113 Utilization of a Standard Scribe Script to Improve Level of Service Charges

Abstract

To determine if the creation of a standard scribe script that delineates what information must be documented for every ED encounter can lead to an improvement in level of service (LOS) charges. A community emergency department with annual volume of approximately 40,000 visits implemented 24-hour scribe coverage in October 2015. Average LOS charges remained flat in the months after this roll out. Therefore scribes, contracted from a national scribe company, were provided with a script that walked them through a typical provider note. This script delineated exactly what pieces of information were necessary for all notes, ie, past surgical history and review of systems, etc. The script provided wording that a scribe would verbalize to their provider to prompt collection of necessary detail and data. The script also contained prompts to make sure a proper differential diagnosis was documented as well as key imaging and lab values that were imperative to the providers’ medical decisionmaking. Providers were also educated, via staff meetings and emails, that the scribes would begin to ask them for information should they not obtain it during their initial patient interaction. Level of service charges were then retrospectively compared, using a two proportion z test, between the two quarters preceding implementation of the scribe script to two quarters after implementation. There was a statistically significant (p=<0.0001) decrease in mid-level charges (99283) and a statistically significant (p=<0.0001) increase in two of the highest reimbursing codes (99284 and 99285). Figure 1 demonstrates the change in LOS charges. Development and deployment of a scribe script can lead to a significant increase in higher reimbursing evaluation and management charges in a community emergency department.