Practice Management Improvement Strategies
How to hire a superstar scribe
Orthopedics Today, July 2018
Cheryl Toth, MBA
If you have you been thinking about hiring a scribe to handle your electronic health record data entry, then you are not alone.
More physicians are hiring scribes to reduce administrative overload. Physicians who use them report improved quality of life, clinic efficiency and productivity. If U.S. industry estimates prove accurate, by 2020 there will be 100,000 medical scribes or one scribe for every nine physicians.
The three options for finding the right superstar to support you are develop one from within, recruit a scribe or engage a scribe service.
Cheryl Toth
Start by looking at your staff for someone who is energetic, bright and looking for a new challenge.
Two years ago, Millennium Orthopaedic Surgery and Sports Medicine, in Farmington, Michigan plucked a highly capable medical assistant (MA) from its ranks and groomed her to be the scribe for orthopedist Robert B. Kohen, MD. "We felt she would be a good fit," office manager and billing supervisor Lee Sierocki, CPC, said. "She is a smart, high caliber employee who rarely misses a day of work," according to Sierocki.
Therefore, Kohen set out to "raise his own scribe," Sierocki explained. "He developed the EHR templates and prompters himself, integrated the right information for billing documentation and trained the MA to ask the right questions." After 2 years, the two speak the same language and it sometimes sounds like Kohen is speaking to another doctor, Sierocki said.
"He no longer has to walk back and forth from patient to computer during the exam because the scribe is in there with him, clicking, listening and watching. She knows exactly what to enter into the EHR," Sierocki said.
Internal scribe candidates do not require a clinical background or professional certification. Transcriptionists are another employee type to draw from, especially since many of their jobs have been cut due implementation of EHRs and voice recognition. Administrative staff who are personable, fast on the keyboard and have a desire to learn also make good internal candidates.
"I've tried to piggyback on in-house people who are having their transcription jobs eliminated," said Lauren Kaiser, PHR, SHRM-CP, director of human resources at Tri-State Orthopaedics, in Evansville, Indiana, a 20-physician group that employs multiple scribes. "Often they are able to work part-time and bend their schedule when the physician is in the OR."
In cultivating non-clinical scribes from within you may need to offer medical terminology and anatomy training. The AAPC offers online courses in both areas. It is also smart to invest in comprehensive scribe training and certification. If you do not have a nearby college that offers scribe courses, online curriculums are available. The American College of Medical Scribe Specialists offers training, certification, recertification and continuing education for medical scribes. The American Healthcare Documentation Professionals Group offers an online program, too. A number of colleges have put their scribe programs online. William Paterson University, in Wayne, New Jersey, for example, offers a medical scribe program in its WPconnect online university.
The bottom line: growing your own takes time and training. Sierocki attributes the success of her MA's metamorphosis to the employee's quality and the amount of time Kohen invested in the MA's development. "He created the prompts and templates and took the time to teach her," Sierocki said.
Recruit a new employee
If hiring from within is not an option, contact a local physician assistant, nursing or medical school program, if one exists in your area. Drawing from these student populations attracts smart, motivated candidates who already know anatomy and terminology and seek opportunities to gain experience with patients. Ask to post a job ad on the program's message boards or use their placement services.
Hiring students, of course, comes with the possibility of schedule changes each semester. Once the student graduates, he or she will move on to the profession for which he or she is training. So, if you're looking for a longer-term solution, consider other options.
Half the scribes at Abilene Bone & Joint Clinic, in Abilene, Texas, which provides 19 high schools with football and basketball trainers, are athletic trainers who had a working medical knowledge of orthopedics. "We were able to hire many of them as scribes when the practice switched to an EHR 7 years ago," Spence Southall, PT, practice manager, said.
Southall said anyone who has worked in the medical field has the potential for being a good scribe.
"We just hired someone who worked for an optometrist and another one of our scribes worked in billing at an OB-GYN clinic that closed," he said.
"We've hired external candidates that are having their transcription jobs eliminated," said Kaiser. The practice employs both full-time and part-time scribes. She said some of the practice's scribes work two part-time roles for two physicians and other scribes work full-time with one physician.
"The physician only needs the scribe when seeing patients in the office," Kaiser said. "So, when we have two physicians with opposite schedules, we can pair them with the same scribe to provide full-time employment."
