PAs are providers—not scribes

Medical scribing has emerged in response to the introduction of the EMR into clinical practice. Medical practices, hospitals, and emergency departments hire scribes to mitigate the inevitable slowdown created by providers who are not adept at typing or navigating computer systems. According to an article in Medical Economics, providers who use scribes in their practices report improved productivity, clinical documentation, completion of medical records, and provider satisfaction. Patient satisfaction has also been reported to have improved; this is thought to be due to the provider's increased attention to the patient, rather than the computer screen and keyboard.

The Joint Commission states that physicians, physician assistants (PA), and nurse practitioners (NP) are authorized to use scribes to document their patient encounters. However, some practices have been tasking PAs with entering encounters into the medical record, functioning as "scribes" for physicians.

PAs are providers, and therefore should not act as scribes for another provider. They practice medicine, providing services that a physician would otherwise provide (CMS 2014) (American Academy of Physician Assistants 2013). PAs perform the history, physical exam, and medical decision-making components of a patient encounter, and may submit a claim to a payer for having done so. A medical scribe, on the other hand, may not act independently, and serves solely to record the actions and words spoken by the provider as they occur. According to guidance from National Government Services, "Scribes may not interject their own observations or impressions into the medical record."

It is important to distinguish between the appropriate service of a scribe, which is solely to document the work of the provider during an encounter and serve as a "live recorder," and the medical evaluation and management services provided by a PA, which is the actual performance of the encounter itself. Employing a PA as a scribe is not only poor use of a highly educated and learned medical professional, but also can subject practices to allegations of fraud and abuse.

Source: Medical Staff Briefing