Ownership of Outpatient Clinics and Scope of Practice

I have been receiving questions from medical assistants who work in outpatient clinics owned by hospitals.  They are wondering whether their legal scope of practice is different because they do not work in outpatient settings owned by physicians.

I am not aware of any state laws that establish a different scope of practice for medical assistants who work in settings owned by hospitals or other non-physician entities.  The consistent requirement in all states is that medical assistants work under direct physician supervision in outpatient settings, regardless of the ownership structure of the setting.

Tuberculin Skin Tests

I am receiving an increasing number of questions about medical assistants reading tuberculin skin tests.  My opinion is that medical assistants are permitted to report their observations of the results of the test to the overseeing/delegating physician.  However, the physician must make the diagnosis.

Video: “How Medical Assistants Can Meet the CMS Meaningful Use Requirement”

Below is a video of my presentation at the AAMA 58th Annual Conference in St. Louis, in which I discussed order entry into the computerized provider order entry (CPOE) system and answered questions about the Centers for Medicare and Medicaid (CMS) Stage 2 Meaningful Use requirements.

The video can also be accessed through the AAMA YouTube channel: https://www.youtube.com/watch?v=Hz4avFT3XZE

Eligible Professionals for Medicare and Medicaid EHR Incentive Programs

The Medicare Electronic Health Record (EHR) Incentive Program and the Medicaid EHR Incentive Program are two similar, but different, federal initiatives.  Questions have arisen about which health care providers are eligible to participate in the Medicare Program, the Medicaid Program, or both.

Medicare-only eligible professionals (EPs) are optometrists, podiatrists, and chiropractors. Medicaid-only EPs are nurse practitioners, nurse midwives, and physician assistants—when working at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a physician assistant.  In some circumstances, physicians, osteopaths, and dentists could be eligible for both the Medicare and Medicaid Incentive Programs.

Scribes Not Permitted to Enter Orders for Meaningful Use

The Centers for Medicare and Medicaid Services (CMS) recently issued an important clarification regarding meaningful use order entry. See the following quote from a report by the American Academy of Ophthalmologists:

EHR Meaningful Use Update: CMS Comes Out Against Scribes
Despite Academy efforts, the Centers for Medicare & Medicaid Services clarified this week that medical scribes − even those who are certified − are not permitted to enter electronic medication, laboratory, or radiology orders into electronic health record systems. The Academy believes that changes to the criteria for satisfying the EHR Meaningful Use Program’s Computerized Provider Order Entry measure lacked clarity regarding appropriate personnel who may perform this task.

In communication to the Academy, CMS explained that it is not permitting scribes to enter medical data under the CPOE measure. Medical staff entering orders into EHRs for purposes of satisfying the CPOE measure must be, at minimum, a certified medical assistant or equivalent, which includes certified ophthalmic technicians, certified ophthalmic technologists, and certified ophthalmic assistants.