Showing posts with label medical assistants. Show all posts
Showing posts with label medical assistants. Show all posts

Thursday, June 13, 2024

Using medical assistants to handle patient portal messages

Penn Family Care, a large urban academic practice, successfully implemented a new workflow to manage the increasing volume of Patient Medical Advice Requests (PMARs), which have surged over the past decade and intensified during the COVID-19 pandemic, according to a report published in the Annals of Family Medicine. Traditionally, primary care physicians, directly received these messages, contributing to clinician burnout. Penn Family Care instituted an approach utilizing certified medical assistants that has demonstrated significant improvements in both efficiency and clinician workload, according to the report.

The new workflow at Penn Family Care reassigns the management of PMARs from primary care physcicians to medical assistants, capitalizing on existing telephone call routing guidelines. This change aims to alleviate the burden on the physicians, who were previously managing an average of 20 messages per week, with some handling up to 112 messages. The practice, which includes more than 60 clinicians, has divided its operations into four suites and nine pods to foster continuity and efficient care delivery.

According to the report, instead of messages going directly to the primary care physicians, they now flow into CMA pools according to the suite and pod structure. CMAs distribute these messages to the appropriate team members based on established protocols. This restructuring required collaboration with information services analysts and thorough training and socialization for both the medical assistants and physicians.

The number of messages routed directly to physicians decreased by about 40%, and medical assistants now manage over 92% of messages within two business days, compared to an 85% response rate by the primary care doctors. This efficiency allows physicians to maintain direct communication with patients when necessary, without the initial overload of messages, according to the report.

Surveys done at Penn Family Care indicate that the medical assistants enjoy this work, and patients have largely accepted the team-based care model. This approach has also helped reduce the gender gap in message volumes between male and female physicians, from 17% to just 2% after adjusting for clinical full-time equivalents. Female primary care physicians now receive only two more messages per month than their male counterparts, a significant improvement toward equity.

The report notes that the success of this model at Penn Family Care suggests a promising alternative for practices struggling with RN staffing shortages. Future steps include refining protocols to further empower medical assistants in managing more messages directly, which could further reduce the message load on PCPs and streamline patient care processes.

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Tuesday, October 11, 2022

What duties can medical assistants take on? Some principles for delegating

A number of resources exist for physicians to research whether they can delegate some practice duties to medical assistants (MAs).

In just the last year, there has been a current of change in the laws governing delegation and duties for medical assistants, said Donald A. Balasa, JD, MBA, CEO and legal counsel of the American Association of Medical Assistants (AAMA).

There also are a lot of laws to keep track of, he said during the presentation “How Recent Changes in State and Federal Medical Assisting Law Can Increase Revenue and Decrease Cost.” Balasa was a presenter in the 2022 Medical Practice Excellence Leaders Conference of the Medical Group Management Assocation.

He outlined a number of recent changes to MA duties in various states and some definitions and general guidelines for integrating MAs into practices. Changes are coming quickly and more may be in the works.

In Connecticut, starting this month, MAs may administer vaccinations. In South Carolina, starting in July, MAs may administer certain medications by certain routes under supervision of physicians, advanced practice registered nurses, and physician assistants. In March, Utah allowed physicians to exercise “general supervision” over MAs, meaning supervision by direct face-to-face contact or direct voice contact by telephone, radio, or another means.

And there have been other legal changes in states such as Washington, Colorado, and Delaware.


It’s the law


The Code of Federal Regulations defines services and supplies incident to a physician’s services. The services and supplies incident to a physician’s professional service are reimbursable under that rule if the service or supply is furnished as an incidental, although integral, part of a physician’s professional services.

That rule now goes beyond traditional doctors of allopathic and osteopathic medicine. It now includes nurse practitioners and physician assistants as providers, Balasa said.

The federal law determines reimbursement for services of medical assistants under the Medicare and Medicaid programs. State law generally governs scope of practice for medical assistants.



General principles


When considering delegating duties to medical assistants, physicians should know:

Some state laws are general, while others are specific, in covering what tasks medical assistants may perform. In fact, the phrase “medical assistant” may not appear in state laws, leaving statutes open to interpretation, Balasa said.



Here are some points to keep in mind:

  • There is a litmus test to consider MA duties: Is the task customarily designated to MAs in your area of the state?
  • Consider the curriculum for MAs in local programs and if the task is taught, that bolsters the argument that a task is delegable to an MA.
  • It is not permissible for MAs to perform tasks that constitute the practice of medicine or require the skill and knowledge of physicians or other licensed providers. Balasa noted physicians or administrators may believe if a physician thinks the MA is competent at a task, then the task may be delegated, but that is not correct legally. If the task requires the skill and knowledge of a licensed provider, it cannot be delegated to an MA.
  • MAs may not perform tasks that are restricted in state law to other health professionals, including licensed professionals such as physical therapists or acupuncturists. For example, health care leaders may think that by teaching physical therapy exercises to an MA, they do not have to hire a licensed physical therapist, but that is not legally correct, Balasa said.
  • MAs may not perform tasks that require clinical assessments, evaluations, or interpretations.
  • Generally, MAs must not be delegated and must not perform any tasks for which they are not sufficiently knowledgeable and competent.
  • If there is a question, physicians can ask medical malpractice insurance carriers for a written opinion about tasks that may be delegated and would be covered in the case of negligence.



More information


The AAMA website has a number of additional resources, including a list of “State Scope of Practice Laws.” Balasa is the author of the AAMA’s Legal Eye: On Medical Assisting blog, and an archive of public affairs articles is available from 2005 to the present.


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