See how 10 additional patients will pay for an optometric scribe

The newest trend for optometrists is having a scribe assist in the exam room. In other areas of healthcare, physicians have been using exam room assistants for decades. Using scribes, however, is relatively new for the optometric profession as a whole. Scribes can relieve a little of the optometrist’s stress by taking care of some aspects of clinical care, meaningful use, HIPAA compliance, and business and staff management.

Adding a scribe sounds like a great idea, but how can it be done without negatively affecting the bottom line?

Three steps to adding a scribe while minimizing the initial costs:

1. Transition an existing paraoptometric (doctor’s assistant) – Begin by taking advantage of any additional time–patient cancellations, slow days, or the end of the day–for your assistant to observe you in the exam room. Your assistant will begin to get a feel for filling in portions of the exam. Then gradually ask your assistant to fill in certain sections of the exam. For instance, one week fill in only the slit lamp exam. As your assistant becomes familiar and more efficient with this practice, you will be able to concentrate on your patient instead of charting. This gradual approach can take months, but it does allow you to make this transition with minimal overhead cost increase.  Once your assistant is fluid with a complete exam, begin looking for an additional assistant. Consider paying your scribe considerably more than the additional assistant, because you want to encourage your scribe to remain with you for many years to come. Many times hourly pay reflects the capacity of individuals to do certain positions. Invest in a scribe who has a high capacity for learning and doing.
2. Observe other optometrists – The best advice I never took early in my career was to observe other optometrists. Now I am amazed that some of the best ideas have come through observing other offices. In the past I assumed that a three-doctor practice in the Midwest would run about the same as any other three-doctor practice in the Midwest. I was wrong.  Details and systems vary widely. By observing offices that successfully use scribes, you will increase your chances of not making expensive mistakes in the transition process.
3. Calculate the cost – How many patients per day will you have to add to your schedule to make adding an additional staff person cost neutral? If each comprehensive exam averages $300 and your scribe will cost you $17.50/hr then you would have to add 10 comprehensive exams per month.

• 1. Monthly production/comprehensive exams = production per patient (in this example $300)
  2. The $17.50 is the “total package hourly rate” meaning that someone who is paid $15/hr and gets health insurance may be a resultant $17.50/hr.
  3. 40 hrs/wk x 4 wks in a month = 160 hrs per month
  4. 10 patients x $300 (from #1 above) = $3,000
  5. 160 hrs (from #3 above) x $17.50 hourly wage = $2,800

Optometrists are becoming accepted as primary care physicians of the eye across all medical fields. Consequently, optometric practices need to adjust. Changing a system that has run successfully for so many years is difficult. However, the consequences of not adapting are more risky than the investment in change. Adding a scribe may not make sense initially because it seems like added costs with no additional production. Visit with those who have made the investment and you may discover that you should have done it years ago.