Medical Assistant Scope of Practice

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As a health professional, you may receive numerous coaching that makes you the proper assistant in each clinical body. If you’re operating in a very tiny establishment, chances are high that you can just decide to perform clinical duties by yourself. However, if you would like to specialize in a single branch, you’ll be required to search around for established organizations.

Physician roles are increasingly done by medical assistants in place of nurses for a number of reasons and with significant impact on office efficiency. Medical assistants are educated and trained in both clinical and administrative functions, allowing one staff member to do the work of two. The assistants can help manage patient traffic at the front desk, perform some billing functions, and provide some clinical care. As you consider including medical assistants to your practice or optimizing the work of the assistants you already have on staff, you might be wondering: What clinical scope should a medical assistant focus on?

While some states, for example California, have statutes addressing the scope of practice of medical assistants, most states do not provide such statutes or regulations. It is advisable to consult around your state or area to determine what laws or regulations are applicable before utilizing medical assistants.

Often times, the successful completion of a medical assistant certification program is an indicator of a person’s ability to practice perfectly. Certification programs are provided for both formally trained and on-the-job trained medical assistants. Reputable certifying organizations such as the American Association of Medical Assistants, American Medical Technologists, and the National Center for Competency Testing are responsible for this.

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Tasks That Medical Assistants MAY Perform

With utmost keenness on patient safety, what clinical services may a medical assistant render in a medical practice setting?

Considering your state’s laws and/or regulations, medical assistants are typically allowed to perform the following clinical roles under the guidance and supervision of a physician:

  • Measure and record vital signs
  • Arrange exam room instruments and equipment
  • Change wound dressings and take wound cultures
  • Get rid of sutures or staples from minor cuts
  • Give guidelines and information to patients
  • Provide right doses of oral medication to a patient, as directed by the physician, for the patient to take on his or her own under the assistant’s supervision
  • Give medication topically, vaginally, rectally, or by injection
  • Get patients ready for examination, including draping, shaving, and disinfecting treatment sites
  • Gather blood specimens
  • Collect other types of specimens by non-invasive techniques, such as wound cultures
  • Undertake simple laboratory and screening tests usually done in a medical office, such as urinalysis
  • Request prescription orders or refills to the pharmacy, but only as ordered and approved by the physician
  • Fill electronic prescriptions in advance for the provider to review and send when there is an established policy and procedure for doing so

 

Tasks That Medical Assistants May NOT Perform

Subject to your state’s laws and regulations, your medical assistants are not allowed to partake the following:

  • Solely perform telephone triage, as medical assistants are not legally allowed to interpret data or diagnose symptoms
  • Administer medications into a vein unless specifically permitted by state law
  • Begin, flush, or discontinue IVs unless specifically permitted by state law
  • Conduct analysis or interpret test results, such as blood or skin tests
  • Do assessments or perform any kind of medical care decision-making
  • Handle laser gadget
  • Perform medical or nursing roles, or present themselves to patients as a doctor or nurse

 

Supervision Considerations

Physicians are responsible for the practice and actions of medical assistants in most states. It is important to realize that while you may assign tasks to a medical assistant, you retain the responsibility and legal part for the task. Inappropriate practices and care given by a medical assistant has in many cases resulted in malpractice liability for physicians, as well as actions by medical licensing boards.

You should always make it a point to check your state laws to determine whether your practice’s physician assistants and nurse practitioners may assign tasks to medical assistants, as many states do not allow it.

 

CMS Meaningful Use Requirements

It is highly recommended that you consult the Centers for Medicare and Medicaid Services (CMS) for their “meaningful use” requirements. This outlines how medical assistants can interact with patient data and information. In October 2012, CMS rolled out guidance regarding eligible professionals under the meaningful use incentive program. This guidance provided the following statement with regards to medical assistants being allowed to enter data:

“A licensed and credentialed medical assistants, is allowed to enter orders into the medical record for objectives of including the order in the numerator for the goal of CPOE if they can give the initial order per state. Credentialing for a medical assistant must be from an organization apart from the organization employing the medical assistant.”

Practices requiring meaningful use must ensure data that may be used for meaningful use attestation is recorded by certified medical assistants or licensed staff personnel.

 

Ensuring Efficient, Effective, and Safe Practices

Medical assistants serve as a cost-effective staffing solution unique to physician practices. However, due the fact that medical assistants are not necessarily needed to be formally licensed or registered by most states, you should consider them as unlicensed assistant staff.

