The Latest Healthcare Quandary: Medical Assistants

What can medical assistants (MAs) do and not do?

Medical assistants (MAs) have a narrow list of things they can do for patients or a physician in a doctor’s office. It’s often difficult to know what’s allowed, because there are not strong laws regarding medical assistants in place.

In fact, most MAs learn their skills on the job. They’ve only recently started earning medical assisting certifications and/or getting certified with national agencies or community colleges.

But recently, there have been some U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) posts and even a complaint filed in New Jersey regarding the use of an MA and the patient perception of what an MA is and what they are legally able to do. Many physician practices refer to their back-office staff as “nurses.” This general term can range from an actual Registered Nurse (RN) to an NP (Nurse Practitioner) to an APP (Advanced Practice Provider). But as noted, the term has also been used to refer to the physician’s back-office ancillary staff and MAs as well – that is an incorrect title, and can give a patient a false impression that they are working with a medical decision-making professional. They are not.

There are no specific federal rules for MAs, and it is imperative that practices read up on their state statues before undertaking any task about which they are unsure. Each state has different rules.

That’s why it’s important to know your medical assisting scope of practice. 

The profession as a whole is lacking a unified scope of practice.

Medical Assistants and Delegation

Whenever a medical assistant performs a task, he or she is doing so under a doctor’s supervision. The doctor assumes responsibility for whatever the medical assistant does.

But there’s a gray area that can leave medical assistants open to litigation.

Doctors can tell a medical assistant to do anything, but if the doctor is out of line, and telling him or her to do something outside his or her medical assisting scope of practice, then they may be liable for doing something that they are not qualified to do.

Many states have in their laws that a medical assistant can perform duties they are adequately trained to perform, and are not prohibited from performing, under state medical or nursing laws.

As a medical assistant, you need to make sure that you understand what state nursing law reserves for nurses. Nurses can delegate certain duties to medical assistants, but some duties must stay strictly with the nurse.

What Medical Assistants Can Do

Medical assistants can perform certain basic tasks without any supervision from a doctor or nurse. These include the following:

• Prepare medical records;
• Maintain patient charts;
• Order supplies;
• Maintain medical office equipment;
• Manage money accounts of patients; and
• Schedule appointments.

They can also prepare instruments for examination, prepare exam rooms, and record vital signs. Assisting the doctor during procedures and minor surgical interventions may also be within the medical assisting scope of practice, but again, check with your state. In California, for example, an MA cannot assist with minor procedures, but in Texas, they can, on a limited basis. 

Medical assistants can collect specimens, such as urine, blood, or sputum, for lab tests, and perform STAT screenings, under the supervision of a physician or NPP, not independently. They can relay questions from a patient to a doctor by phone, and can transcribe dictated medical documents for the doctor.

Medical assistants can also relay lab test results, but can’t provide an interpretation of them. In some states, they can even start an intravenous line.

What Medical Assistants Can’t Do

 There are a few things that medical assistants can definitely not do.

They cannot treat or diagnose patients. They can educate patients about a diagnosis a doctor has given, or perform a prescribed treatment, but cannot treat or diagnose on their own.

Medical assistants also cannot assess, plan for, or evaluate a patient or their care. A doctor or nurse has to examine a patient to determine the plan of care for them.

Medical assistants cannot interpret test results or advise a patient about their medical condition in any way.

Medical assistants also cannot give IV medications or administer anesthetic medications for the purpose of rendering a patient unconscious.

Prescribing and refilling medications independently is not within the scope of practice either, and they cannot perform physical therapy, except in an assisting role.

Medical assistants cannot perform any procedure, technique, or treatment that would constitute the practice of medicine.

Every state is different, so check with your state board of medicine to determine what your medical assisting scope of practice is. For instance, in Connecticut, medical assistants are not allowed to perform X-rays or give medication by any route, including oxygen or injections.

In Maine, a doctor must be a reasonable distance away from the practicing medical assistant to help, in case anything should go wrong. Of course, if anything should go wrong, the responsibility falls on the physician.

In Nevada, a medical assistant was sued for illegally administering medications. That state is currently revising its scope-of-practice laws for medical assistants and their ability to work with medications. In New Mexico, medical assistants have to be trained to use equipment before they can be reasonably delegated the responsibility. 

Even then, it cannot be invasive equipment.

As you can see, each state has its own ideas about what a medical assistant can reasonably do in their scope of practice. You are open to liability if you do not know your limitations, so do your homework and learn what your scope of practice is in your particular state.

Programming Note: To hear more on this topic, tune in to Talk Ten Tuesdays today, when Terry Fletcher will continue her guidance on MAs and their role in a physician practice.