delegation, On the Job, Professional Identity, Scope of Practice

Can Medical Assistants Oversee and Perform Physical Therapy?

Recently I fielded a question from a chiropractor in New Jersey looking to expand his practice to include services such as physical therapy. In conducting research into this matter, he had been told that in New Jersey, state law allows MDs to delegate to medical assistants full oversight and performance of physical therapy activities, as prescribed by the MD. He asked whether this was true.

In my response, I cited a recent CMA Today article that addresses this very topic:

An example of [procedures that can be delegated only to certain health professionals other than medical assistants] is physical therapy. Although some states—explicitly or implicitly—permit physicians to delegate very minor physical therapy modalities to competent and knowledgeable medical assistants working under the physician’s direct supervision, no state allows a physician to delegate the full range of physical therapy to anyone other than a licensed physical therapist.

In addition, I recommended contacting the New Jersey Board of Chiropractic Medicine to inquire whether New Jersey statutes, regulations, and policies permit doctors of chiropractic medicine to assign to unlicensed professionals such as medical assistants the overseeing of patients performing exercises assigned by an MD, and whether there are any legal limitations on this. (Similarly, I would recommend such action to chiropractors in other states, as well.)

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

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

On the Job, Scope of Practice

Breaking News on Epic

It had been brought to my attention that the standard electronic health record (EHR) software product of Epic Systems Corporation did not permit medical assistants to enter orders into it unless the software was specially customized.

Yesterday I spoke with Stirling Martin, senior vice president of Epic.  He informed me that Epic’s EHR product allows users to configure the authorizations to enter data as they think best.  Mr. Martin assured me that Epic’s software permits medical assistants to enter orders into it if the user authorizations are set up properly.

Please contact me if you have any questions.

Certification and the CMA (AAMA) Credential

Follow-up: The Specific Nature of the “Certified Medical Assistant”

Many of you came forward with anecdotes in the comments section of my last post about the importance of properly identifying “Certified Medical Assistants.”  In light of all the issues you have highlighted, I thought it important to further elaborate on the topic.

MA is Not a Medical Assisting Credential

Some medical assistants, in an attempt to abbreviate the name of the profession, refer to themselves as “MAs.”  While this is a fairly common and innocuous usage, it is best to write or state the full profession name (i.e., medical assistant). Doing so helps promote the profession, while clearing up potential confusion in the marketplace.

Concern arises when the intialism for the profession is presented after an individual’s name, giving the appearance of a credential. Only professional or academic credentials—not positions of employment—belong after the person’s name.  Furthermore, the MA credential indicates the person possesses a Master of Arts degree. No MA credential exists in the medical assisting profession, and thus the letters should not appear after the name of any person who does not possess a Master of Arts degree.

Graduation is Not Certification

Much of the confusion around my previous post comes from the similar natures, and appearances, of certificates, certification, and “Certified Medical Assistant (AAMA).” While there is some overlap between the terms, the distinctions are specific. More importantly, they carry legal implications.

The completion of a medical assisting education program—whether accredited or not—will most likely earn the graduating student a certificate, diploma, or associate degree, which represents only the individual’s completion of the program.

Certification is a process by which a professional demonstrates competency in a field. To demonstrate this competency, that person is often required to pass an examination, as is the case with CMA (AAMA) credential. However, as I have written in the past, different medical assisting credentials exist, along with different pathways to certification. Remember, certification is always a separate process. For instance, successful completion of a CAAHEP or ABHES accredited medical assisting program is the first step toward CMA (AAMA) certification, but individuals must pass the CMA (AAMA) Certification Examination before they can use the CMA (AAMA) credential after their names.

Remember, employers can immediately verify their employees’ CMA (AAMA) status on the AAMA website.

Certification and the CMA (AAMA) Credential

Memo to Employers: Use of “Certified Medical Assistant,” “CMA”

In the days following my last post on the issues regarding the use of “Certified Medical Assistant” and “CMA” in New Hampshire, I have received a number of requests for a more generic version of the memorandum.

Below you will find such a document, which can be downloaded and distributed in your own state.

Remember, employers can immediately verify their employees’ CMA (AAMA) status on the AAMA website.

Thank you!

Generic Memo