Medical Assistants, the Different Hats They Wear and How They Can Impact Efficiency

Transcription

1 Medical Assistants, the Different Hats They Wear and How They Can Impact Efficiency Tricia Hamm, CMA Clerical Supervisor, Denver Health SBHC Wanda Marshall, CPNP Program Manager, Denver Health SBHC

2 Presenter Disclosures Tricia Hamm and Wanda Marshall The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No Relationships to Disclose

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4 Outline Introduction Various Models of Care in Schoolbased Health Centers Medical Assistant Education Certification Duties Attributes Denver SBHC Model Transition Expanded Model Statistics Staff Satisfaction

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7 Models of Care in SBHC 996 (91%) SBHCs nationally have clerical support. Type of support RN/LPN 55% MA* Health Aide 39% Clerical 52% Support the Primary Care Provider Usually a Nurse Practitioner or Physician s Assistant. NASBHC, National Census, Brindis, 2003 * Mentioned, Lear, 1991

8 Medical Assistants One of the fastest growing occupations. Majority of health care is being delivered in outpatient settings. Allows outpatient settings to deliver high quality care at a reasonable cost. Average salary of $28,300 (2008). Range is between $23,700-$33,050. Education is concentrated around outpatient settings.

9 Medical Assistants What is a Medical Assistant? Education Vocational-technical school Community or junior college 1-2 years Results in either a diploma or an Associates Degree Specifically educated to work in ambulatory health care settings.

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11 Certification, Registration, and Licensing Certification or Registration Neither is a requirement Difference is due to the organization that credentials the MA There are 4 U.S. organizations that have valid certification processes. The American Association of Medical Assistants (AAMA)certification exam. National Center for Competency Testing has a designation of NCMA for completion of a certification exam.

12 Certification, Registration, and Licensing (continued) Registrations National organizations provide the registration either by continuing education or exam. The American Medical Technologists (AMT) The American Registry of Medical Assistants (ARMA) Both give the title of RMA

13 Certification Must graduate from an accredited academic program to sit for certification boards. Certification is deemed from passing an exam. AAMA is the only certification that allows one to use the title CMA. The title is copyrighted. Must recertify every 5 years Continuing education Retesting

14 Registration Initial (ARMA) Takes online CEUs to become registered Recommended by a licensed, accredited affiliate school from which they graduated Recommended by their physician employer after one year on-the-job post graduation experience from a licensed, accredited non-affiliate school Recommended by their physician employer after having a minimum of three years on-the-job experience performing the clinical and clerical duties of a traditional medical assistant. Annual Renewal completes online CEUs

15 Licensing Licensing Licensure may be defined as a mandatory credentialing process established by a government entity, usually at the state level. Some states have defined the scope of practice for a MA but the individuals remain unlicensed. Arizona, Connecticut, California, Florida, Maine, Nevada, New Hampshire, New York, and Pennsylvania make comment about MAs somewhere in the state code. South Dakota registers MAs in the state in order to practice. Washington has Health Care Assistant laws which include MAs.

16 Duties Administrative Clinical Financial

17 Duties Administrative Duties Schedule, coordinate and monitor appointments Schedule admissions and procedures Work with health care plans and have knowledge of billing. File medical records appropriately

18 Duties continued Financial duties Enters procedural and diagnostic coding for reimbursement Vaccine coding Submit coding electronically Prepare submittable insurance forms Able to do bookkeeping and financial procedures. Ordering and purchasing of supplies and vaccines.

19 Duties continued Clinical Duties Taking vital signs Recording patient history Phlebotomy Preparing patients for exams Patient Instruction Establishing and maintaining the medical record Preparing and administering oral and parenteral medications as directed by the provider Immunization administration Laboratory testing

20 Duties continued Miscellaneous Duties Obtain and maintain immunization records. Obtaining test results for the provider. Perform telephone and in-person screening. Knowledgeable of medical law such as HIPAA and OSHA. Trained in both verbal and non-verbal patient communication.

