January 12, 2016

4 Ways Scribes Help Get the Most Out of Value-Based Purchasing

When the Centers for Medicare and Medicaid Services (CMS) say “value-based purchasing,” they don’t mean for the clinician or hospital. Rather, CMS is talking about purchasing services from clinicians and hospitals for a rate that is valuable to them.

The current state of value-based purchasing

According to a new GAO report, the Hospital Value-based Purchasing (HVBP) program redistributed about $140 million from hospitals that received penalties to hospitals that received bonuses in 2015. The bonuses and penalties received by most of the approximately 3,000 hospitals eligible for the program amounts to less than 0.5% of applicable Medicare payments each year. Where hospitals don’t earn bonuses that outstrip the penalties, that money is returned to CMS.

In 2016, there will be 24 measures represented in four categories, each of which is weighted differently when determining the penalty or bonus a hospital receives:

  • HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey composite, which measures patient experience of care — 25% in 2016
  • Outcome measures — 40% in 2016
  • Process of care measures — 10% in 2016
  • Efficiency of spending measures — 25% in 2016.

When it comes down to it, HVBP is a pay-for-performance program. But how best to perform so that you prove your ‘value’ to CMS and, therefore, maximize reimbursement bonuses? Here are four ways scribes can help.

1. Making data collection smoother and more efficient

Officials from selected hospitals interviewed by GAO reported that the HVBP program generally reinforced ongoing quality improvement efforts, but did not lead to major changes in focus. In addition, hospital officials cited a variety of factors that affected their capacity to improve quality — most notably challenges related to using information technology including electronic health records (EHR). Scribes trained in the particulars of your EHR system are able to navigate, ensure documentation is complete, and that the clinical data you need will be collected, to later track progress and, hopefully, hit those bonus targets. For example, influenza immunization is a new process of care measure — a scribe is sure to note in the chart whether this task was performed, or can set up a reminder in the EHR system that it needs to be carried out at another point during the course of care. Equally importantly, physicians and nurses are freed up to provide excellent patient care — making everyone better able to meet outcomes of care targets — rather than struggle with documentation.

2. Enhancing patient experience

HCAHPS surveys a variety of patient-experience measures, including communication with nurses, communication with doctors, communication with hospital staff, communication about medicines, discharge information and responsiveness of hospital staff. According to the GAO report, hospitals are still working to improve patient experience measures — on which, unlike clinical process measures, hospital scores were not at nor close to 100 percent. It’s not that hospitals and healthcare providers are unconcerned with patient experience and satisfaction; many hospitals have ways of tracking the patients’ perception of care and satisfaction. Rather, it’s that adjusting to the realities of a national, standardized evaluation takes effort. To help hospitals and providers succeed at this, EHR scribes alleviate them of duties that are not directly linked to interacting with the patient, and EHR scribes are capable of delivering accurate, detailed and timely medical documentation day in, day out. In addition, scribes can document post-discharge care instructions and medication information that doctors communicate orally to patients, so that a written version can be given to patients to take home. These kinds of tasks, which boost patient satisfaction with communications and their experience are worth one-quarter of reimbursement bonuses, so hiring a scribe can more than pay for itself.

3. Tracking ancillary services

Aside from reducing your overhead costs by improving the patient to medical staff ratio, increasing revenue by being able to see more patients, and improving the hospital’s reputation by allowing for better focus on HCAHP performance, your new hospitalist scribes will help keep track of lab work and radiology records so that they do not get lost or forgotten in the hustle and bustle of running a hospital. The timely management of these medical documents is vital to the effective care of patients as well as to a positive experience of care — both of which ultimately improve the bottom line. If you want your hospital to run like a well-oiled machine, using scribes helps make the most of the resources you have, helping you meet spending efficiency targets.

4. Providing messages and reminders

Doctors may feel they are constantly interrupted by requests from various care team members. A scribe can help the physician stay focused on the task at hand by recording notes from the tech, nurse, or another department. This lets the doctor manage new requests in order of actual priority, rather than the order in which they are delivered — and ensures the care plan for the patient in the room is executed in a timely manner. The scribe can also play a critical role in keeping the physician on track to revisit patients or follow up on test results. If the physician wants to see a patient again in 30 minutes or get a report back from radiology or the lab, the scribe can track the time and provide reminders. If the hospital has standardized targets for patient visits — for example, a patient shouldn’t be left waiting longer than an hour without an update in the emergency department — scribes can remind doctors that Mrs. Smith needs to be seen soon. Time and again, scribes bring critical value to the patient experience.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

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