Virtual Scribes Return on Investment Case Study

The use of Skywriter MD medical scribes benefits the patients, physicians, and the health system. The return on investment seen by participating clients can be measured quantitatively in formal calculations of financial monthly returns and qualitatively in testimonials that describe the increased satisfaction of patients and their providers. In this study, quantitative and qualitative forms of investment return measurements will be examined separately and classified as Hard ROI and Soft ROI, respectively. Both forms of measurement are included to provide a holistic understanding of the return on investment seen by current Skywriter MD clients: hard ROI demonstrates the financial gains current clients have experienced using Skywriter MD and soft ROI reveals the invaluable impact the use of Skywriter MD has on patients and providers. 

Hard ROI

The financial return on investment that providers experience on a monthly basis is dependent on the cooperation of the providers with Skywriter MD, the capacity of the providers to add patients, and the specialty of the provider. The following study examines several provider clients of Skywriter MD and ultimately presents a potential financial return on investment for all prospective Skywriter MD clients. There are several methods that clients have pursued to gain a large return on investment. This includes but is not limited to the following: increased patient visits, improved note documentation (leading to increased billing), and reduced support staff hours. Many clients gain a return on investment through a combination of the discussed methods. 

In a Hard ROI study on a successful Skywriter MD physician client 6 months post-implementation, it was found that the client received a net total financial return of over $5,000 monthly (Figure 1). This financial return sample demonstrates the potential financial return prospective Skywriter MD clients stand to gain from service. The particular client examined in this financial return experienced success because of their dedication to coordinate with Skywriter MD staff on documentation improvements, ability to increase the number of patient visits, and willingness to adapt workflow to be most efficient with Skywriter MD. 

Figure 1 Monthly Financial Sample: The above monthly financial sample is a study of one physician client of Skywriter MD. The red bar indicates the cost to the client and the blue bars indicate gains to the client.

With the use of Skywriter MD services, the client was able to reduce the total amount of time spent on each patient visit without reducing the amount of time the client spent in the room with each patient. This time reduction is largely due to efficiencies in documentation that the client was able to gain through pre-determined speech templates and reduced staff coordination time with Skywriter MD medical scribe usage. The client decreased the total time spent with each patient from 16 minutes to 12 minutes; a 25% decrease in time spent (Figure 2). This allowed the client to add an additional 2 patients per clinic day. As the client has 2.5 clinic days per week, they were able to add approximately 20 patient visits per month, which lead to an additional $2600 monthly in earnings (Figure 1). 

Figure 2 Average Time Spent per Patient: The above time sample chart is a study of one physician client of Skywriter MD. The gray bar indicates the average time the client spent on each patient post Skywriter MD implementation. The blue bar represents the amount of decrease in time spent on each patient the client experienced with Skywriter MD.

Furthermore, by implementing pre-determined speech templates and note completion checks with Skywriter MD staff, note consistency and quality greatly improved. This improvement led to increased billing reimbursements from an average of $78 per visit to $86 per visit; approximately a 10% increase (Figure 3). This increased documentation reimbursement caused a $1,300 increase in monthly earning (Figure 1).

Figure 3 Average Reimbursement per Patient Visit: The above sample chart is a study of one physician client of Skywriter MD. The gray bar indicates the average reimbursement per patient visit the client received prior Skywriter MD implementation. The blue bar represents the amount of increase in average reimbursement per patient visit the client received post Skywriter MD implementation. 

In this monthly financial sample, Skywriter MD increased the client’s monthly income by allowing the client to increase their patient load and improve their documentation. Skywriter MD also took over much of the documentation duties and allowed for efficiencies that decreased total documentation time. This led to client cost reductions in many areas: support staff overtime, medical assistant time spent on documentation, support staff hours reprocessing bills, and eliminating other transcription fees. These reductions totaled to approximately $3420 monthly (Figure 1). 

The cost reductions and increased income that were made attainable through the use of Skywriter MD services more than covered the monthly cost of a full-time Skywriter provider, $2,200. The net return of investment achieved by this client was approximately $5,120 (Figure 1). These hard return on investment monthly figures quantitatively exhibit the benefits of Skywriter MD. 