21 Attributes Communicate to a variety of patients Has the basic principles of psychology Able to explain provider recommendations Link between provider and patient and family Culturally Competent Knowledge of age appropriate care Knowledge of medical law and ethics Knowledge of preventive medicine Telephone and in-person screening

22 Expanded Role Robert Wood Johnson Grant In 2005, the University of Texas received a grant to study utilization of Medical Assistants. Study incorporates the use of CMAs to: Reduce or eliminate smoking Assist patients to increase activity Educate in healthy eating habits Assist patients who abuse alcohol

23 Expanded Role continued The Teamlet Model of Primary Care Definition of Teamlet: Primary Care Provider and a health coach who is a CMA. CMA receives further training in chronic disease management. Does initial data gathering, check on medication use and perform testing. Remains in the room when the provider sees the patient. Documents for the provider. Fills out forms. Retrieves items not in the exam room. After provider leaves, CMA ensures patient understanding.

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25 Denver SBHC Model prior to 2008 Utilized a Health Care Technician prior to Main duties were clerical Registration Making appointments Vital signs Database management Entering codes for billing

26 The Transition During the School Year , Medical Assistants were transitioned into the clinics. Tasks involved in transition Review of administering vaccines Lab competencies Scheduling of immunization only patients for Medical Assistant while provider seeing well/sick visits Job description changed which resulted in a pay increase.

27 Transition continued Staff mind set had to be changed. Clinicians had to let go of duties. Medical assistants had to accept increased responsibilities. Policies and procedures changed to include new duties. Delegation of duties changed to attending physician. Training period with documentation of competencies

28 Denver SBHC Model after 2008 Duties were expanded to include: Vaccines Other injections Phlebotomy Urine dipsticks Throat cultures Pregnancy tests Spirometry

29 Clinical Duties including Hearing and Vision screenings.

30 Expanded model Administrative Patient registration Appointment scheduling Gatekeeper Assists other clinical staff in finding students Collecting and entering of superbills Data entry Tickler files Supervises Student Assistant Assists with School registration Miscellaneous Clinical Vital Signs Hearing and Vision screening Phlebotomy Vaccines Other injections Waived lab testing May assist School Nurse

31 Statistics Immunizations Medical visits HPV vaccine became widely available to SBHC

32 Staff satisfaction Providers The lab is also another area. At present she does the strep tests. How nice it is not to be waiting the six minutes for the test (one minute and then the other five minutes) while the kid is already in the exam room. I can just call the kid back after I know the test results. Sue H., NP Better customer service. Instead of multi-tasking (i.e. preparing shots, setting up for blood draws while getting patient histories or educating patients), I'm able to spend more face to face quality time with patients during their visits. Thia G., NP

33 Staff satisfaction continued Providers Continued The clinic has been able to increase immunization compliance and productivity since having Medical Assistants in the clinic. Prior to this change the provider did all the immunizations. Now, the MA can assess records and give immunizations prior to a patient coming back for an appointment. The other benefit is that the MA's can assist with blood draws. Laura M., NP Immunizations--the year before I was the only one who could do it. What a bottle neck. Now she manages the immunization schedule of each kid and I can help when I have time. Very nice collaboration. ---Sue H., NP The biggest change I have seen is their ability to give immunizations. That has been a great help to me as a provider and allows me to see more patients for appointments. ---Nancy, NP

34 Staff satisfaction continued Medical Assistants Faster process (ex...immunizations) we can give them before they see clinician...blood draws we don t have to send the patient to the lab and it takes the load off of the clinician. Maria V., MA I was happy with the change because of the fact that I could do the things that I was trained to do. I love being more clinically focused. I feel I add more efficiency to clinic by being able to support my nurse practioner so that she doesn't have to the tasks that I'm trained to do. I'm able to perform lab tests and give shots before her seeing the patient which makes everything run smoother,and helps the appointment run faster and because she doesn't have to wait for a strep test because she is seeing the patient with results on hand. -- Sonya S., MA

35 DSBHC MA Team

36 References AAMA. (2008, January 9). Occupational Analysis of the CMA. Retrieved April 24, 2011, from American Association of Medical Assistants: Balasa, D. (2008). New Roles for the Certified Medical Assistant to Enhance Quality and Effectiveness of Care. Medical Practice Management, 1-3. Balasa, D. (2009). The Certified Medical Assistant: An Invaluable Asset for the Pediatric Office. Practice Management Online. Bodenheimer, T. L. (2007). The Teamlet Model of Primary Care. Annals of Family Medicine, American Association of Medical Assistants:

37 Contact Information Tricia Hamm, CMA Clerical Supervisor, DHSBHC Wanda Marshall, MSN, CPNP Program Manager, DHSBHC