69–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–151 

VETERANS AFFAIRS MEDICAL SCRIBE PILOT ACT OF 2017 

MAY 23, 2017.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 1848] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 1848) to direct the Secretary of Veterans Affairs to carry 

out a pilot program on the use of medical scribes in Department 

of Veterans Affairs medical centers, having considered the same, 

report favorably thereon without amendment and recommend that 

the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 2 

Subcommittee Consideration .................................................................................. 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmarks and Tax and Tariff Benefits .................................................................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 5 

Constitutional Authority Statement ...................................................................... 5 

Applicability to Legislative Branch ........................................................................ 5 

Statement on Duplication of Federal Programs .................................................... 5 

Disclosure of Directed Rulemaking ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill as Reported ...................................... 7 

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1 Rajiv Arya MD, Danielle M. Salovich, Pamela Ohman-Strickland PhD, Mark A. Merlin DO. 

‘‘Impact of Scribes on Performance Indicators in the Emergency Department’’ Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine. April 23, 2010. 

http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00718.x/full 

PURPOSE AND SUMMARY

Representative Phil Roe of Tennessee introduced H.R. 1848, the 

‘‘Veterans Affairs Medical Scribe Pilot Act of 2017,’’ on April 3+, 2017. H.R. 1848 would require the Department of Veterans Affairs 

(VA) to carry out a two-year pilot program at ten VA medical facilities to employ medical scribes in emergency department and specialty care settings. 

BACKGROUND AND NEED FOR LEGISLATION

Section 2. Department of Veterans Affairs Medical Scribe Pilot Program 

The use of electronic health records (EHRs) has become standard 

practice for the vast majority of healthcare delivery systems in 

United States. While evidence shows that EHRs do improve patient 

safety and outcomes, many clinicians find using EHRs to be burdensome and feel that taking time to enter data into a computer 

detracts from the quality of their interaction with patients and also 

limits the amount of patients they are able to see daily. To address 

this disconnect between providers, patients, and productivity, private practices have begun employing non-clinical staff whose sole 

purpose is entering dictations from the physician into a patient’s 

EHR and helping the physician navigate the patient’s existing 

record. 

In particular, medical scribes have proven to be particularly useful for increasing physician productivity and satisfaction in fastpaced clinical environments such as the emergency department 

(ED) and specialty care settings.1 Medical scribes are trained on 

privacy considerations and how to swiftly and accurately navigate 

and enter data into a patient’s health records before being assigned 

to a physician. Once appropriately trained, the scribe then follows 

the physician during his patient interactions, carefully documenting each encounter. 

The Veterans Affairs Medical Scribe Pilot Act of 2017 would create a two-year pilot program under which VA will increase the use 

of medical scribes in emergency department and specialty care settings at 10 VA medical centers. To provide transparency on staffing 

methodology for medical scribes at the Department, this pilot 

would have half of the participating scribes be employed by the Department, with half employed under contract with a private-sector 

provider of medical scribes. Under this legislation, VA would be required to report to Congress every 180 days regarding the effects 

the pilot program has had on provider efficiency, patient satisfaction, average wait time, the number of patients seen per day and 

the amount of time required to train an employee to perform medical scribe functions under the pilot program. A report from the 

Comptroller General is also required not more than 90 days after 

the conclusion of the pilot. 

HEARINGS

There were no full Committee hearings held on H.R. 1848. 

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On March 29, 2017, the Subcommittee on Health conducted a 

legislative hearing on a number of bills including a draft of H.R. 

1848. 

The following witnesses testified: 

The Honorable David. P. Roe M.D. of Tennessee; The Honorable Jackie Walorski of Indiana; The Honorable Doug Collins 

of Georgia; The Honorable Mike Coffman of Colorado; The 

Honorable Stephen Knight of California; The Honorable Ann 

M. Kuster of New Hampshire; Jennifer S. Lee, M.D., the Deputy Under Secretary for Health for Policy and Services for the 

Veterans Health Administration of the U.S. Department of 

Veterans Affairs who was accompanied by Susan Blauert, the 

Chief Counsel for the Health Care Law Group of the Office of 

the General Counsel for the U.S. Department of Veterans Affairs; Kayda Keleher, Legislative Associate for the National 

Legislative Service of the Veterans of Foreign Wars of the 

United States; Shurhonda Y. Love, the Assistant National Legislative Director for the Disabled American Veterans; and, 

Sarah S. Dean, the Associate Legislative Director for the Paralyzed Veterans of America. 

Statements for the record were submitted by: 

The Honorable Lee Zeldin of New York; The American Legion; the National Association of State Veteran Homes; Swords 

to Plowshares; and, the Wounded Warrior Project. 

SUBCOMMITTEE CONSIDERATION

On April 6, 2017, the Subcommittee on Health met in an open 

markup session, a quorum being present, and ordered H.R. 1848 to 

be reported favorably to the Full Committee by voice vote. 

COMMITTEE CONSIDERATION

On May 17, 2017, the Full Committee met in open markup session, a quorum being present, and ordered H.R. 1848 to be reported 

favorably to the House of Representatives by voice vote. A motion 

by Representative Tim Walz of Minnesota, Ranking Member of the 

Committee on Veterans Affairs, to report H.R. 1848 favorably to 

the House of Representatives was agreed to by voice vote. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 1848 reported to 

the House. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

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objectives are to create a pilot program to increase the use of medical scribes in Department medical centers. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 1848 does not contain any Congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9 of rule 

XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 1848 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 1848 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, May 19, 2017. 

