Ravenswood Family Health Center II

Round
Spring-Summer 2020
Project Location
East Palo Alto, CA
Project Type
Full team
Project Focus
Finance,
Operations Review
Organization Type
Children, Youth & Families,
Health,
Women

Organization

Founded in 2001, RFHC is a federally qualified health center (FQHC) located in San Mateo County’s East Palo Alto. It provides a full scope of health care services—women’s health, pediatrics, family practice, integrated behavioral health, dentistry, optometry, pharmacy, ultrasound, mammography, x-ray, lab, health education, referrals, and enrollment—to low-income communities in Southern San Mateo County and Northern Santa Clara County. The RFHC mission is to improve the health of the community by providing culturally sensitive, integrated primary and preventive health care to all, regardless of ability to pay or immigration status, and collaborating with community partners to address the social determinants of health.

Situation

Electronic Medical Record (EMR) systems have become a necessary platform for recording clinical patient data and driving related workflows for Rx and test orders, referrals, etc.  The use of EMRs can make physicians’ offices more efficient and improve the quality of patient care and are mandated under the Affordable Care Act since 2014.  However, it there is now a widespread acknowledgement in the medical profession that EMRs impose significantly clerical burdens on physicians, contributing to provider burnout, job dissatisfaction and costly attrition.  RFHC suffered a spate of clinical staff departures in 2018-2019 which it believes would likely have been averted if these physicians had been supported by medical scribes, professional personnel who unburden MDs of clerical EMR tasks.

Project Objectives

To address RFHC’s request for a “feasibility and financial analysis” into expanded medical scribe coverage, the following high level objectives were agreed for this project: a cost-benefit analysis; ongoing financial and provider satisfaction measurement methods associated to a medical scribe program; and a description and evaluation of medical scribe service solution options available to RFHC.

Project Overview

The project entailed seven workstreams, which ran mostly consecutively: 1) evaluating medical literature that describe medical scribe program experiences and performance; 2) framing the solution choices (e.g. DIY, hire a service, AI automated speech recognition); 3) analyze RFHC clinic operating history and, from it, develop breakeven productivity-gain thresholds and avoided cost of turnover estimates for financial decision making; 4) identify and down select to a shortlist of vendors via an RFI; 5) present to Executive Team and Board to obtain program go-ahead; 6) development of an Implementation Plan; and 7) shortlisted vendor interviews to support RFHC’s final vendor selection.

Key Recommendations

The ACT team made the following recommendations:

  • The medical scribe service market is well established – the adoption level is somewhere around middle mainstream.
  • A remote, live-agent medical scribe service is the type best suited to RFHC’s operation.
  • Assuming the most expensive medical scribe service provider bill rates, an increase of 6 ppts of physician productivity (patient visits per session) will pay for the RFHC medical scribe program.  Experiences shown in the literature indicate 6 ppts of productivity gain is achievable given RFHC’s current utilization rates. 
  • Avoided cost of turnover amounts to roughly $250K per attrition financial “gravy” to be added to the productivity gain.