Educating and Empowering Medical Assistantsthe Forgotten Member of

Educating and Empowering Medical Assistants-the Forgotten Member of the Primary Care Team Betty Springer, CMA-C(AAMA) Florida Society of Medical Assistants Ed Shahady MD, FAAFP, ABCL Clinical Professor of Family Medicine Medical Director Diabetes Master Clinician Program

Declarations Dr. Shahady • Speakers Bureau Merck and Sanofi • Advisory Boards Boehringer Ingelheim/Lilly, Janssen,

Agenda • Changes in out patient care of Diabetes in the last 40 years • Demographics and Education of Medical Assistants • Contributions of Medical Assistants to Diabetes Master Clinician Program (DMCP) • How Diabetes University Teaches Medical Assistants • Collaboration of DMCP and Florida Society of Medical Assistants • Think about ways to teach MA’s in your office and collaborate with MA associations in your area of influence.

Not Just a Medical Waitress

Agenda • Changes in out patient care of Diabetes in the last 40 years

Changes in out patient care of Diabetes in the last 40 years • Went from RN to LPN to Medical Assistants • Diabetes Care more complex • Many Labs done in the office—medical assistant may do them • Multiple oral and injectable medications are available and someone has to train the patient to use them. • Guidelines now recommend immunizations, annual foot exams, annual exam by eye doctor etc • Physician Can not survive without help of office assistant—in 2014 that is a Medical

Agenda • Demographics and Education of Medical Assistants

Medical Assistants • The 560 000 medical assistants working in the United States • Fast-growing allied health occupation • Projected to increase by 29% from 2012 to 2022. • Medical assistants are ubiquitous in primary care, ethnically and linguistically diverse, and culturally concordant with a variety of patient populations. US Bureau of Labor Statistics Occupational Outlook Handbook. http: //www. bls. gov/ooh/healthcare/medicalassistants. htm. As of Nov 5, 2014

http: //www. bls. gov/ooh/healthcare/medical-assistants. htm accessed Nov 5, 2014

Agenda • Contributions of Medical Assistants to Diabetes Master Clinician Program (DMCP)

Diabetes Master Clinician Program • Began 11 years ago with 4 practices now has 115 practices • Uses a Internet based Diabetes Registry • Office staff usually the MA enters data, gives patients report card at time of the visit and participates in Population Management based on gap reports from the registry. • In addition to the registry the program provides on site education by the medical director • MA’s taught how to do monofilament exam/or Ipswich touch test—shoes are now off for clinician exam

Ipswich touch test MA Instructs patient to close his or her eyes while lightly resting his or her finger on each of the patient’s first, third, and fifth toes for 1 to 2 seconds. Asks if patient felt something. Head to head trial was as good as monofilament test and does not require extra equipment. Miller JD et al How to do a 3 -

Patient Report card given to Patient by MA with some explanation

Clinic Report informs practice of Gaps in Care Clinician and MA/Staff create plan based on gaps MA leads the way in gap resolution with Clinician

Solutions calls, emails, text messages

Phone calls, emails, text messages Look at individual physicians and team

Ipswich touch test MA Instructs patient to close his or her eyes while lightly resting his or her finger on each of the patient’s first, third, and fifth toes for 1 to 2 seconds. Asks if patient felt something. Head to head trial was as good as monofilament test and does not require extra equipment. Miller JD et al How to do a 3 -

Impact of Team Care, 8 -Month Period 1. Sat down as ain 140 Patients team and discussed gap reports; created Team decisions 2. Emails, phone calls (4 a day) 3. Improved use of patient report cards 4. Protocols developed for MA to use

Agenda • How Diabetes University Teaches Medical Assistants

Diabetes Master Clinician Program • MA’s stated they wanted to be more than a Medical Waitress but needed some extra training in Diabetes • Created diabetesuniversitydmcp. com to increase diabetes knowledge base and provide certificate acknowledging their taking and passing the test • Test on survey monkey—self corrects—skip logic • Also created familymedicineteams. org to help teach about Teams

www. diabetesuniversitydmcp. c om

www. familymedicinetea ms. org

Bodenheimer T, et al JAMA Internal Medicine 2014 ; 174: 1025 -26

Expanding Roles of Medical Assistants • Panel management--provide evidence-based preventive and chronic care based on standing --also review registries for gaps and initiate solutions based on protocol • Health coaches provide information to patients about their condition, assist patients with lifestyle changes and medication adherence, and encourage care participation. • Clinical scribing using templates within the EHR to document during the visit, stays with Bodenheimer T, et al JAMA Internal Medicine 2014 ; 174: 1025 clinician during the visit

Challenges to Expanding Roles • Scope of Practice-State Laws Some states do not allow medical assistants to do more—need political will to have laws changed • Physician, Nurse, CDE acceptance—may be the biggest challenge—Nurse CDE etc may feel threatened by increasing MA responsibility— need to ask them to be part of the teaching process and obtain their endorsement—means that physicians may need to compromise some of their limiting of Nurse responsibility • Payment for services—once laws change and politics change the payers will usually change Bodenheimer T, et al JAMA Internal Medicine 2014 ; 174: 1025 -

Agenda • Collaboration of DMCP and Florida Society of Medical Assistants • Think about ways to teach MA’s in your office and collaborate with MA associations in your area of influence.

