What is an Administrative Medical Assistant? Administrative Functions Assisting in Utilization Reviews, Admissions, Insurance Claims. Medical assistants, especially those employed by the hospital administration, are tasked to assist in utilization reviews. Utilization review is a tool used to ensure that healthcare is necessary and its declared costs are appropriate. Concurrent utilization review is the evaluation of healthcare services while they are being administered or given to the patient.
The patient may choose to cut off the healthcare services if they are found to be not necessary. Utilization reviews have become mandatory under Medicare standards and policies. Concurrent utilization review instructs healthcare providers to relay healthcare information to patients. Healthcare services that meet the terms of the review with costs deemed to be appropriate will be reimbursed.
Consumer healthcare choice will depend on the insurance because they can only seek medical care in hospitals that are covered by their insurance. They cannot choose the best hospital if it is not covered by their insurance. Consumers are forced to see only see the physicians and avail of other healthcare services authorized by the insurance of the company. Should the consumers choose another physician outside of their coverage, they will have to pay for the services of the physicians themselves.
Consumers who only have limited coverage cannot access better quality care. They will just have to make do with the hospitals that they are restricted to. This will not be as bad if all hospitals are able to give the same type and quality of care to patients who do not have private insurance. Consumers have less choice when it comes to healthcare. When the price of one of the overhead variables of the hospital will rise, the cost of hospital services will also increase. The consumer will be left to pay for that increase.
The consumers are the ones who feel the most impact of the rising healthcare costs. Consumers try to avoid this because it is an added expense on their part. The consumer does not have a choice really because of the economic factors that drive the healthcare industry. The cost of health insurance is one of those factors. Insurance plays a big factor in consumer choice because insurance companies cannot cover all the hospitals consumers want. The consumer will not know for sure if the hospitals listed in the network deliver quality healthcare.
The uninsured suffer the most because they have no insurance at all. They have no one to depend on to cover their expenses. This must be an issue that government should address. Access to healthcare is vital to public health. Those people with insurance are also having difficulties because of the rise in health costs. Insurance companies may no longer cover as many hospitals because of the increasing cost.
If this will happen, consumer choice will be further limited. There is no assurance that the healthcare that they receive is effective and of the best quality. Something must be done to expand consumer choice because it is the public health that we are talking about. The people should decide who will treat them and where. Their decision is influenced by economic factors and their effects on the healthcare industry. Consumer choice must be broad enough for people to decide for themselves.
Consumers are the people who need and demand the services of the healthcare organization. With a low consumer demand, there is no need for increased spending. Hospitals have to increase their expenditures because of the rising demand for healthcare. They need bigger facilities and better equipment. Hospitals need more doctors, nurses, and personnel to be able to serve the needs of the patients. Since hospitals are spending more on their facilities, medication, and personnel, the hospitals need to offset their expenses with their revenues. Of course, if the cost will increase so will the fees that they will charge for the services administered to their patients.
It is right to say that information technology is another cost driver. Hospitals that implement and install information technology systems are more likely to save on costs because the technology will automate and integrate operations like accounting, billing, and organization of medical records. There is no need to hire more non-medical personnel to handle the documentation since the computers will be the ones to do it. Both the hospital and the patients will save time because information technology systems will make the transactions between them more efficient and effective.
Utilization review is primarily conducted in hospitals with the help of medical assistants. It has the purpose of evaluating the need for patient admission and determining how long the patient has to stay in the hospital. A concurrent utilization review has many advantages as an assessment tool. One of the strengths of utilization review is to allow patients to refuse services that are not necessary. Another advantage is that utilization review provides guidelines for the development of staff and healthcare programs. The patient may choose a less costly care alternative if he or she is found to be stable and does not need hospital admission.
Utilization review allows health consumers to pursue an alternative care option such as outpatient facilities to generate cost savings in the event that hospital admission is not necessary. According to a report conducted by the Centers for Disease Control and Prevention, the number of ambulatory or outpatient surgeries in the United States is increasing. Ambulatory surgeries also account for two-thirds of total surgeries in 2006.