Physicians must have respect for both the benefits and risks of employing medical assistants. Hire well, supervise and assign accordingly, and consider requiring formal certification.

One of the interesting thing about becoming a Medical Assistant, though, is that what you’re permitted to do also depends on where you live. The profession is regulated by sole states, so what’s right in one location, may not be allowed in the next. For instance, in the State of California, Medical Assistants are allowed to perform additional supportive services once they’ve got training from their employer.

In states like Montana, Medical Assistants are required to have “active and continuous” supervision from a physician, but the regulations don’t say that the doctor actually needs to be onsite to watch over activities. In Alaska, a professional nurse practitioner can even assign the administration of IV med to a certified Medical Assistant.1

If you’ve always dreamed of a career assisting people who reside in your state, find out just what you’ll be allowed to perform as a Medical Assistant.

 

Challenges in Adoption of New Roles

Lack of clarification of Medical Assistants scope of practice rules was a challenge in developing new Medical Assistant roles in several sites. Many site leaders were not sure of the Medical Assistant areas of practice in their state. A few portion of the sites imposed more stringent restrictions regarding Medical Assistant practice than state regulations did. Injections and protocol‐based triage were often areas of doubt. Site leaders who were interviewed reported that scope of practice concerns were sometimes caused by nurses who feared displacement if Medical Assistant were given permission to take on expanded duties.

Both the providers and staff reported that they found practice change challenging. Medical Assistant reported lack of confidence to take on new duties and some resented taking on more complex work. Providers and nurses were reluctant to delegate tasks, concerned about relinquishing patient contact, and distrusting of the knowledge and reliability of the Medical Assistant. A few sites highlighted this by engaging providers and nurses in training and assessing of Medical Assistant skills, allowing them to choose if “their” Medical Assistant met the required competencies for the new jobs.

Sustaining practice change needed the buy‐in of top leadership. All of the case study sites had a practice change individual who also championed the development of new Medical Assistant duties. At two sites, visionary champions initiated a small‐scale practice change in Medical Assistant duties that was stopped when that champion left the organization.

The important costs in time and finance for additional Medical Assistant training were reported to be a challenge across sites. Most sites focused training first on supplementing basic Medical Assistant skills which freshly hired Medical Assistant reportedly didn’t have. Costs included hiring additional staff to cover if a training was conducted during the workday or paying Medical Assistant overtime if they were required to attend during off-work hours. Retention of Medical Assistant trained in new duties was a challenge in some of the smaller sites as larger competitors sometimes attracted the newly trained by providing higher wages.

Employers often had to make the business case to leadership that increasing the number of Medical Assistant, providing high level training, increasing salaries, and changing job details were worth the investment. Reimbursement for unbill-able services provided by Medical Assistant in new roles presented a vital challenge to sites with a fee‐for‐service reimbursement designs.

 

The following are Medical Assistant Scope of Practice laws for selected states

So, if you’ve read our other articles on What Does A Medical Assistant Do, you’re probably what the law allows a Medical Assistant to do. The Medical Assistant scope of practice includes both clinical and administrative tasks that a medical assistant may perform. It is governed by state laws and regulations, and therefore varies accordingly. The following are scope of practice laws for selected states, and medical assistants mentioned must be certified medical assistance as defined by the American Association of Medical Assistants, the National Center for Competency Testing, or American Medical Technologists.