It is important to note that while this financial sample has been the most in depth study performed by Skywriter MD with the help of our clients, it is not the only example of success with Skywriter MD. Another study by Skywriter MD with the help of several clients demonstrated that with Skywriter MD services mid-level providers were especially able to significantly increase their patient visit numbers when using Skywriter MD services (Figure 4). Mid-level providers, such as Nurse Practitioners and Physician Assistants who have the capabilities to add more patients, have experienced increased efficiencies using Skywriter MD. The increase in patient visits per clinic day for these providers was reported to be in the range of 30% – 80%. This allowed clinics to have large monthly financial gains because of the increased efficiencies of mid-level providers. We specifically examined two particular mid-level providers further (Figure 4). These mid-levels were exceptionally successful at adding on new patients because they had the capability to add on new patients and worked to set-up pre-determined speech and order templates to increase Skywriter MD efficiencies.

Figure 4 Mid-level Provider Sample Patient Additions: The above sample chart is a study of two physician assistant clients of Skywriter MD. The gray bar indicates the average number of patient visit per clinic day prior Skywriter MD implementation. The blue bar represents the amount of increase in patient visits per clinic day post Skywriter MD implementation.

The above case studies reveal the financial benefits of Skywriter MD services. The potential for success with Skywriter MD has been proven by our existing clients and has the capability to succeed for a variety of providers and clinics. At this point, this study will shift to examine how Skywriter MD has improved patient and provider satisfaction through testimonials from numbers Skywriter MD clients.

Soft ROI Provider Testimonials

Qualitatively, we can measure the more abstract benefits of Skywriter MD via testimonials and feedback from current clients. Skywriter MD focuses on two key areas of invaluable soft return of investment: patient satisfaction and provider satisfaction. 

Patient satisfaction is important to all clinics and healthcare providers. However, with the rise of electronic medical records, some providers have taken to documenting while seeing patients to increase efficiencies. This in many cases leads to decreased patient satisfaction ratings. Skywriter MD can provide the efficiencies providers are seeking while still allowing providers to focus on patients during visits. This allows providers to focus on patient care, increasing patient and provider satisfaction. Increased efficiencies could additionally aid in reducing patient wait times by helping to prevent clinics from becoming overwhelmed and getting behind schedule. Together, returning the focus to patient care and reducing wait times could ultimately increase HCAHPS Scores in Patient Satisfaction surveys. 

Providers enjoy these efficiencies as much as patients do and often have higher job satisfaction because of a decreased amount of time spent working in the EMR with Skywriter assistance. Half of physicians’ 

average workdays are spent entering data into EHRs and conducting clerical work, while just 27% of their workdays are spent with patients.7 Over half of physicians (56 percent) suggested reducing documentation burdens could help alleviate burnout and 24% of physicians complaining of burnout blamed increased computerization of EHR work.7 Physician burnout continues to make headlines as this is a real threat to the medical industry. Burnout symptoms in the United States affect 30% to 68% of physicians overall—exceeding the levels of any other professional group.6 Long-term work-related stress may lead to the potential for negative effects on the quality of patient care, and to attrition.6 Provider satisfaction has been found to be the overwhelming driving force to keep physician burnout at a minimum leading to less attrition and less early retirement. According to a study conducted by Landon et al, dissatisfied physicians were 2 to 3 times more likely to leave medicine than a satisfied physician which has implications for physician manpower projections and quality of care.3 The cost associated with provider attrition is startling; with lost revenues while a position is open generating at a minimum $500,000 annually with most primary care open positions generating a loss of over $1 million annually for hospitals.5 Furthermore, recruiting costs at a minimum tend to hit the $40,000 mark.5 Just as patient safety is the responsibility of communities of practice, so is clinician well-being and support.1 Support programs for providers show a positive correlation with satisfaction and feelings of well-being. It is in the self-interest of health care institutions to support the efforts of all members of the health care workforce to enhance their capacity for resilience (the capacity to respond to stress in a healthy way such that goals are achieved at minimal psychological and physical cost); it will increase quality of care while reducing errors, burnout, and attrition.1 Dissatisfied providers result in cognitive errors, strong feelings, and moral distress.1 One major effect of dissatisfied providers without support is the cost of medical errors. In the United States alone, medical errors cost around $20 million per year.4 Typically the cost per case to assess concerning providers is $35,000 alone.4 Another developing factor needing to keep primary care providers satisfied and the primary care field growing is the ageing population of the United States. By 2060, it is estimated there will be double the amount of elderly citizens in the US going from 50 billion today to nearly 100 million.2 Skywriter MD takes away the burden of EMR documentation while supporting the providers by taking special care regarding Best Practices, Quality Metrics, and discrete documentation, so not only do the providers see a return on their documentation, but have peace of mind knowing their documentation is being done accurately. 

