Be sure you and your scribe work as a team to help the patient feel well cared for.

Employing scribes is one way to add value to your practice.

With Obamacare still a point of debate at presstime, I know I’m not alone in contemplating the changes that lie ahead. It appears we’ll have more patients—particularly under age 19—since they’ll have that essential benefit of exams and glasses/contacts each year.

The latest information also indicates that many patients will be added to Medicaid type coverage. That means each office will be paid the same for an exam and the compensation will be less than usual and customary.

Which is why many practices have starting to think about adding scribes, basically someone who records findings, dictated by the eyecare professional (ECP), as she examines the patient. The scribe can be remote, sitting at a computer in another room with a headset, or be present with the patient. What follows are remarks from Carole Burns, OD, of The Solution Center in Westerville, OH, who has successfully added scribes to her practice.

Why did you begin using scribes?
“We began using scribes to speed up the office flow and to ensure recordkeeping was consistent and complete. Once we started using scribes we found an unexpected result—doctors had more time to concentrate on the patient and his treatment plan. Rather than trying to complete the electronic record and sometimes turn our backs to the patient to type, we spent the entire time engaging the patient. This resulted in greater patient compliance and increased revenue.”

What are the advantages of using scribes?
“Once we jumped into electronic billing 100% of the time we found that without a scribe, portions of the records had to be completed at lunch or at the end of the day. E-prescribing and other meaningful use requirements require more time, and when the doc had to scribe, our patients had to wait.

The advantages to scribing include: staying on time and fitting in more patients; no records to complete at the end of the day; more uniform recordkeeping; and being able to spend more time problem solving and ensuring that the patient completes her treatment plan.”

How did you implement scribes into your practice?
“We were very cautious at first. We began with one doctor as a pilot program and had that doctor learn how to best use the abilities of our scribes. At first the scribes were typing too much, so we created dropdown libraries which increased consistency. Once we were convinced that we could move patients through more efficiently, we had each doctor assigned to a scribe. In order for each of us to be with our scribe from beginning to end, we added one pre-tester. This enabled patient flow to be at its maximum.”

What advice do you have for others about adding scribes?

“The biggest advantage to having a scribe is that they can lessen your time with the patient without diminishing the patient experience. It is best to not hire new people immediately. Start with a bright employee in-house and try having her or him scribe for an afternoon or morning. Be sure the doctor is concentrating on the patient and note how much more agreement is received on the treatment needed.

Be sure you and your scribe work as a team to help the patient feel well cared for. Let your patient know that you will be giving information throughout the exam to ‘Susan.’ Having the patient listen to what you tell your scribe also helps the patient understand how in depth the testing is for a vision evaluation. This adds value to your examination.”

Peter G. Shaw-McMinn is an assistant professor at the Southern California College of optometry and senior partner of Woodcrest Vision Center in Riverside, CA.


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