Full Text of CMS Ruling

The full text of the CMS ruling, as published in the Federal Register, can be accessed at http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf. Read the official wording of the recent victory!

Laboratory and Radiology Orders with the CPOE System

Since the Centers for Medicare and Medicaid Services (CMS) issued a final rule permitting “credentialed medical assistants” to enter medication orders into the computerized provider order entry (CPOE) system as directed by an eligible professional (e.g., a physician or osteopath), many questions have followed. The issue of whether this final rule permits credentialed medical assistants to enter laboratory and radiology orders into the CPOE is one of particular interest.

The wording of the final rule, although open to some debate, supports the conclusion that credentialed medical assistants are authorized to enter medication, laboratory, and radiology orders into the CPOE. Please note the following:

1. On page 53985 of the Federal Register, the following CMS Proposed Objective is presented:

Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines to create the first record of the order.  [Emphasis added.]

2. The CMS receives feedback and narrows the decision down to a few different options (described in the previous entry on this blog).

3. The CMS essentially chooses the third option and concludes on page 53986 that “credentialed medical assistants” should be permitted to enter orders into the CPOE (as described in the previous entry on this blog).

4. CMS issues its modified objective on page 53987:

After consideration of the public comments received, we are modifying this objective for EPs as § 495.6(j)(1)(i) and for eligible hospitals and CAHs [critical access hospitals] at § 495.6(l)(1)(i) to use the same language as Stage 1 (with the addition of laboratory and radiology orders), as we did not finalize our proposed changes to when the order must be entered: “Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines.”  [Emphasis added.]

The CMS objective clearly expands CPOE to laboratory and radiology orders, as well as medication orders. However, it seems as though the wording of this finalized order contradicts the excerpts quoted above and the wider context of the comments and the CMS responses.

A fundamental rule of reconciling conflicting statements in a legal document is that the specific supersedes the general. Based on this principle, it is apparent that the general wording of the modified CMS objective contradicts the specific findings and conclusions in the body of the final rule. Therefore, a correct rendering of the final rule would be as follows:

“Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by an licensed health care professional or credentialed medical assistant who can enter orders into the medical record per state, local, and professional guidelines.”  [Emphasis added.]

Medical Assistants Win Big in CMS Ruling

It thrills me to report that the Centers for Medicare and Medicaid Services (CMS) recently ruled that credentialed medical assistants are permitted to enter medication orders into the computerized provider order entry (CPOE) system.

This decision scores a great victory for medical assistants across the country. Previously, only licensed health care professionals—a group that excluded medical assistants—were allowed to perform entries into the CPOE system. Given that CMAs (AAMA) are formally educated in their discipline, have current certification from a national credentialing body, and have the knowledge and ability to enter orders into the CPOE system as directed by an overseeing heath care provider, the previous restrictions diminished not only the role of CMAs (AAMA) in the practice, but also the overall effectiveness of team-based care.

Prior to the ruling, the CMS considered a few different options. One option would have allowed “anyone, including those commonly referred to as scribes,” to enter orders into the medical record. The AAMA and the CMS both agreed this option would be unwise and risk exposing patients to substandard allied health services from unqualified professionals. Yet another option allowed for “any licensed, certified, or appropriately credentialed health care professional” to enter orders into the CPOE. The CMS decided this option was too broad, as well, since the concept of “credentialed health professionals” could include any number of workers with a similarly wide range of qualifications. In the end, the CMS made the decision to use the more limited description of including credentialed medical assistants.

Again, this is a great victory—and a great day—for medical assistants nationwide!

(Read the full CMS ruling as published in the Federal Register at http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf.)

Associations and the ADA

Some recent court decisions regarding the Americans with Disabilities Act (ADA) could affect credentialing examinations. The cases, which dealt with legally blind law school students requesting special accommodations for taking the bar exam, should be of interest to any association or certification body.

I recently penned an article for Associations Now, a publication of the American Society of Association Executives. The article can be found here and shares a brief history of the court cases, as well as the legal implications for credentialing exams.

Thank you, colleagues!

Continued Support of CARE in Medical Imaging and Radiation Therapy

The AAMA works to promote health care personnel standards as a guarantee that patients receive quality care from properly trained professionals. Our ongoing support for the Consistency, Accuracy, Responsibility, and Excellence (CARE) in Medical Imaging and Radiation Therapy bill reflects this stance. Recently the Alliance for Quality Imaging and Radiation Therapy—an organization consisting of 22 separate medical communities, including the AAMA—penned a letter to Senators Tom Harkin and Michael B. Enzi, Chairman and Ranking Member, respectively, on the Senate Committee on Health, Education, Labor and Pensions.

In that letter, the Alliance commended Senators Harkin and Enzi for their support of the CARE bill, and outlined the positive implications the bill has for patients, as well as the American health care system. The letter went on to detail how previous versions of the CARE bill have passed through the Senate with unanimous consent, and passed the Committee on Health, Education, Labor, and Pensions (HELP) without significant opposition.

With the support and work of these two senators, in addition to their colleagues in Congress, the CARE bill could provide standards of care for patients nationwide. As always, I will do my utmost to keep you informed as the bill progresses.

A copy of the Alliance’s letter can be accessed at http://www.ismrm.org/smrt/signals_online/Alliance_Senate_CARE_Intro_Support.pdf.