Abstract
Purpose :
High quality, high volume international surgical sites implement a strategy of deskilling, or assigning well-circumscribed care tasks to personnel trained for this limited role, as a means of achieving cost savings. Our previous work has demonstrated personnel costs account for the largest categorical difference in cost of cataract surgery between international and US sites. This paper examines the extent to which deskilling strategies are available to US ophthalmic surgical practices by evaluating state differences in care tasks allowed to be performed by medical assistants. Engaging medical assistants to the full extent of their scope of practice could reduce personnel costs by optimizing care teams for skill mix and efficiency.
Methods :
We defined seven central tasks in cataract surgery care, most of which are performed by mid-level ophthalmic providers at international eye hospitals. These tasks include taking a patient’s vital signs, administering eye drops, collecting point of care glucose levels, inserting IVs, counseling patients on their surgery, and performing post-op monitoring. Using the American Association of Medical Assistants State Scope of Practice Laws, we determined which of these tasks are allowed, not allowed, and not addressed in regulations governing medical assistants’ practice in each state.
Results :
States varied in the extent to which each task is allowed to be carried out by lower level providers. New York and Washington have the greatest number of tasks allowed to be performed by medical assistants. The most commonly permitted tasks included IV insertion (48%) and taking vital signs (36%). 6% of states prohibit MAs from administering eye drops, while 28% either explicitly or possibly allow this. A few states remain silent on these issues in the official regulations, which begs the question of whether the services are permitted or excluded in MA scope of practice there.
Conclusions :
Significant variation exists in state-by-state regulations of medical assistant activities. Understanding scope of practice of medical assistants in the United States will permit better integration of MAs into delivery of eye care and optimize cost and efficiency of cataract surgery.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.