THE ROLE OF THE CREDENTIALED MEDICAL ASSISTANT IN TEAM HEALTHCARE Betty Springer, CMA-C(AAMA) Florida Society of Medical Assistants Past president of American Association of Medical Assistants

Medical Assisting Profession • Demand for medical assistants has grown, continues to grow. • Medical assisting training programs increase, vary greatly in breadth, depth and rigor, standards and quality. Quality programs include clinical and administrative training (i. e. coding & EHR) with practicums which is a value added component to primary care. • Employers should be able to expect a meaningful level of quality. • Ability to perform to the highest level of the scope of practice is key in all healthcare practice formats, especially in a team coordinated environment. • Screen the credential and the individual to join your staff

The 2014 Florida Statutes Title XXXII REGULATION OF PROFESSIONS AND OCCUPATIONS Chapter 458 MEDICAL PRACTICE 458. 3485 Medical assistant. — (1) DEFINITION. —As used in this section, “medical assistant” means a professional multi-skilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician. This practitioner assists with patient care management, executes administrative and clinical procedures, and often performs managerial and supervisory functions. Competence in the field also requires that a medical assistant adhere to ethical and legal standards of professional practice, recognize and respond to emergencies, and demonstrate professional characteristics.

(2) DUTIES. —Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties: (a) Performing clinical procedures, to include: 1. Performing aseptic procedures. 2. Taking vital signs. 3. Preparing patients for the physician’s care. 4. Performing venipunctures and nonintravenous injections. 5. Observing and reporting patients’ signs or symptoms.

(2) DUTIES. —Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties: (b) Administering basic first aid. (c) Assisting with patient examinations or treatments. (d) Operating office medical equipment. (e) Collecting routine laboratory specimens as directed by the physician. (f) Administering medication as directed by the physician. (g) Performing basic laboratory procedures. (h) Performing office procedures including all general administrative duties required by the physician. (i) Performing dialysis procedures, including home dialysis. (3) CERTIFICATION. —Medical assistants may be certified by the American Association of Medical Assistants or as a Registered Medical Assistant by the American Medical Technologists.

BRIEF (overview) COMPARING 4 MEDICAL ASSISTING CERTIFICATIONS American Assoc. American Medical National Health National Center of Medical Assistants Not for Profit Technologists Not for Profit Career Association For profit for Competency Testing For profit AAMA certifies Medical Assistants exclusively CMA(AAMA): CAAHEP or ABHES 160 hrs practicum Strict outcomes criteria National Test audited by NBME *60 CE in 60 AMT certifies several allied health professions RMA(AMT) 5 Pathways including OJT 160 hrs practicum National Testing *30 CE 30 months NHA certifies several allied health professions CCMA 2 Pathways including OJT No accreditation standard *10 CE 24 months NCCT certifies several allied health professions NCMA *14 CE 12 months

MEANINGFUL USE • CMS Ruling: Only licensed health care professionals or credentialed medical assistants are allowed to perform CPOE (computerized provider order entry). • (anyone can enter vitals; CMS ruled that a person who understands the “alerts” in EHR is needed for order entry) • For more detailed explanation go to American Association of Medical Assisting web site…. Legal Blog section. You will see the official explanation from the CMS in video format.

DIABETES UNIVERSITY AND GOING “UPSTREAM” • Florida Society of Medical Assistants, in collaboration with Dr. Shahady, offers online CE to guide working with patients for adherence, understanding and reinforcing patient participation in the prevention and care management of diabetes. • FSMA is promoting participation by medical assisting training programs • To date, we have trained medical assistants in different sections of FL • Statistics as to demographics are being gathered for the Diabetes Association • Spanish translation will be completed soon

IN CONCLUSION: • Medical Assistants are value added to the primary care setting • Medical Assistants can augment the capacity of Physicians, Nurse Practitioners, Physician Assistants • Medical Assistants can assume more instrumental roles in population management and preventative care initiatives • Medical Assistants can provide a valuable conduit between clinical and administrative regarding documentation requirements, coding and insurance/referral requirements • A well trained Medical Assistant can participate with the healthcare team in the quality and efficiency standards of a primary care practice to meet the acute, chronic and

Thanks for your attention Questions?

Contact Information • springerassoc@aol. com • eshahady@att. net • www. diabetesmasterclinician. org • www. diabetesuniversitydmcp. com • www. familymedicineteams. org