delegation, On the Job, Scope of Practice

Medical Assistants and Fetal Nonstress Test Monitors

State laws are the best place to look for guidance on medical assisting scope of practice, but they are sometimes less thorough than desired. For cases such as those, consider the following:

We have some CMAs (AAMA) and RMAs(AMT) assisting physicians who are providing obstetrical services. The physicians delegate to the medical assistants the hooking up of patients to fetal nonstress test monitors. The medical assistants do not interpret the results of the fetal nonstress test. Is this delegation permitted by Minnesota law?

Based on my research, hooking up a patient to a fetal nonstress test monitor is a straightforward, repeatable process that does not require (1) the knowledge or skill or a licensed health care professional, (2) the exercise of independent clinical judgment, or (3) the making of clinical assessments. Therefore, my legal opinion is that this task is likely delegable to knowledgeable and competent unlicensed allied health professionals such as medical assistants working under direct/onsite physician supervision.

The delegating physicians should reverify periodically (perhaps every 12 months) the knowledge and skill of the medical assistants performing this task and should document in writing each medical assistant’s current competence in this task.

It may also be advisable to request a written opinion from the practice’s malpractice insurance carrier stating that it would cover any negligence by a medical assistant in hooking up a patient to a fetal nonstress test monitor.

On the Job

The Role of Medical Assistants in Increasing Colorectal Cancer Screening Rates

On April 16, 2019, I presented a webinar for the Illinois Primary Health Care Association to illustrate that the utilization of knowledgeable and competent medical assistants, especially CMAs (AAMA), across health care settings significantly increases colorectal cancer (CRC) screening rates.

Review the supporting evidence in the July/August 2019 Public Affairs article, “The Role of Medical Assistants in Increasing Colorectal Cancer Screening Rates,” on the AAMA website.

delegation, On the Job, Scope of Practice

Relaying Providers’ Orders by Telephone

Part of the AAMA’s mission is to protect medical assistants’ scope of practice. Sometimes that means gathering evidence to prove that what other health professionals think is a limitation of medical assistants’ scope of practice is unsubstantiated by state law. Consider the following from a medical assistant in Wisconsin:

I work in a small physician-owned clinic. Our primary care providers visit two local skilled nursing facilities each month. … [Does] our state permit nurses to take a provider’s order by telephone that is conveyed by a medical assistant? These telephone orders are always followed up by a written electronic order from the provider. [But] we are being told that nursing home staff will only take telephone orders directly from licensed health professionals.

Why would this be any different from a provider directing one of our medical assistants to convey a normal lab value? Our providers would spend all day calling the nursing homes if medical assistants cannot relay information at the request of the provider. If the nursing home staff members do not understand the order, they can always ask for clarification from one of our providers.

I reviewed the nurse practice act and the regulations and policies of Wisconsin’s state board of nursing. I found nothing stating that registered nurses (RNs) and licensed practical nurses (LPNs) are prohibited from receiving and executing orders from a licensed provider (e.g., physicians, nurse practitioners, physician assistants) that are transmitted verbatim by telephone by an unlicensed allied health professional, such as a medical assistant.

Unless state law specifically indicates otherwise, my legal opinion is that knowledgeable and competent medical assistants are permitted to convey verbatim information (including orders) on behalf of the delegating provider and receive verbatim information for the overseeing provider. Information conveyed by telephone should be followed up by a written order (electronic or hard copy).

delegation, On the Job, Scope of Practice

Standing Orders and Supervision Requirements

I welcome further questions about my blog posts because addressing those questions allows me to dive deeper into a pertinent topic for medical assistants who wish to better understand their scope of practice.

For instance, in response to my blog post “Standing Orders from an Overseeing Provider,” I received the following question:

Does a standing order change the supervision requirements for medical assistants? For example, if our state law requires the delegating licensed provider to be on the premises when a medical assistant is performing venipuncture, is this supervision requirement changed by a standing order from the provider?

A standing order does not change the supervision requirement established by state law. The supervision requirements apply regardless of whether the licensed provider issues a standing order, verbal order, or written order. If this were not the case, a provider could circumvent supervision requirements by issuing standing orders instead of verbal orders.

The purpose of supervision requirements is patient protection.

On the Job, Professional Identity

Misuse of “CMA (AAMA)” and “CMA” Can Have Legal Consequences

Some medical assistants who do not hold the CMA (AAMA) credential awarded by the Certifying Board (CB) of the American Association of Medical Assistants (AAMA) incorrectly use the initialisms “CMA (AAMA)®” or “CMA” after their names. The AAMA has also received reports that some employers are permitting their medical assisting employees to misuse the “CMA (AAMA)” or “CMA” designations.

The AAMA owns Registration Number 4,510,101 issued by the United States Patent and Trademark Office (USPTO) for the certification mark “CMA (AAMA).”

The predecessor credential to the CMA (AAMA) was the CMA. Because of the decades of use of the CMA initialism in interstate commerce, the AAMA has common law rights in the “CMA” designation.

Consequently, using the initialisms “CMA (AAMA)®” or “CMA” or the phrase “Certified Medical Assistant” to describe a medical assistant who has not been awarded or has not maintained currency of the CMA (AAMA) credential from the Certifying Board of the AAMA is both incorrect and a matter of intellectual property law. Anyone who does so may be in jeopardy of legal sanctions.

The AAMA urges all medical assistants who are misusing the CMA (AAMA) or CMA initialisms, and all employers who are permitting their medical assisting employees to do so, to cease and desist immediately. The AAMA also requests that any instances of such misuse be brought to our attention.

I further explain the legality behind the AAMA’s claim to “CMA (AAMA)” variations in “Letters and the Law.”

The CMA (AAMA) Logo and Branding Usage Guide describes who has permission by the Certifying Board of the AAMA to use the CMA (AAMA) designation, initialism, and/or logo and lists common misunderstandings.