Costs and Productivity Benefits of the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act Scribes Trial.

To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments. Medical scribes are employed in clinical settings with the goals of increasing provider productivity and satisfaction by minimizing physicians' documentation burden. Our objective is to quantify the economic outcomes of the MISSION Act scribes trial. A cluster-randomized trial was designed with 12 Department of Veterans Affairs (VA) medical centers randomized into the intervention. We estimated the total cost of the trial, cost per scribe-year, and projected cost of hiring additional physicians to achieve the observed scribe productivity benefits in relative value units and visits per full-time-equivalent over the 2-year intervention period (June 30, 2020 to July 1, 2022). The estimated cost of the trial was $4.6 million, below the Congressional Budget Office estimate of $5 million. A full-time scribe-year cost approximately $74 600 through contracting and $62 900 through VA hiring. Randomization into the trial led to an approximate 30% increase in productivity in cardiology and 20% in orthopedics. The projected incremental cost of using additional physicians instead of scribes to achieve the same productivity benefits was nearly $1.7 million more, or 75% higher, than the observed cost of scribes in cardiology and orthopedics. As the largest randomized trial of scribes to date, the MISSION Act scribes trial provides important evidence on the costs and benefits of scribes. Improving productivity enhances access and scribes may give VA a new tool to improve productivity in specialty care at a lower cost than hiring additional providers. • To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments—the largest randomized trial of scribes to date worldwide. Medical scribes are employed to increase provider productivity and satisfaction by minimizing documentation burden. The trial found that scribes were not effective in the emergency departments, increasing total length of stay; however, scribes were effective at increasing productivity in cardiology and orthopedics. • A recent Government Accountability Office report suggested that Veterans Health Administration "assess the scalability of the medical scribe pilot." The total cost of the trial was approximately $4.6 million, in line with the Congressional Budget Office estimate of $5 million. The projected cost of using additional physicians to achieve the observed productivity benefits by randomization into the scribes trial was nearly $1.7 million more, or 75% higher, than the observed cost of scribes in cardiology and orthopedics. • As VA endeavors to improve access and quality of care within fiscal and workforce constraints, the MISSION Act scribes trial provides important evidence on the costs and benefits of scribes. Scribes may offer VA a new tool to enhance access through improving productivity in specialty care at a lower projected cost than hypothetically hiring additional providers, creating additional value from the existing physician workforce. [ABSTRACT FROM AUTHOR]