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Scribes and RVUs – A Mixed Picture

April 28, 2017

Short Attention Span Summary

Scribes and Pharisees
Of about 49,000 visits, roughly 16% were scribed in this cohort.  Scribed charts raked in 0.2 more RVUs per patient in high acuity adult patients but not in pediatric patients or lower acuity adult patients.  Scribes actually pulled in 0.08 lower RVUs in pediatric patients.  For real numbers, a major academic medical center may collect an average of $50/RVU.  If scribes did charts for 50,000 high-acuity adult patients per year, this would be an extra $500,000 income for the department.  But use of scribes for a similar PED might end up costing $200,000 a year with the same assumptions.  But the peds numbers were small in this study and may not represent a larger pediatric emergency practice with high volume and higher acuity.  This also doesn’t take into account physician morale and the ability to retain talented physicians, the loss of which are very expensive to replace.

Spoon Feed
Scribes appear to be revenue positive in higher acuity adult patients.  The jury is still out on low acuity adult patients and pediatric patients.  ACEP has a paper on scribes that discusses more of the practical and economic impacts of scribes.


J Emerg Med. 2017 Mar;52(3):370-376. doi: 10.1016/j.jemermed.2016.11.017. Epub 2016 Dec 14.

Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department.

Heaton HA1, Nestler DM1, Jones DD1, Varghese RS1, Lohse CM2, Williamson ES3, Sadosty AT1.

Author information:

1 Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.

2 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

3 Mayo Clinic Revenue Cycle, Mayo Clinic, Rochester, Minnesota.



Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.


Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).


A prospective cohort study was developed in a tertiary academic ED. Charts were coded by an external billing and coding company, then returned and mapped by International Classification of Diseases, 9th revision diagnostic codes. After training by a staff member with significant experience in implementing scribe programs, scribes provided 1-to-1 support to a provider as staffing allowed. Comparisons were made between scribed and nonscribed visits.


There were 49,389 patient visits during the study period (39,926 adult [80.84%] and 9463 pediatric [19.16%] visits), of which 7865 (15.9%) were scribed. For adults, scribed visits produced 0.20 additional RVUs per patient (p < 0.001). Scribes generated additional RVUs in Emergency Severity Index (ESI) 2 (p < 0.001) and 3 (p < 0.001) patients. There were variable effects of scribes on RVUs by diagnostic codes. For pediatric patients, scribed encounters generated 0.08 fewer RVUs per patient (p = 0.007). ESI score had no effect on RVUs. The impact of scribes on pediatric diagnostic groupings was inconsistent.


Scribes had a positive impact on RVUs in adult but not pediatric patients. Among adults, scribes led to higher RVUs in ESI 2 and 3 but not 4 and 5 patients, perhaps suggesting a limitation to improve revenue capture on lower-acuity patients.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27988262

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