Three decades ago, if an individual will undergo surgery, he will have to stay in the hospital for at least one day. Sometimes, the patient will have to stay for several days. Since that time, there has been a dramatic shift in outpatient surgery that has brought with it certain benefits like cost savings, the convenience of the patient, and in some instances, quality care. The change in trend is due to several factors all working together including social, economic, and medical factors.
Utilization review has weaknesses as well. The explicit criteria used to determine denial or approval of healthcare services fit all types of patients despite their diagnosis. Utilization review does not recognize the patient’s need to for continuous healthcare management to avoid further complications due to the illness. If the utilization review personnel do not approve this type of care, reimbursement from Medicare will be denied.
Weakness can also be seen on the side of the utilization review committee of healthcare providers. The number of skilled personnel used to support the utilization review function should also be evaluated in the context of high historical denial rates and limited resources for care. Another weakness in the process of utilization review is the lack of evidence-based standards. A number of studies have shown how utilization review processes often lack the ability to identify impaired quality.
The personnel involved in utilization programs are sometimes non-physicians who lack the skill and medical knowledge to really understand clinical information. They are the ones who have a high denial rate in terms of Medicare reimbursements. Many cases should have been appealed. The process of verifying clinical information takes much time and effort that the clinician will have the tendency to deny payment.
Medical Assistants in Ambulatory Care
Ambulatory care is a department that steadily demands medical assistants. Ambulatory surgery was perfected in an effort to generate cost savings for healthcare organizations. Surgeons were able to demonstrate certain surgical procedures that can be safely done without needing to confine the patient in the hospital. Insurance companies may protest if the patient will be admitted to the hospital even if it is not really necessary. Physicians have also developed quicker recovery methods for the patient. Along with the advantages of ambulatory surgery come the disadvantages.
Several cases have been reported that after being sent home, the patient experienced complications with the surgery. The patient is sent home without making sure that he is able to do so on his own. Because of the complications, the patient will have to go back to the hospital and may even be asked to stay more than a day. As a result, the patient’s bill will increase. Sometimes, the patient is given a catheter and sending him home without even providing instructions on how to use it. The quality of care is not the same as being confined to a hospital.
It is important for patients to understand they are only allowed to go home if they are judged to have stable vital signs and can manage pain by taking medication. It is the job of the medical assistant to handle the situation or perform patient education. Usually, ambulatory surgery centers will not release a patient if he does not have a companion with him.
Most patients of ambulatory surgeries are recommended to have someone watch them during the first night. Some people may need more assistance depending on the type of surgical procedure for many days. For people who do not have someone to care for them while they are recovering at home, most private health insurance companies and Medicare will be covering the expense for a visiting nurse if it is according to doctor’s orders.
Health insurance companies usually allow doctors to judge whether or not to admit the patient who has a certain health condition that will make the surgery a risk to the patient. This is allowed even if the surgical procedure is considered an outpatient treatment. These instances must first pass the medical necessity test of insurers.
Despite the weak state of the economy and the troubled times of financial markets, many investors still place their money on ambulatory surgery centers (ASC). ASC companies have grown in number because well-capitalized and oriented to acquire. The growing industry of ASC is now preparing for expansion and acquisition of more supplies to meet the demand for outpatient surgery.
One of the factors that drive the growth of ambulatory surgery centers is lower cost. Ambulatory surgery has been recognized as the cost-efficient alternative to hospitals that have high costs of in-patient services. Hospitals are struggling with high overhead and administrative expenses and costs for the development of facilities. These costs increase the cost of surgical procedures.
The lower costs of ambulatory surgery centers are partially attributed to the lower individual cost of outpatient surgery. As a result, employers who provide insurance and payers of government have shifted to ambulatory surgery centers because of the lower cost involved. The development of new technology also drives the growth of ambulatory surgery. The development of fiber optics, lasers and improved surgical or endoscopic techniques, developments in anesthesiology have all significantly reduced the period of trauma and recovery associated with different types of surgical procedures.
