The Disturbing Confessions of a Medical Scribe: Adding to the Bill

Summary: How a little bit of money can become a lot of money is described here in an anonymous blog post by a “scribe,” a person occupying this relatively new role of helping a physician document charges for billing. The post appears on kevinmd.com, detailing how $20 here and $30 there, and an “autocomplete” on a patient’s chart, can suddenly mean big money.

We are often asked who’s the villain in the health-care marketplace: rapacious insurance companies, fat-cat doctors, overpaid hospital administrators, greedy patients, money-hungry Big Pharma, do-nothing regulators or politicians who’ve been bought and paid for by special interests?

We usually take the point of view that the villain is the system we’ve created, where incentives are misaligned and consequences may be hard to see. Also, the decisions being made are paid for (usually) with someone else’s money.

So it was with a heavy heart that I read this piece from a bit ago, written by an anonymous scribe, about how the job is performed. Here’s one tiny example; the entire piece is quite alarming. Go, read.

“In Epic’s CareConnect, a widely used EMR, there is a small button that, when pushed, indicates the physician has counselled the patient to stop smoking. It adds a small amount ($20-30) to the billing, and the physician makes a little more.

“I’ve been told by physicians, ‘If the patient is an active smoker, just click that button about the counselling.’ Most of the time, the patient is counselled. Sometimes though, they aren’t. But if that button isn’t pressed, eventually, it comes back onto me.

“’I told you to press it, so just press it.’ At which point, I protest, ‘But you didn’t counsel them.’

“The physician responds, ‘You probably just weren’t paying attention.’ Or ‘It’s okay, just click it anyways.’ As a ‘good’ scribe, I don’t say anything and I click the button.” Anonymous, via The disturbing confessions of a medical scribe.