly.

27 Cost / Access Impact Visit Cost Savings WITH a Scribe One additional patient per hour more than covers the cost of a Scribe. Time Savings / Provider = 11 minutes / visit =88 minutes / Day =440 minutes / Week =21,120 minutes / Work Year =1,920 Additional Patients Seen

28 Key Measures Considered for Evaluation Increase revenue per patient through increased charge capture, Decrease medical record delinquency rate, Increase Productivity, Improve meaningful use data indicators, Increase patient access, decreasing the amount of time to wait for a scheduled appointment, Increase provider satisfaction.

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34 On the Ground Insight from Practices 7:30 AM webinar: Bonnie Roundy, Inland Medical Associates Debbie Jacobs, Blue Hill/EMHS Paula Eaton and colleagues, Martin s Point Bangor 4:30 PM webinar: Catherine Princell, Debbie Jacobs, and Shawna Ambrose-Pasternack, Blue Hill/EMHS Theresa Brown, Eastport Healthcare Tel , ID: # * 6 to MUTE, *7 to UNMUTE

35 Monday, March 31 st / 5:30-7:30pm Augusta - Alfond Center for Health, Education Pavilion Presque Isle Univ. of Maine, Room TBD Brewer - EMHS, Cianchette Auditorium Portland Univ. of Maine, Wishcamper Center, Rm 102 Lewiston - University of Maine campus, Rm 170 Waterville Thayer Center for Health, Dean Auditorium Machias - University of Maine campus, Science Bldg, Rm 102 For more info and to register, call Judy Ward at , ext. 1016

36 Keynote Speakers: Registration and Agenda details available at: /54qpbc/1Q Doug Eby, MD John Santa, MD, MPH Susan Burden

37 PCMH/HH Spring Regional Forums Topic: Building Collaborative Partnerships between Primary Care Teams and Skilled Nursing/Rehab Facilities to Improve Care Transitions Remaining date: Tues, April 8 - Orono Tel , ID: # * 6 to MUTE, *7 to UNMUTE

38 Upcoming Webinars Next PCMH and HH Webinar: Wednesday, April 23, :30 8:30 a.m. or 4:30 5:30 p.m. Topic: Optimizing the Care of Complex, Multi- Needs Patients Want to share what your practice is doing? Contact your QI Specialist Tel , ID: # *7 to UNMUTE, *6 to MUTE

39 PCMH/HH Learning Sessions Learning Session for all PCMH/Health Homes June 20, 2014 at the Augusta Civic Center Primary Care Leadership in a Changing World: The Next Big Thing Care management Health info technology Inclusion of patients/families Using social media in primary care Substance abuse screening and care coordination Pediatric-specific content Much more! Tel , ID: # * 6 to MUTE, *7 to UNMUTE

40 Tel , ID: # * 6 to MUTE, *7 to UNMUTE

41 Contact Info/Questions Your Quality Improvement (QI) Specialist Maine Quality Counts Maine PCMH webpage (See Our Work Maine PCMH Pilot Maine PCMH/HH Learning Collaborative) Tel , ID: # *7 to UNMUTE, *6 to MUTE