The below testimonial from Skywriter MD clients within the Baylor Scott/White Healthcare system whom recently went live with Skywriter MD. 

“I have had issues with live scribes in the past where they missed information or incorrectly put items in my charts. With Skywriter MD, my notes are exactly how I want them and how they need to be done for billing purposes. I am extremely happy with this service.” – Matthew Sokol, MD, Baylor Scott & White Health 

“The Skywriter MD team has been phenomenally responsive to my questions and accommodating to my workflow. I wasn’t expecting the Skywriters to be able to do some of the things I have asked of them, but they can like pre-visit charting, adding chronic problems and histories, and doing all of the extra clicks that take up so much of my time. They have really listened to my pain points and have helped me. I really see the niche for Skywriter MD especially with folks who are not good with their EMR, are frustrated or don’t care to be better with their EMR, or have long, intricate notes. Skywriter MD will take care of the EMR documentation, and let the provider be a provider. This is an incredibly valuable service.” – Mark English, MD, Baylor Scott & White Health 

Providers greatly enjoy the improved lifestyle that Skywriter MD has the potential to offer via reduced documentation time and reduced time spent in the EMR. Ultimately, this can lead to increased retention rates which can save recruitment and training costs for clinics and hospital groups alike. 

Conclusion

Skywriter MD has demonstrated via existing customers the valued return on investment that clinics and providers have received when using Skywriter MD scribe service. Provider and patients have testified to increased satisfaction with the implementation of Skywriter MD. The results of Skywriter MD scribe service have been proven and have the potential to greatly increase financial gains of clients as well as provider and patient satisfaction while concurrently delivering better documentation. 

References 

1) Epstein, R. MD; Krasner, M. MD. (2013). Physician Resilience: What it Means, Why it Matters, and How to Promote It. Academic Medicine: 88(3), 301-303. Doi: 10.1097/ACM.0b013e318280cff0

2) Haseltine, W. A. (2018, April 02). Aging Populations Will Challenge Healthcare Systems All Over The World. Retrieved from https://www.forbes.com/sites/williamhaseltine/2018/04/02/aging- populations-will-challenge-healthcare-systems-all-over-the-world/#1b99a7202cc3

3) Landon, B., Reschovsky, J., Pham, H., & Blumenthal, D. (2006). Leaving Medicine: The Consequences of Physician Dissatisfaction. Medical Care, 44(3), 234-242. Retrieved from http://www.jstor.org/stable/3768157

4) Walsh, K. (2013). An Economic Argument for Investment in Physician Resilience. Academic Medicine, 88(9), 1196. Doi:10.1097/acm.0b013e31829ed1cc

5) Warren, B. (n.d.). The Shocking Cost of Physician Turnover. Retrieved October, 2018, from http://www.selectinternation.com/blog/bid/112226/the-shocking-cost-of-physician-turnover

6) Schrijver, I. (2016). Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout. Archives of Pathology & Laboratory Medicine,140(9), 976-982. doi:10.5858/arpa.2015-0524-ra

7) Spitzer, J. (2018, July 11). 6 stats on EHR-related physician burnout and 7 tips to combat it. Retrieved from https://www.beckershospitalreview.com/ehrs/6-stats-on-ehr-related-physician- burnout-and-7-tips-to-combat-it.html