Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department

J Emerg Med. 2017 Mar;52(3):370-376. doi: 10.1016/j.jemermed.2016.11.017. Epub 2016 Dec 14.

Abstract

Background: Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.

Objectives: Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).

Methods: A prospective cohort study was developed in a tertiary academic ED. Charts were coded by an external billing and coding company, then returned and mapped by International Classification of Diseases, 9th revision diagnostic codes. After training by a staff member with significant experience in implementing scribe programs, scribes provided 1-to-1 support to a provider as staffing allowed. Comparisons were made between scribed and nonscribed visits.

Results: There were 49,389 patient visits during the study period (39,926 adult [80.84%] and 9463 pediatric [19.16%] visits), of which 7865 (15.9%) were scribed. For adults, scribed visits produced 0.20 additional RVUs per patient (p < 0.001). Scribes generated additional RVUs in Emergency Severity Index (ESI) 2 (p < 0.001) and 3 (p < 0.001) patients. There were variable effects of scribes on RVUs by diagnostic codes. For pediatric patients, scribed encounters generated 0.08 fewer RVUs per patient (p = 0.007). ESI score had no effect on RVUs. The impact of scribes on pediatric diagnostic groupings was inconsistent.

Conclusions: Scribes had a positive impact on RVUs in adult but not pediatric patients. Among adults, scribes led to higher RVUs in ESI 2 and 3 but not 4 and 5 patients, perhaps suggesting a limitation to improve revenue capture on lower-acuity patients.

Keywords: RVUs; documentation; emergency department; relative value units; revenue; scribe.

MeSH terms

  • Academic Medical Centers / organization & administration
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cohort Studies
  • Documentation / economics
  • Documentation / methods
  • Documentation / standards*
  • Electronic Health Records / trends
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Medical Record Administrators / economics*
  • Medical Record Administrators / standards
  • Middle Aged
  • Prospective Studies
  • United States
  • Workforce