Hon. PHIL ROE, M.D., 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1848, the Veterans Affairs Medical Scribe Pilot Act of 2017. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

KEITH HALL. 

Enclosure. 

H.R. 1848—Veterans Affairs Medical Scribe Pilot Act of 2017 

H.R. 1848 would require the Department of Veterans Affairs 

(VA) to establish a two-year pilot program to increase the number 

of medical scribes (or personal assistants to physicians) employed 

at the department. The bill also would require VA to report to the 

Congress every six months and would require the Government Accountability Office (GAO) to report, within 90 days of the program’s 

termination, the results of the pilot program compared to similar 

programs in the private sector. 

Under the bill, CBO estimates that VA would need to hire 40 

medical scribes (20 term employees and 20 contractors) in 10 medVerDate Sep 11 2014 22:38 May 24, 2017 Jkt 069006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR151.XXX HR151
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ical centers. CBO expects that the pilot would run from the middle 

of fiscal year 2018 through the middle of fiscal year 2020 and that 

the GAO report would be completed in 2020. On the basis of information from VA on the average salary for medical support assistants, CBO estimates that pay and benefits for a medical scribe 

would be roughly $48,000 in 2018. After incorporating the effects 

of inflation, CBO estimates that implementing the two-year pilot 

program and preparing the required reports would cost $5 million 

over the 2018–2022 period; that spending would be subject to the 

availability of appropriated funds. 

Enacting the bill would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. CBO estimates 

that enacting H.R. 1848 would not increase net direct spending or 

on-budget deficits in any of the four consecutive 10-year periods beginning in 2028. 

H.R. 1848 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act, and would 

not affect the budgets of state, local, or tribal governments. 

The CBO staff contact for this estimate is Ann E. Futrell. The 

estimate was approved by H. Samuel Papenfuss, Deputy Assistant 

Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 1848 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 1848. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 1848 is authorized by Congress’ power to ‘‘provide for the common Defense and general Welfare of the United States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 1848 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), the 

Committee finds that no provision of H.R. 1848 establishes or reauthorizes a program of the Federal Government known to be duplicative of another Federal program, a program that was included in 

any report from the Government Accountability Office to Congress 

pursuant to section 21 of Public Law 111–139, or a program related 

to a program identified in the most recent Catalog of Federal Domestic Assistance. 

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DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), the 

Committee estimates that H.R. 1848 contains no directed rulemaking that would require the Secretary to prescribe regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would provide the short title for H.R. 1848, 

as the ‘‘Veterans Affairs Medical Scribe Pilot Act of 2017’’. 

Section 2. Department of Veterans Affairs Medical Scribe Pilot Program 

Section 2(a) of the bill would require the Secretary to carry out 

a pilot program to increase the use of medical scribes at Department of Veterans Affairs medical centers. 

Section 2(b) of the bill would require the pilot program established by Section 2(a) of the bill be carried out at ten medical centers of the Department 

Section 2(b)(1) would require four medical centers established by 

Section 2(b) to be located in rural areas. 

Section 2(b)(2) would require four medical centers established by 

Section 2(b) to be located in urban areas. 

Section 2(b)(3) would require two medical centers established by 

Section 2(b) to be located in areas with need for increased access 

or increased efficiency, as determined by the Secretary. 

Section 2(c)(1) of the bill would require the Secretary to hire 20 

medical scribes as Department employees and enter into contracts 

with appropriate entities to employ 20 medical scribes, with four 

medical scribes assigned to each of the medical centers identified 

by Section 2(b) of the bill. 

Section 2(c)(2) of the bill would require the Secretary to assign 

four medical scribes to each pilot site established by Section 2(b). 

Section 2(c)(2)(A) of the bill would assign two scribes to each of 

two physicians participating in the pilot established under Section 

2(a). 

Section 2(c)(2)(B) of the bill would require thirty percent of the 

scribes participating in the pilot established by Section 2(a) to be 

employed in an emergency care setting. 

Section 2(c)(2)(C) of the bill would require seventy percent of the 

scribes participating in the pilot established under Section 2(a) to 

be employed in specialty care setting, prioritized by longest wait 

times or lowest efficiency ratings, as determined by the Secretary. 

Section 2(d)(1) of the bill would require the Secretary to submit 

a report to the House and Senate Committees on Veterans’ Affairs 

on the pilot program established by Section 2(a) of the bill by not 

later than 180 days after the date of the commencement of the 

pilot, and every 180 days thereafter for the duration of the pilot, 

including a separate analysis with respect to medical scribes employed by the Department and those performing Department functions under contract, and stipulates which metrics are to be included in the report. 

Section 2(d)(2) of the bill would require the Comptroller General 

to submit a report to Congress no more than 90 days after the termination of the pilot established under Section 2(a), to include a 

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comparison of the pilot program with similar programs carried out 

in the private sector. 

Section 2(e)(1) of the bill defines the term ‘‘medical scribe.’’ 

Section 2(e)(2) of the bill defines the terms ‘‘urban’’ and ‘‘rural.’’ 

Section 2(f) of the bill would stipulate that no additional funds 

are authorized to be appropriated to carry out the requirements of 

Section 2 of the bill, and the requirements of Section 2 of the bill 

are required to be carried out using amounts otherwise authorized. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

If enacted, this bill would make no changes in existing law. 

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