Developments in anesthesia that help reduce side effects of surgery such as drowsiness and nausea have reduced the amount of recovery time. This, in turn, minimized the need for an overnight stay in the hospital in several cases. As a result, doctors have increased their ability to perform ambulatory surgeries rather than in the facilities of the hospital.
Another factor that contributes to the growth of ambulatory surgery is the preference of the patient and the physician. The growth of ambulatory surgery centers also creates employment opportunities for medical assistants. Many doctors prefer the use of ambulatory surgery centers because of their enhanced productivity. They realize that they have greater flexibility of schedule and the staff of nurses and medical assistants is more reliable and consistent.
The turn-around time between cases is also faster. The physicians are more efficient in their surgeries because they can do them in less time than the amount of time compared to hospital settings. Doctors also prefer ambulatory surgery centers because they can avoid the bureaucracy associated with hospitals.
If patients were given the chance to choose, they would like to come and visit the ambulatory surgery center rather than the hospital. The patients feel more comfortable in this setting. They perceive hospitals to make them feel institutionalized and cold. Patients also think that get more personalized care in ambulatory surgery centers than in hospitals.
Clinical Medical Assistants in Palliative Care
When there are cases that it is no longer possible to prevent a patient from dying and doctors cannot do anything, it is the job of the clinical medical assistant to provide care and support not only to the patient but also to the family. The clinical medical assistant is tasked to keep the patient as comfortable as possible and free from pain. There must be little suffering for both family and patient in the remaining days of the patient’s life.
The clinical medical assistant should also assist the patient so that he or she may be able to die in a peaceful manner. Comfort to the family must also be provided by the clinical medical assistant. Clinical medical assistants who are caring for the dying must also be aware of their own feelings regarding their patients and the subject of death. Many barriers are presently affecting the quality of nursing care at the end of life. The process of the disease may present a problem when the patient, family, and the nurse may have a hard time admitting that medicine may not as advanced as they would like it to be.
If healthcare professionals such as the nurse will lack sufficient training in caring for dying patients, this will result in ineffective pain management including the other symptoms of the patient. If the nurse does not have any knowledge of palliative care services, there is a delay in the patient’s access to those services. Another barrier to end-of-life care is if the family and the patient denied the impending outcome of the patient’s health.
Palliative care seeks to improve the life of patients and their families who are dealing with an illness that threatens the life of the patient. Many medical assistants have worked in palliative care. This is done by ensuring that the patient does not experience suffering. The treatment of pain is also included. The objective of palliative care is to provide comfort and end of life closure.
It is included in the principles of palliative that the patient and his family will be regarded as the unit of care. An interdisciplinary team is involved in palliative care such as the doctor, nurse, social worker, pharmacist among others. In the evaluation of what type of end-of-life care the patient will receive, it is important to determine what this quality care means to the patient. The level of quality is different for everyone.
A good medical assistant must be accurate in carrying out the orders of the doctor. The physician is responsible for treating the illness or condition of the patient. The family and the patient are also responsible for their own choice of doctor. A medical assistant must not think that he or she knows better than everyone else even the doctor. Another duty of the clinical medical assistant is being watchful at all times. Without this, the patient may be able to get out of bed. If a patient is experiencing delirium, he may hurt himself walking around. If his clothes will come off, a chill might follow. The life of the patient may be thrown in the hands of the nurse as also the safety of the patient.
Handling Patient and Medical Records
Handling electronic medical records (EMRs) and electronic health records (EHRs) is part of a medical assistant’s administrative function. The availability of healthcare information systems has enabled medical assistants to perform this task more effectively and efficiently. The use of barcoding will help hospitals reduce errors in documentation especially in medication. This will work by cross-checking the ID band of the patient along with the ordered medicine.
The implementation of this system would be costly but this should not be an issue if the lives of the patients are at stake. All medicines have corresponding bar codes and the ID band of the patient also has one. The system is online wherein the nurse will just pull up the screen. It will highlight the medication that will be given to the patient. Scanning would be done on the medication. If something does not match, then the system will give an alert. If the medication is right, the patient ID will be scanned to determine the correct patient.