Scribe recruitment should follow the same best practices used to hire other employees.
"Our firm has recruited hundreds of practice staff and managers at all levels," Cheyenne Brinson, MBA, CPA, consultant with KarenZupko & Associates, said. "We always start with a written position description because it's the foundation for creating a job ad, establishing key performance indicators and setting expectations during interviews."
A good job description lists required skills and experience, job tasks and reporting relationships, Brinson said.
Setting expectations for this role is particularly important. Southall advises practices to be fully transparent when talking with candidates about job requirement and duties.
"Don't undersell how busy they will be," he said. "The worst thing you can do is hire and train a scribe and have them quit after a few months."
Southall is clear with candidates the role involves more than writing things in the EHR. It requires multitasking, knowledge of primary and secondary insurance and an ability to move fast.
"We've had interviews that ended with the candidate declining the next interview because they realized the job was not what they expected," Southall said.
In addition to documenting the EHR, Abilene Bone & Joint Clinic scribes manage the surgery schedule, room patients and take on coding. They also send their scribes to coding courses.
Kohen's scribe obtains authorizations for MRIs and tests and works with the billing team to provide documentation and diagnosis code data when appealing denied claims, Sierocki said.
Because not all scribe roles are the same, clearly communicate what the role of your scribe entails in the job description, the ad and discussions with candidates. Assess candidate proficiency with keyboarding skills, spelling, writing, as well as anatomy and terminology knowledge. Brinson advises administering a skills assessment.
"Not only do assessments rule out candidates who won't cut it. They also identify training needs for those you do hire," she said. Services, such as Total Testing, offer low-cost online assessment options. Practices can also create their own fill-in-the-blank assessments for technical skills, such as billing or anatomy knowledge, Brinson said.
One orthopedic practice requests writing samples and a personal statement in which scribe candidates state why they are interested in the job. It also administers an on-the-fly writing test in which candidates are given a series of bullet points that could be from a patient encounter and are asked to assemble them into a paragraph appropriate for a medical record.
Brinson also advises clients to make the offer contingent on a background check that includes credit and criminal history, subject to state guidelines.
Engage a scribe service
The third option is to outsource scribe recruitment to one of the more than 20 scribe companies nationwide, which include ScribeAmerica, I Am Scribe, PhysAssist, ProScribeMD and Physicians Angels. Most of these services provide practices with a scribe who physically works in the practice. However, Physicians Angels provides virtual scribes that are located off-site and listen to the patient visit on a HIPAA-compliant, secure IP channel and document what they hear into the practice's EHR in real-time.
Tri-State Orthopaedics uses the virtual scribe service. "When we couldn't find the right fit for one of the surgeons and didn't meet the minimum number of hours per week required by other scribe services, it was a good solution for us," Kaiser said.
Engaging a scribe service is a good option for practices without the time or resources to advertise, interview, assess and perform other recruitment activities. Scribe services do all that and delivers a scribe who is trained in anatomy and terminology, often certified and may even know how to use your EHR. This reduces the need to arrange for additional training and speeds the integration of the scribe into your workflow.
Depending how the service is structured, the practice pays an hourly rate that includes the company's service fee, and the scribe's compensation and benefits, which are paid to the scribe by the service company. Usually, practices must commit to a minimum number of hours.
Although there are advantages to using a service, the practice gives up some control because the scribes are not employed by the practice. When evaluating which service to use ask about its scribe training, performance management and the protocol for missed shifts. If the latter occur frequently, without a back-up plan, it can wreak havoc on the appointment schedule.
Medical scribes: A physician's secret weapon, Derek Klein, Merritt Hawkins, March 6, 2018, https://www.merritthawkins.com/news-and-insights/blog/healthcare-news-and-trends/medical-scribes-a-physicians-secret-weapon/; Accessed on June 18, 2018.
Cheryl Toth, MBA, is a business writer with KarenZupko & Associates Inc. She brings 20 years of practice consulting, technology management and presentation experience to her projects.
Disclosure: Toth reports she is a business writer with KarenZupko & Associates Inc, which develops and delivers CPT coding and practice management workshops presented by the American Academy of Orthopaedic Surgeons in conjunction with KarenZupko & Associates Inc., and which has developed educational content for Physicians Angels.
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