  • Arizona – In Arizona, a medical assistant may perform the following procedures only under the direct supervision of the physician: whirlpool treatments, diathermy treatments, electronic galvation stimulation treatments, ultrasound therapy, massage therapy, traction treatments, transcutaneous nerve stimulation unit treatments, hot and cold pack treatments, and small volume nebulizer treatments.
  • California – In the state of California, medical assistants are unlicensed, and thus may only perform basic administrative, clerical and technical supportive services as permitted by law. They may administer medications intradermally, subcutaneously, or intramuscularly, perform skin tests, and other technical supportive services after specific authorization and under supervision of a licensed physician or podiatrist. They may apply and remove bandages and dressings, remove sutures, perform ear lavage, prepare patients for examinations, and shave and disinfect treatment sites. They are also permitted to draw blood if they have completed the minimum training prescribed by regulation.  On the other hand, they are not permitted to diagnose or treat or perform any task that is invasive or requires assessment. Invasive tasks include placing the needle or starting and disconnecting the infusion tube of an IV, administering IV medications, administering IV injections, charting the pupillary responses, inserting a urine catheter, injecting collagen, administering chemotherapy, interpreting the results of skin tests, using lasers for hair removal, wrinkles, scars and other skin blemishes, and performing telephone triage without direct physician supervision.
  • In Florida, medical assistants may perform the following clinical procedures under the direct supervision and legal responsibility of licensed physicians: aseptic procedures, obtain vital signs, prepare patients for the physician’s care, perform venipunctures and non-intravenous injections, monitor and report the patient’s signs or symptoms, administer basic first aid, assist during patient examinations or treatments, operate office medical equipment, collecting routine laboratory specimens as directed by the physician, administer medication as directed by the physician, perform basic laboratory procedures, perform dialysis procedures, and other general administrative duties required by the physician.
  • In Illinois, medical assistants may perform all tasks that are delegated by a physician licensed to practice medicine, under their supervision.
  • In Maryland, a medical assistant may perform the following tasks if they have been explicitly delegated by a licensed physician: surgical technical procedures while the physician is in the same room, and nonsurgical technical acts under the physician’s direct or on-site supervision. Tasks which a medical assistant may perform without on-site supervision include preparing patient for physician examination, patient history interview, collecting and processing specimens, such as performing phlebotomy and inoculating culture media, preparing specimens for pregnancy tests, dipstick and microscopic urinalysis,  and microbiology, laboratory tests that the physician believes the assistant is qualified to perform under state and CLIA regulations, tuberculin skin tests, electrocardiography, administering basic pulmonary function tests, visual field tests, transmitting prescriptions to a pharmacy, providing medication samples, selected by a physician, and preparing and administering oral drugs. On-site supervision by licensed physicians is required for preparing and administering injections intradermally, subcutaneously, and intramuscularly, establishing a peripheral intravenous line and injecting fluorescein-like dyes for retinal angiography. Direct supervision by the licensed physician is mandatory when performing intravenous injections. Finally, medical assistants are not permitted perform physical examinations, administer intravenous or inhalational anesthetic agent or sedatives, independently initiate treatment aside from CPR, dispense medications, provide physical therapy, and give medical advice without consulting of a licensed  physician.
  • New Jersey allows the medical assistant to perform injections under on-site supervision provided the licensed physician has thoroughly assessed the patient and the need for the injection, as well as determined all the aspects of the treatment such as drug, dose, route of administration, side effect, etc. Medical assistants are not permitted to inject the following substances: any substance related to allergenic testing or treatment, local anesthetics, controlled dangerous substances, experimental drugs, and chemotherapeutic agents aside from corticosteroids.
  • In South Dakota, medical assistants are permitted to perform the following under the direct supervision of a licensed physician, physician’s assistant, nurse practitioner, or nurse midwife: performing clinical procedures to include: aseptic procedures, taking vital signs, preparing patients for examination, phlebotomous blood withdrawal and non-intravenous injections, monitoring and reporting patients’ signs or symptoms, administering basic first aid, assisting with patient examinations or treatment, operating office medical equipment, collecting routine laboratory specimens, administering oral and inhalation medications by unit dosage, performing basic laboratory procedures, performing skin tests, telephone prescriptions to the pharmacy, and performing general administrative duties. They are not permitted to inject insulin, collect blood via arterial puncture, perform irrigations for stoma or ostomy care, administer medications that require calculation of the dose, and perform health teaching or counseling.
  • Virginia permits licensed physicians to delegate the administration of controlled substances to medical assistants under his or her direct and immediate supervision, provided the route of administration is not intravenous, intrathecal, or epidural.

In summary, since medical assistants are not licensed healthcare providers, the delegation of certain clinical tasks usually depends on the discretion of licensed physicians, unless state laws and regulations explicitly state otherwise. Prior to delegation, the licensed healthcare practitioner must ensure that the medical assistant is competent and properly trained to perform these tasks, as liability will fall completely on his or her shoulders.

 

Conclusion

Driven by population factors and changing health care regulations emphasizing primary care, many primary care practices are revising their workflow to enhance efficiency and quality. Administration of new patients, and increasingly complex patients, require new models of care using non-provider staff to take on some of the tasks. Innovative models employing Medical Assistants in new roles have gathered considerable attention over time, but challenges to diversifying these models remain.

Payment model reform may assist in addressing some of those challenges. Thorough research on the effects of these new roles is required.

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