Legal differences between working in inpatient and outpatient settings
An increasing number of medical assistants, including CMAs (AAMA), are contacting the American Association of Medical Assistants to ask whether their medical assisting education and medical assisting credential will permit them to work in inpatient settings, such as hospitals, skilled nursing facilities, correctional institutions, hospices, and assisted living facilities. “After all,” these inquirers will state, “the education I received in a CAAHEP (or ABHES) accredited medical assisting program is vastly greater than what certified nursing assistants (CNAs) and medication aides get. Also, it takes much, much more study to pass the CMA (AAMA) Certification Examination than it does to pass the tests for CNAs and medication aides. Surely, I don’t have to take any more tests or courses to work in inpatient settings!”
Perhaps surprisingly, the general, simplified answer is that medical assistants—even CMAs (AAMA)—must meet the state educational and testing requirements to become nursing assistants or medication aides if they want to work as CNAs or medication aides (or in similar, primarily clinical, positions) in inpatient settings. Why is this the case?
Medical assistants work primarily in outpatient delivery settings (such as medical offices and clinics) under direct physician supervision, which is defined in most state laws as the physician being on the premises and reasonably available when the medical assistant is carrying out clinical duties except the most basic and non-patient-jeopardizing tasks, such as taking vital signs and collecting certain specimens. Because all physician assistants work under general physician supervision, the laws of most states empower physicians to assign medical assistants to work under the direction and supervision of their physician assistants. Similarly, most state laws permit physicians to direct their medical assistants to work under the supervision of their nurse practitioners or other advanced practice nurses. In traditional ambulatory care settings—in which physicians are delegating duties directly to medical assistants, or are authorizing their mid-level providers to oversee and delegate to medical assistants—the operative law is the state medical practice act and the regulations and decisions of the state board of medical examiners.
On a side note, the laws of some states allow advanced practice nurses to work autonomously, and without a collaboration agreement or other arrangement with an overseeing physician. The scope of practice for medical assistants working under an autonomous advanced practice nurse (such as a nurse practitioner) is determined by the state nurse practice act and the regulations and decisions of the state board of nursing. The state medical practice act and the regulations and decisions of the state board of medical examiners are not germane in this scenario.
However, medical assistants who want to function in a primarily clinical position in an inpatient setting without direct physician supervision are not under the aegis of the board of medical examiners or the state medical practice act. Rather, they are subject to the laws that govern health personnel (such as nursing assistants and medication aides) in these types of settings. These laws very seldom mention or take into account medical assistants or CMAs (AAMA). Consequently, because statutes and rules in each state provide a scope of practice for CNAs and medication aides or assistants, and establish the educational and examinational requirements for these personnel, medical assistants will be given authorization to work clinically in these inpatient environments only if they meet the legal requirements and actually become nursing assistants or medication aides.
To clarify further, medical assistants who want to work in inpatient settings in a purely administrative role are usually permitted to do so, and do not have to meet additional legal prerequisites.
In some states, medical assistants who have completed medical assisting academic programs and who have a medical assisting credential, such as the CMA (AAMA), may be exempted from certain parts of the training and testing required of certified nursing assistants and medication aides or assistants. To ascertain whether this is the case, it will be necessary to contact the appropriate state agencies and find out how much credit or advanced placement will be granted for medical assisting education and certification. This research can be time-consuming and challenging because some states have one agency that oversees CNAs, and another agency that has jurisdiction over medication aides. Additionally, the people at these state agencies may be unaware of or confused about medical assistants and CMAs (AAMA), and may not be able to provide ready answers regarding “advanced standing” for CMAs (AAMA).
Even though medical assisting education in CAAHEP or ABHES accredited academic programs is appropriately geared toward preparing students to work in outpatient settings, the breadth and depth of this education can be of great benefit to graduates who want to work in inpatient settings, or other nontraditional settings. Similarly, those medical assistants who have passed the CMA (AAMA) Certification Examination have demonstrated a mastery of a significant degree and scope of general, administrative, and clinical knowledge. However, state oversight of inpatient care delivery settings is often more prescriptive and proscriptive than state oversight of outpatient settings, and the legal requirements for health personnel in inpatient settings are often more specific and inflexible.
CMAs (AAMA) must make sure they meet the legal requirements for working in these inpatient settings, even if some of the mandatory training and testing is duplicative of their medical assisting education and certification.
Questions? Contact Donald A. Balasa, JD, MBA, at firstname.lastname@example.org or 800/228-2262.