Addressing Recent Concerns About Order Entry

The Centers for Medicare and Medicaid Services (CMS) Blog recently posted these articles dealing with forthcoming changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs:

EHR Incentive Programs: Where We Go Next

Comments of CMS Acting Administrator Andy Slavitt at the J.P. Morgan Annual Health Care Conference, Jan. 11, 2016

In the wake of these pieces, there has been some concern about the potential effects on medical assistants’ ability to enter orders into the computerized provider order entry (CPOE) system for meaningful use purposes. I have addressed these concerns in a memorandum to AAMA leaders. The body of this message is as follows:

January 22, 2016

Within the last 10 days the Centers for Medicare and Medicaid Services (CMS) has issued statements about forthcoming changes in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Incentive Programs) required by the passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015, referred to as “MACRA.”

Congress enacted MACRA on April 16, 2015.  This legislation replaces the current meaningful use (MU) payment adjustment provisions with the Merit-Based Incentive Payment System (MIPS), effective January 1, 2019.  According to CMS, MIPS will incorporate some meaningful use elements of the current program and will introduce new elements.

There has been a groundswell of concern that MACRA will do away with the requirement that only third-party-credentialed medical assistants, licensed health care professionals, and third-party-credentialed individuals “who hold a more specific title than ‘medical assistant’ because their duties include only parts of the medical assisting scope of practice, or because of the specialization of the overseeing eligible professional (EP),” are permitted to enter medication, laboratory, and diagnostic imaging orders into the computerized provider order entry (CPOE) system for meaningful use calculation purposes under the Incentive Programs.

In my legal opinion, this concern is not warranted because of the following:

  1. The order entry credentialing requirement of the Incentive Programs was established by CMS rule, not by federal statute.
  2. No provisions of MACRA impact the CMS order entry credentialing requirement.
  3. The legislative history of MACRA does not indicate that Congress was concerned about the CMS order entry credentialing requirement.

CMS regulations implementing MACRA and MIPS are scheduled to be published for comment in 2016.  I do not anticipate that these forthcoming regulations will include any changes to the credentialing requirement of the CMS MU order entry rule.  However, if changes are proposed that could potentially harm patients by lowering the credentialing requirement for medical assistants who enter orders into a CPOE system, the American Association of Medical Assistants will be quick to point this out to CMS decision makers, and to persuade them to maintain or increase the current requirement.

Posted in Certification and the CMA (AAMA) Credential, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Meaningful Use, Medicaid, Medicare, On the Job, Scope of Practice | Tagged , , , , , , , , , , , | 2 Comments

The CMA (AAMA) Credential in Conjunction with Other Roles

In recent days I received the following two questions:

I would like to know if it is legal in the state of Michigan to work as a medical assistant and a nursing assistant. I started as a certified nursing assistant (CNA) and later went to school and became a CMA (AAMA). Can I work for two companies—for one company as a medical assistant and for another company as a nursing assistant? I have tried to search for an answer elsewhere but have had no luck.

I am currently in nursing school (practical nursing). I will graduate in May. Am I able to maintain my CMA (AAMA) even after I obtain my licensed practical nurse (LPN) license? I hope I am able to do so.

I responded to these questions as follows:

  1. Thank you for your question. It is my legal opinion that Michigan law permits an individual to work as a nursing assistant for one employer, and as a medical assistant for another employer. It is important that you keep your CMA (AAMA) current, and that you fulfill any requirements for maintaining your CNA.
  1. Thank you for your question. There is no law or policy that would forbid you from keeping your CMA (AAMA) credential after you become an LPN. As you know, you will have to recertify every sixty (60) months in order to maintain currency of your CMA (AAMA).
Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity | Tagged , , , , , , , | 2 Comments

Medical Assistants as “School Nurses”

Today I received a question about whether a medical assistant is allowed to work as a “school nurse.”

Just as medical assistants cannot use the title “nurse,” “office nurse,” or “doctor’s nurse” (see my Public Affairs article from the January/February 2011 CMA Today), under the laws of all American jurisdictions medical assistants—even CMAs (AAMA)—are not permitted to be employed as “school nurses.”  In some states medical assistants are permitted to assist registered nurses who are functioning as school nurses.  To reiterate, however, medical assistants are not allowed to work as “school nurses.”

Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity | Tagged , , , | 14 Comments

CMS Final Rule Reaffirms Credentialing Requirement for Medical Assistants

On October 6, 2015, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for the Electronic Health Record (EHR) Incentive Programs. In responding to comments urging that the “credentialed medical assistant” requirement be made less stringent, CMS reaffirmed that medical assistants must have a third-party credential (such as the CMA (AAMA)), and must have sufficient knowledge to handle properly clinical decision support (CDS) alerts.

One party commenting on the CMS notice of proposed rulemaking for the EHR Incentive Programs made the suggestion “that if a standard for medical assistant CPOE [computerized provider order entry] is required, then the standard should be that the medical assistant must be appropriately trained for CEHRT [certified electronic health record technology] use (including CPOE) by the employer or CEHRT vendor in order to be counted [toward meeting the meaningful use requirements of the Incentive Programs].” (page 322 of the attached document)

CMS responded as follows:

We [CMS] disagree that the training on the use of CEHRT is adequate for the purposes of entering an order under CPOE and executing any relevant action related to a CDS. We believe CPOE and CDS duties should be considered clinical in nature, not clerical.  Therefore, CPOE and CDS duties, as noted, should be viewed in the same category as any other clinical task, which may only be performed by a qualified medical or clinical staff. (page 323 of the attached document)

This position of CMS is a resounding affirmation of the fact that only professionally-credentialed medical assistants (such as CMAs (AAMA)) are qualified to enter orders safely into the CPOE system.

More information about the CMS final rule will be forthcoming in Legal Eye: On Medical Assisting and CMA Today.

CMS Final Rule (10/6/15), pages 322-323

Posted in Certification and the CMA (AAMA) Credential, Computerized Provider Order Entry (CPOE), EHR Incentive Programs, Meaningful Use, Medicaid, Medicare, On the Job, Scope of Practice | Tagged , , , , , , , , , | 15 Comments

Further Information on SB 110

Information regarding Senate Bill (SB) 110 continues to emerge. Please see the following missive from the Ohio Board of Nursing:

SB 110, passed by the 131st General Assembly, authorizes CTP [Certificate to Prescribe] holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons. Please click on the links below to access the statute and the Legislative Services Commission (LSC) Analysis for further details.

Effective October 15, 2015, APRNs [Advanced Practice Registered Nurses] holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation, set forth in the law and rules, including Chapter 4723-13, Ohio Administrative Code (OAC). Please be aware that the new authorization in ORC Section 4723.48(C) supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person.

SB 110 authorizes the Board to adopt rules establishing standards and procedures for APRN delegation. The Board will convene a Board Committee on Practice meeting on January 20, 2016 at noon at the Board office to gather public input regarding the need for administrative rules.

If you have questions, please email practice@nursing.ohio.gov. To access the Ohio Revised Code and the Ohio Administrative Code, go to the Board website at www.nursing.ohio.gov.

https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-SB-110

https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA131-SB-110

Posted in delegation, medication administration, On the Job, SB 110, Scope of Practice | Tagged , , , , | 1 Comment