The Impact of Medical Scribes on Relative Value Units in a Pediatric Primary Care Practice Troy A. Phillips, MHA; Kasey A. Foley, MA; Benjamin H. Levi, MD, PhD; Pooja Jhaveri, MD; Cynthia H. Chuang, MD; Denise Abdulahad, BS; Erik Lehman, MA; Benjamin N. Fogel, MD, MPH From the Department of Learning and Performance Systems, Penn State University (TA Phillips), State College, Pa; Department of Communication Arts and Sciences, Penn State University (KA Foley), State College, Pa; Department of Pediatrics, Penn State College of Medicine (BH Levi, P Jhaveri, D Abdulahad, and BN Fogel), Hershey, Pa; Department of Humanities, Penn State College of Medicine (BH Levi), Hershey, Pa; Penn State College of Medicine (P Jhaveri), Hershey, Pa; Department of Medicine, Penn State College of Medicine (CH Chuang), Hershey, Pa; and Department of Public Health Sciences, Penn State College of Medicine (CH Chuang and E Lehman), Hershey, Pa The authors have no conflict of interest related to this project. Address correspondence to Troy A. Phillips, MHA, Department of Learning and Performance Systems, Penn State University, 118 Keller Building, University Park, State College, PA 16802 (e-mail: tap146@psu.edu). Received for publication January 15, 2020; accepted May 13, 2020. TAGGEDPABSTRACT OBJECTIVE: Our study assessed the impact of adding medical scribes to an academic pediatric primary practice by measuring the relationship between work relative value units (wRVUs) and use of the medical scribe. METHODS: This is a retrospective comparative study on the effect of medical scribes on average wRVUs per patient encounter. wRVUs were abstracted from procedure codes in the billing system. RESULTS: Six clinicians performed 2277 patient visits included in the study over 2 different time periods during 2017 and 2018. The first period was without the use of medical scribes and the second period included scribes. Average clinician wRVU production per visit increased by 7.68% (P < .001) with medical scribes over the previous period without them. CONCLUSIONS: This study shows that scribes contribute to improving the wRVU per visit in a primary pediatric practice. This finding is consistent with other research showing that scribes help increase volume and improve wRVUs for special- ists who perform complex procedures. TAGGEDPKEYWORDS: medical scribe; pediatrics; relative value units ACADEMIC PEDIATRICS 2020;XXX:1-6 TAGGEDPWHAT’S NEW Current research on medical scribes’ impact on increasing work relative value units (wRVUs) includes increases in the number of patient visits per session. This study focused on the impact of medical scribes increasing the wRVUs generated per visit in a primary pediatric practice. TAGGEDPOFFICE OF THE National Coordinator reports that 86% of office-based physicians used an electronic health record (EHR) in 2017. 1 The goal of the EHR, as defined by the Institute of Medicine, is to improve patient care delivery, management, supportive, and financial processes, and empower the patient to increase participation in their care. 2 Although the current EHR technology enables improvements, it also comes at a cost. Documenting a visit in an EHR increases the amount of time clinicians spend to complete a chart, resulting in added pressure and hours to the workday. 3-5 A recent study revealed that physicians in 4 specialties (family practice, internal medi- cine, cardiology, and orthopedics) spent 49.2% of their time on EHR and desk work, with at least 1 to 2 hours of EHR work each night, contributing to burnout. 4,5 In addi- tion to lengthening the day, added stress from EHR docu- mentation has been shown to decrease clinicians’ diagnostic accuracy. 6,7 In the face of these increased burdens, financial pres- sures in health care are also on the rise, including for aca- demic practices. Compounding these financial and time pressures is the growing emphasis on quality and risk- based payments. Taken together, these changes pose some serious challenges to the US health system and its clini- cians. Spending more time entering data into the EHR increases clinicians’ stress and urgency, decreases the number of patients they can see in a clinic session, poten- tially compromises diagnostic accuracy, and thereby fur- ther exacerbates both physician burnout and financial pressures. 4,5,7 To help alleviate some of these concerns, medical scribes have been introduced in outpatient clinic environ- ments—to accompany the clinician into the exam room and document the interaction. 8,9 The clinician must still review, revise, and sign off on the document, but having a scribe draft the initial documentation allows the clinician to focus on the interaction with patient instead of the ACADEMIC PEDIATRICS Copyright © 2020 by Academic Pediatric Association 1 Volume 000 XX 2020 ARTICLE IN PRESS