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Saturday, February 8, 2014

Physician Assistants and Medical Scribes

Physician Assistants and Medical Scribes

The word scribe is Latin for scribere, which means "to write." A scribe has been known historically for recording events, making written copies of documents, and more recently, "transcribing" word for word. Medical scribes have emerged most recently in response to the extensive use of EMR into clinical practice from widely used handwritten and dictation methods. 

What Role do Medical Scribes Have in Healthcare?

Medical practices, hospitals, and typically lots of emergency departments hire medical scribes to relieve the providers unequipped with rapid typing skills or who cannot simply find their way around on EMR software. A medical scribe serves to record the actions and words spoken as they occur. Scribes cannot implement their own observations into the medical record. The scribe documents the activities of the provider as they occur and must include the name and signature of the provider who performed the encounter. The provider is required to attest of his/her presence during the encounter, verifying they have reviewed the scribe's documentation and the accuracy. The provider must also sign and date the encounter. 

What are the Benefits of Medical Scribes? 

(This one's for you, providers)
  • Improved productivity - mitigate inevitable slowdown
  • Enhanced clinical documentation
  • Provider satisfaction greatly increased
  • Completion of medical records ensured
  • Patient satisfaction increased - thought to be due to provider's increased attention to patient, rather than computer screen and keyboard

Who is Authorized to Use a Medical Scribe?

Physicians, physician assistants and nurse practitioners are all providers authorized to use scribes to document their patient encounters. 

So, Why Draw My Attention to Scribes? 

  1. If you are ill-experinced and new to the profession, becoming a scribe can be a great way to become acquainted with healthcare and to gain entrance into other positions, such as a patient care technician, a medical assistant, or any other type of tech. 
  2. During your career you might be asked by your supervising physician to perform tasks mentioned above; tasks of a scribe, not a physician assistant. The use of a PA as a scribe is not only a waste of a highly intelligent medical professional, but can subject practices to allegations of fraud and abuse. It's important to remember your role in healthcare: to perform the history, physical examination, and medical decision making components of a patient encounter, and submit a claim to a payer for such services
    1. Medicare says that when a PA/NP and a physician both provide documentation in the medical record of patient encounters (i.e. they both participated), these encounters cannot be billed under the physician's NPI (National Provider Identifier) because they do not meet necessary requirements for the service to be billed by the physician. 
    2. If the PA performs the history of present illness, the physical exam, and/or the medical decision-making - then the "shared visit" rules must be met to bill under the physician's number to the Medicare program. If those requirements are not met, the encounter will be billed under the PA's NPA with reimbursement at 85% of the physician fee schedule. 
  3. It's okay if you don't understand all of this "mumbo-jumbo" stuff now. It will begin to make more sense as you become more acquainted with healthcare later. For now, start with the basics. 
Pre-PA Students: Want to become a scribe? Need healthcare experience (HCE) for your CASPA application? PhysAssist Scribes is just one company of many that hires scribes. 

If you have experience as a scribe, I encourage you to comment on this article about your experience as a scribe for others and leave any advice for other pre-PA students wishing to join the scribe workforce. 

3 comments:

  1. I was a scribe/medical assistant. Started off as an MA, then proceeded to a scribe. Still did some MA stuff while a scribe. Did both for 3-4 years before applying to PA school. I think it helped a lot, especially knowing the different ortho exams and medications etc.

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    1. I have been thinking about pursuing a MA/scribe position, I have much more experience as a scribe and I would like to use those skills as a MA. It seems like the majority of time would be spent scribing, but one may be able to juggle both. How much were you able to accomplish as a MA?

      I realize that I'm 18 months late on this convo, but if anyone has anything relevant to add I would love to hear it.

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  2. Let me provide some framework for my answer. I have a PhD in physical chemistry and have been involved in the medical profession most of my career, much of it as a laser tech in my own laser rental business. My interest in the PA profession is that my daughter is now applying for admission to PA schools (mostly in Texas) and I spent the past year coaching her, more because its fun for me than because I am indispensible as her coach. She chose to get her health care experience as a scribe and called all of the Texas schools plus LSU to be sure her experience would be accepted. They all agreed that a scribe counted as HCE. I can also tell you that her scribe experience has been an incredible education. After one year, she has learned how to take a patient history and knows what tests to prescribe for any number of patient complaints or presentations. From the tests she can often arrive at the correct diagnosis and treatment plan, though that isn't her job. She sees both main ER and Fast Track patients everyday keeps all the MDs notes in the hospital's electronic records system and often relays information back to patients, nurses and hospitalists. I should add that she volunteers 4 hours per week at an understaffed clinic for the uninsured where her role is medical assistant/lab tech and anything else that needs to be done (not requiring a license of course.) She now has interviews at half the schools she applied to and, I believe, will end up with interviews at most all of them. I know there are many ways to get HCE. Some have more direct hands on contact like EMTs and physical therapists among many others, but if you choose to become a scribe you should not be at any disadvantage. If any school says they won't accept "scribe" as HCE, they probably don't know what scribes actually do. Good luck!

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