Medical Assistant Scope of Practice

Article
Physician practices are increasingly using medical assistants in place of nurses for a variety of reasons and with significant impact on office efficiency. Medical assistants are trained in both clinical and administrative functions, allowing one staff member to do the work of two. These assistants can help manage patient flow at the front desk, perform some billing functions, and provide some clinical care. As you consider adding medical assistants to your practice or optimizing the work of the assistants you already have on staff, you might be wondering: What is the clinical scope of practice of a medical assistant?

Regulations and Training
While some states, such as California, have statutes addressing the scope of practice of medical assistants, most states do not have such statutes or regulations. Consult with counsel to determine what laws or regulations are applicable in your state before utilizing medical assistants.

When there is no state-specific regulatory guidance, the scope of practice of medical assistants should be based on education, demonstration of clinical competency, and the comfort level of providers who are delegating clinical tasks to the medical assistants. 

Of course, successful completion of a medical assistant certification program is a good indicator of an individual’s ability to practice safely. Certification programs are available for both formally trained and on-the-job trained medical assistants. Certifying organizations include the American Association of Medical Assistants, American Medical Technologists, and the National Center for Competency Testing.

Tasks That Medical Assistants MAY Typically Perform
With an eye on patient safety, what clinical services may a medical assistant perform in your medical practice?

Depending on your state’s laws and/or regulations, medical assistants are typically allowed to perform the following clinical services under the supervision of a physician:
  • Measure and record vital signs
  • Record patient information and basic information about current and previous conditions
  • Arrange exam room instruments and equipment
  • Change wound dressings and take wound cultures
  • Remove sutures or staples from minor cuts
  • Give instruction and information to patients
  • Provide a single dose of oral medication to a patient, as ordered by the physician, for the patient to take on his or her own under the assistant’s supervision
  • Administer medications topically, sublingually, vaginally, rectally, and by injection
  • Prepare patients for examination, including draping, shaving, and disinfecting treatment sites
  • Collect blood specimens
  • Obtain other specimens by noninvasive techniques, such as wound cultures
  • Perform simple laboratory and screening tests usually done in a medical office, such as urinalysis
  • Call in prescription orders or refills to the pharmacy, but only as ordered and approved by the physician
  • Prefill electronic prescriptions for the provider to review and send when there is an established policy and procedure for doing so

Tasks That Medical Assistants Typically May NOT Perform
Again subject to your state’s laws and regulations, your medical assistants typically may NOT:
  • Independently perform telephone triage, as medical assistants are not legally authorized to interpret data or diagnose symptoms
  • Inject medications into a vein unless specifically permitted by state law
  • Start, flush, or discontinue IVs unless specifically permitted by state law
  • Analyze or interpret test results, such as blood or skin tests
  • Make assessments or perform any kind of medical care decision-making
  • Operate laser equipment
  • Practice medicine or nursing, or present themselves to patients as a doctor or nurse

Supervision Considerations
Physicians are responsible for the practice of medical assistants in most states. It is important to realize that while you may delegate tasks to a medical assistant, you retain the responsibility and legal liability for the task. Inappropriate care provided by a medical assistant has resulted in malpractice liability for physicians, as well as actions by medical licensing boards. 

Also, be sure to check your state laws to determine whether your practice’s physician assistants and nurse practitioners may delegate tasks to medical assistants, as many states do not allow it.

CMS Meaningful Use Requirements
As for how medical assistants can interact with patient data, it’s recommended that you consult the Centers for Medicare and Medicaid Services (CMS) for their “meaningful use” requirements. In October 2012, CMS issued guidance regarding eligible professionals under the meaningful use incentive program. This guidance includes the following statement with regard to medical assistants being allowed to enter data:

“Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.”

Practices attesting for meaningful use must ensure data that may be used for meaningful use attestation is entered by certified medical assistants or licensed staff members.

Ensuring Efficient, Effective, and Safe Practices
Medical assistants are a cost-effective staffing solution unique to physician practices. However, because medical assistants are typically not required to be formally licensed or registered by most states, you should regard them as unlicensed assistive personnel. To help ensure that medical assistants are used safely and effectively in your office or organization, be sure to clearly define their scope of practice in a policy or job description. 

Physicians must respect both the benefits and risks of employing medical assistants. Hire well, supervise and delegate appropriately, and consider requiring formal certification.


COPYRIGHTED
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 

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