Using Health Information Systems
There has been an evolution of health information systems because of their new role in the changing demands of health care quality and the organization themselves. The issues that were common in the 1980s were the need to supply information on the business side of the operations for the health care providers. When these issues of supply were already addressed and people understood them, the attention has now turned to improvements in the application of technology. This new shift in attention has given way to new issues.
These issues are now relevant to the demand for the availability of health information systems in health care organizations. The focus is on the information itself and how it can be used. The tasks that were done by early computers are also the most obvious ones that can easily be improved like billing, accounting, inventory control, and other office tasks that have become labor-intensive. Health information systems have moved from having a central computer station to, replacement of passive terminals by microcomputers and their connection to a network. These technologies help medical assistants perform several tasks at once.
Account Billing and Collection
Medical assistants are also tasked to handle patient admissions, billing, and collection. The activities that have been involved in the conventional health information systems have also evolved from transfers, admissions, and discharges, to billing systems. They are now more complicated and sophisticated tasks involved like clinical information management, simulation, processing of images, and laboratory systems. The adoption of universal information technology and healthcare systems can help improve efficiency and quality in all types of healthcare organizations. A uniform health information technology system will allow more hospitals to provide better and high-quality health care services.
Information technology will reduce the number of workers needed for documentation. It will help automate everything including the billing and collection, accounting, and prescription of medication. The patient will be able to receive care faster because of the automated processes. Hospitals will have instant access to information when locating the file of their patients. There will be no need to go through a file cabinet to retrieve the records of patients. Information technology systems will save more time, space, and money. It will also help reduce the costs of hospitals. Patients will be more encouraged to seek hospital treatment because of the efficient service.
Healthcare needs to move towards the information age. The acceleration of change in all aspects of life significantly affects the implementation of that change within the healthcare system. The digital and information age has made the delivery of healthcare services more mobile and portable. Technology has reduced the intensity and frequency of intervention as well as the creation of faster and more effective treatments. The need for the establishment of interdisciplinary relationships and the integration of different disciplinary practices is also moving at the same pace with the changes in clinical and technological applications.
Career Options and Laddering
After being a medical assistant for many years, you may want to find another type of job for personal reasons or financial gain. You don’t have to switch to a completely different field since career laddering is always an option. Career laddering is a transfer to another occupation based on your training and experience. Aside from ascending the career ladder to the position of medical office manager, there are other employment opportunities within the confines of the hospital. You can choose to become an admissions clerk, medical secretary, and records clerk.
You can also take advantage of your experience and training as a medical assistant by taking a job as a patient care technician. This is considered an alternative job for medical assistants since you will only need additional instructions to carry out your responsibilities. This position is offered by the facility that provides the additional training.
Other opportunities are available for medical assistants who are trained to specialize in a certain field. For example, medical assistants with an ophthalmology background can help perform diagnostic tests on patients. They can assist in examining the function of eye muscles and demonstrate the proper care and technique of putting on contact lenses.
Career Outlook for a Medical Assistant
There is a steady demand for medical assistant jobs since hospitals are trying to avoid a shortage of staff because this affects the quality of healthcare. It is difficult to attend to the needs of patients if there are too many of them and only a small number of staff. The National Quality Forum will be a big help to improve the quality of healthcare for Americans. The goal of the forum is to provide quality healthcare at an affordable cost.
This is needed in light of the current global crisis. People need to spend as little as possible and spend their money on their basic necessities. If people are going to spend their money on healthcare, they deserve to receive quality care in return for their money. Quality care may seem difficult to get because of the rising costs of healthcare. It is time for the government to intervene on behalf of the public to address the need for quality care.
Quality care should cost less with the utilization of information technology and other cost-efficient methods employed by hospitals. It must be an immediate solution to the problem. As long as healthcare facilities continue to employ dedicated medical assistants, the level of quality care is bound to increase. Medical Assistant careers should be a smart choice for at least the next decade.