Doing blood tests is one way that doctors learn about your health. Used to diagnose illness and identify health risks, a test or two is part of most annual physicals. But who draws the blood, and does it require another trip to the hospital? Nurses and doctors have a busy schedule, and medical assistants help patients accelerate the process by performing phlebotomy in the physician’s office. Show Medical assistants are among several allied health professionals who are qualified to draw blood. It’s one of the many clinical and clerical tasks medical assistants perform. You’ll learn how in a vocational school program. What Does a Medical Assistant Do?Medical assistants manage both clinical and administrative duties in medical offices. Versatile support professionals, a few of their daily responsibilities include: Answering Phone Calls The front office handles routine scheduling in medical settings, but requests for urgent appointments are handled by medical assistants who gather clinical information for the doctor, so the patients get timely care. Rooming Patients Medical assistants prepare patients for exams, escorting them to treatment rooms where they take the patient’s vital signs and wrap up recordkeeping tasks before the doctor arrives. By updating medical records first, providers have the most current information with which to make treatment decisions. Giving Injections Medical assistants administer subcutaneous, intramuscular, and intradermal injections, giving most vaccinations and some medications under the supervision of a licensed clinical professional. Assisting with Procedures From setting up equipment trays to passing instruments, medical assistants are a doctor’s second pair of hands during treatments and procedures. Preparing Exam Rooms Medical assistants clean and stock exam rooms between visits to keep patients safe from infectious disease and ensure supplies are ready when needed. Performing Diagnostic Tests Medical assistants are trained to perform a broad range of diagnostic tests, including electrocardiograms and pacemaker checks. They also collect biological samples from urine to blood to do pregnancy tests, and fecal occult blood tests. How Is Phlebotomy Performed?Drawing blood, or phlebotomy, is among a medical assistant’s most marketable skills. Let’s take a closer how the process works and the equipment you’ll use. The Phlebotomy Process From reviewing the order to processing samples, medical assistants can manage the entire phlebotomy process from beginning to end by following these steps: Step #1: Check the Order – Phlebotomy requisitions include all the information necessary to perform the draw. The equipment and supplies you’ll need will vary based on the tests being ordered, so you’ll review them carefully before assembling equipment. Step #2: Screen the Patient – Phlebotomy is a safe procedure but knowing more about the client helps you ensure their safety. Before the draw, you will:
Most people can sit, but patients with a history of fainting should lay down. Step #3: Draw the Sample – The blood draw is the shortest part of the phlebotomy process and takes only a few minutes:
Step #4: Process the Sample – Blood samples typically need processing before they can be used. While some tests require whole blood, for example, others rely on serum or plasma. And samples collected for shipment may require special handling. You’ll learn about processing techniques and more in your vocational school program. What Types of Equipment and Supplies Are Used to Draw Blood?As a medical assistant, you’ll select much of the equipment and supplies used in the phlebotomy process, such as: PPE (Personal Protective Equipment) No one knows whether patients are carrying an infectious disease, so medical assistants protect themselves from bloodborne pathogens by wearing personal protective equipment during every draw. Biohazard Containers Used needles are discarded in tamper-resistant, puncture-proof containers to prevent needle stick injuries. Known as Sharps Containers, they’re a fixture in every lab. Disinfectant Scrubbing a needle insertion site removes enough dirt and bacteria to lower infection risk. Isopropyl alcohol is the most common skin disinfectant, but chlorhexidine and betadine are used for select tests. Tourniquets A tourniquet is applied before a blood draw to sequester blood in the limb. Placed above the phlebotomy site on the wrist or upper arm, the extra blood plumps up the vein, so it’s easier to see and less likely to roll when punctured. Needles Needles come in a wide range of sizes for patients of all ages. Longer needles with a larger bore are standard for healthy adults while shorter, small-bore needles are a better choice for seniors and children. Large needles exert significant pressure on delicate veins, causing them to collapse when the needle is inserted. Medical assistants use their experience and clinical expertise to make the best equipment choices. Collection Tubes Blood is drawn using vacuum tubes. Unlike the syringes used to give injections, they coax blood gently from the vein, minimizing damage to blood cells. Tubes are color-coded and contain preloaded additives, taking the guesswork out of mixing samples for certain tests. Phlebotomy has never been easier. Bandages Venipuncture sites are compressed with gauze after the needle is withdrawn until the bleeding stops. But occasionally, drops can continue to seep, especially when the patient stands up. Applying a small adhesive bandage helps protect their clothes. Final ThoughtsPhlebotomy is just one of the many skills you’ll learn in a medical assisting program, but it’s among the most sought-after by employers. A vocational school will teach you everything you need to know. The only prerequisites are the willingness to learn and the courage to try. Want to Learn More?Ready to learn more about becoming a medical assistant in Central Texas? The Medical Assistant Training Program at CyberTex Institute of Technology takes great care of every student providing hands-on training, practical experience and support it takes to get started in a medical assisting career without spending years in school. Students learn the basics of both clinical and administrative skills. Clinical skills include but are not limited to the following: taking medical histories, preparing patients for examinations, assisting the physician during the exam, collecting, and preparing laboratory specimens, drawing blood, and taking electrocardiograms. Contact us today to learn more about our Austin and Killeen campuses.
In the interests of cost-effectiveness and efficiency, family physicians are hiring more medical assistants (MAs) to help them manage the increasing complexities of patient care and practice management. The Bureau of Labor Statistics projects it to be the fastest growing occupation for the 2002 to 2012 period.1
MAs’ responsibilities can be tailored to the needs of a practice. They can manage front-office functions and patient flow and handle a wide range of tasks that would otherwise be performed by receptionists, practice managers, nurses and physicians. Many physicians are unsure of what tasks are appropriate to assign to an MA and do not help MAs work to their full abilities and potential. This article should help you to better understand the MA’s role and prepare you to make staffing decisions that will make your practice more productive.
