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Julie Miller was the former Managed Healthcare Executive Editor in Chief until May of 2014.
Practices looking to hire medical assistants should consider each candidate’s education and certification, as well as past medical and administrative work experience.
Many practices are adopting an all-hands-on-deck approach to deliver the suite of services required to achieve comprehensive patient care. Experts say medical assistants (MAs) can be cost-effective contributors to these emerging care models.
MAs work under the oversight of physicians, physician assistants, or nurse practitioners in outpatient settings. Their duties range from clinical work, such as recording blood pressure readings, to administrative tasks, such as scheduling patients.
According to the Bureau of Labor Statistics, the median wage for an MA in 2018 was about $16 per hour, or $33,610 per year. There were more than 634,000 MAs in the field in 2016 with job growth expected to be substantial, increasing 29 percent over the next decade.
Practices looking to hire medical assistants should consider each candidate’s education and certification, as well as past medical and administrative work experience. MA positions typically don’t require college degrees.
While there is no licensing for MAs, the two most common credentials are Certified Medical Assistant, which is earned through the American Association of Medical Assistants (AAMA), and Registered Medical Assistant, earned through the American Medical Technologists (AMT) agency.
“It’s important for physicians to understand that certified MAs can have a variety of training experiences,” says Marie Brown, MD, MACP, an internist at Rush University Medical Center in Chicago. Her practice includes three certified MAs, supporting two internists. One of Brown’s MAs completed some nursing classes plus several years of on-the-job training-rather than a structured MA education program-and passed the AMT certification exam with a near-perfect score.
Beyond that, practices should also consider a prospective hire’s interpersonal skills to understand how the candidate would support the daily objectives of patient care. Brown suggests, for instance, that MAs should be comfortable enough to ask questions when they need more information.
Emerging roles for MAs
MAs are equipped to manage some of the new practice responsibilities that have emerged under value-based care initiatives, according to Donald Balasa, JD, MBA, CEO and legal counsel for the AAMA. Patient-centered medical homes are especially well suited to make use of MAs, who can carry out a number of health management strategies, he says.
Emerging roles for MAs include:
MAs acting as prevention outreach specialists can enhance quality scores, which can translate into bonus payments for the practice. For example, medical assistants can review patient records to identify those overdue for preventive screenings, then follow up with reminders and scheduling.
Balasa says the supervising physician sets the criteria for the targeted populations, indicating who should receive which preventive screenings and when.
At Brown’s practice, MAs review records for patients on the next day’s schedule to identify gaps in preventive care such as immunizations, mammograms, or colonoscopies. When a gap is found, the MA prepares the order for the physician and makes it available in the EHR.
“When the patient comes in the next day, the doctor knows the care gaps have been evaluated, the orders are queued, and the doctor just needs to sign off,” Brown says. “It has tremendously increased our percentage of patients who have those gaps met.”
Research shows employing MAs as panel managers is especially effective at increasing colonoscopies, Balasa says. About 37 percent of individuals age 50 and older have not received the recommended colorectal cancer screenings, according to the American Cancer Society, so there’s ample opportunity for panel managers to make a positive impact.
A 2017 study published in Preventing Chronic Disease demonstrated that MAs working in federally qualified health centers in North Carolina were able to increase the percentage of patients up-to-date with colorectal cancer screening from 23 percent to 34 percent. Another study published in Quality & Safety in Health Care in 2009 showed the expanded MA role was associated with a 123 percent improvement in colonoscopy referrals among seven practices in Utah.
Consider the patient’s needs
As a patient navigator, the MA takes on a communications role, advocating for the patient with sensitivity to cultural, socioeconomic, age, gender, or other personal characteristics. It’s a valuable asset for practices that are eligible for bonus payments based on patient satisfaction scores.
In this position, a medical assistant would need well-developed interpersonal skills. An MA who is bilingual, for example, might act as a translator in the exam room or at the reception desk to ensure a patient with language barriers can adhere to care plans.
“Being bilingual is important, but it extends beyond that to include familiarity with the customs of certain ethnic or cultural groups,” Balasa says.
He adds that in some Islamic and Hmong communities, female patients want to be treated only by female clinicians. In those cases, culturally sensitive patient navigators can manage the appointments in a way that works for the patient and the practice. “It makes it easier for the patient to function within the health system,” Balasa says. “It’s a relatively new role for the MA that’s tied into quality.”
Under Medicare’s Chronic Care Management and Transitional Care Management programs, certain services performed by MAs can be billed as “incident to” the services of the overseeing physician or advanced practice provider (chronic care, non-face-to-face service code CPT 99490 and transitional care management codes CPT 99495 and CPT 99496). In other words, practices participating in the two programs can get paid for work performed by MAs.
Some examples of chronic care management duties for MAs include recording patient health information and keeping comprehensive care plans up to date electronically.
Transitional care management services include providing education about available community resources as well as communication with service providers to support the patient’s transitions from one care setting to another.
“Even if that information is conveyed by telephone or electronic means, those services are billable under these two programs as incident to the services of the delegating physician,” Balasa says. “This is a new area in which medical assistants are getting involved in chronic care management.”
Balasa says the contributions of MAs in the team-based care environment are making a difference in how practices function. And when an MA’s work has a positive effect on a patient’s health-such as when a reminder call leads to a mammogram that detects cancer-Brown believes the physician should commend the MA.
“This is hard work, and they enter into it to help people,” she says. “Highlighting the importance of their role in health coaching and adherence is key.”
Ease physician burnout
In May, the Annals of Internal Medicine reported that a significant number of physicians are experiencing burnout, with the economic cost resulting from the associated turnover and reduced clinical time estimated at about $7,600 per physician per year.
In response, many practices are hiring greater numbers of non-physician providers. Medical assistants can be among the most cost-effective additions to practices’ staff because of their lower pay relative to nurses or physician assistants. Ideally, a practice would aim for two MAs for each physician, according to Brown.
Paula Lozano, MD, MPH, a pediatrician and researcher with the Kaiser Permanente Washington Health Research Institute in Seattle, says there’s a payoff when practices employ well-trained MAs and allow them to take on a range of duties. However, physician leaders might need to get comfortable with delegating tasks to MAs.
“Primary care is a team sport,” Lozano says, because the sheer volume of data-gathering, care-planning and care-coordinating is too much for a physician to manage while also trying to care for patients. Although it seems obvious, Lozano says, the relationship between the physician and the MA must be built on mutual trust so the team can function effectively.
“The days are gone when care was a doctor-centric model, where the doctor does everything and makes all the decisions, while the other staff members around the doctor do the stuff at the margins,” she says.
Lozano has conducted research demonstrating best practices in team-based care, and she recommends an approach that allows MAs to take ownership of care-management tasks. However, with many markets experiencing labor shortages, practices should also consider enhanced compensation packages for MAs-not just in terms of wages, but also training and career advancement opportunities-to recruit and retain the best assistants.
“Remember MAs are among the lowest paid health workers,” Lozano says. “To the extent that we take work off the physicians and give it to the MAs, it’s only fair that we reflect that in the compensation.”