Education and scope of practice
The formal training that MAs receive varies widely, from several months of vocational school coursework to a two-year associate’s degree program that might include classes in math, English, anatomy, medical terminology and disease processes. Most of an MA’s clinical training occurs on the job and is carried out by physicians, nurse practitioners, physician assistants, registered nurses and other MAs. Certification is not mandatory for MAs, and currently only 15 percent of MAs in the United States are certified.2,3 (See “About medical assisting certification.”)
There are several different pathways to obtain certification in medical assisting. Certification is optional for MAs, but hiring a certified MA should provide the family physician with greater assurance of the MA’s competency. The first type of certification is received upon successful graduation from an accredited school in medical assisting. The second type of certification can be obtained by taking a certification examination from either a state or nation al medical assisting organization.
Only graduates of accredited schools in medical assisting are eligible to take certification exams. There are two national organizations in medical assisting, the American Association of Medical Assistants (AAMA) and the American Medical Technologists (AMT). The AAMA awards the Certified Medical Assistant (CMA) credential. For CMAs, recertification occurs every five years through continuing education or re-examination. The American Medical Technologists (AMT) awards the Registered Medical Assistant (RMA) credential. The AMT allows alternate pathways as well. Recertification for RMAs occurs by renewal of yearly dues to the AMT.
Although legal requirements addressing MAs’ scope of practice vary by state, MAs generally work under the license of their supervising physician or the managed care organization that employs them. To learn more about medical assisting scope of practice, contact Donald A. Balasa, Executive Director and Legal Counsel of the American Association of Medical Assistants, by e-mail at .
MAs are not licensed to make independent medical assessments or give advice. Physicians must determine the skill level and capabilities of each MA they supervise and take into account liability risk and quality control when assigning them their responsibilities. Physicians should provide initial direct supervision and periodically assess the quality of their work. In practices with nurse managers, medical assistants can receive additional supervision coordinated to maximize workflow in a practice. Communicating the MAs’ roles to other staff and clearly delineating their responsibilities is important in maximizing the productivity of the health care team.
With specific protocols, orders and directions in place, MAs can handle a broad range of duties. (See the outline of MAs’ scope of practice.) In some states, MAs can perform procedures such as urinalysis, strep tests, blood pressure checks, weight checks, electrocardiograms, venipuncture and injections. Some often-overlooked uses of MAs include doing telephone follow-up after visits, notifying patients of lab results, reviewing medications with patients, and engaging in translation and cultural brokering.
Using detailed protocols, MAs have been trained in disease management programs such as tracking PT/INR levels for patients on warfarin or following HbA1c levels for patients with diabetes. Some MAs assist with quality improvement initiatives by tracking and recalling patients who need Pap smears and mammograms, organizing flu vaccine clinics for high-risk patients, ensuring follow up for patients working on smoking cessation or verifying that patients over age 50 have had colon cancer screening.
More advanced roles are delineated in the AAMA advanced scope of practice. These differ in each state and may include placing IVs, helping patients draft a durable power of attorney or educating patients about procedures.
Source: AAMA American Association of Medical Assistants Role Delineation Study: Occupational Analysis of the Medical Assisting Profession. Chicago: AAMA; 2003.
Compensation and reimbursement
In 2003, the median hourly wage for medical assistants was $11.69. Median earnings were $24,310 with a range of $17,400 to $34,630 per year.1 Certified MAs make approximately 5 percent to 10 percent more than their non-certified counterparts.3 MAs performing advanced practice functions would probably warrant higher compensation as well. (See “Average salaries for MAs.”) In evaluating the costs and benefits of hiring an MA, be sure to consider the costs of training and supervising this person as well. Because MAs hone their skills on the job, it might take a significant amount of time to train and supervise an MA.
While MAs do not directly generate large amounts of revenue, physicians can bill for simple visits involving MAs by using code 99211. Per CPT, this code is for “Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal and 5 minutes are typically spent performing or supervising these services.”
For Medicare only, the physician can bill for MAs’ services that are performed “incident to” the physician’s service. The incident-to rules cover services that are “an integral, although incidental, part of the physician’s personal professional services to the patient.” The claim should be submitted in the physician’s name and will be paid at 100 percent of the physician fee schedule. Most MAs’ incident-to services may never be billed higher than a 99211. Private payers may reimburse for non-physician providers’ services differently, and it is important to review the physician participation agreement for the managed care companies your practice contracts with, as well as your state’s laws.4
MAs’ greatest value may be in helping physicians optimize their office flow, allowing more patients to be seen and enabling physicians to accomplish more during their visits. Both scenarios lead to better revenue, either because the physician is performing more services or performing higher-level services more often.
If you’re interested in recruiting an MA for your practice, develop relationships with community colleges or vocational schools in your area that have respectable training programs. You may want to volunteer to have MA students rotate through your practice during their externship to see which MA best fits your practice.
Retaining a talented MA can be more challenging than recruiting one. Turnover rates as high as 20 percent a year have been reported.3 Because of the lack of career advancement potential in the field of medical assisting, many MAs leave positions for opportunities that offer even small salary increases. Others go back to school to become registered nurses, physician assistants or even doctors. Helping MAs further their education and training by offering flexible schedules, money for school or advancement if they increase their skills, credentials and education, leads to higher job satisfaction and retention rates. |