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Standardizing Physician-CMSS Teams to Wellness – MACRA: Quality Payment Program

Appropriately credentialed and Certified Medical Scribe Specialists (CMSS) are now starting to receive increasing attention in the healthcare industry, as many more practitioners are turning to them with the now commonplace use of EMRs/EHRs. Certified Medical Scribe Specialists help practitioners stay focused on providing quality patient care, while relieving practitioners from the burden of charting patient encounters that require ever more detailed documentation. Their services are becoming even more valuable now as the Medicare Access and CHIP Reauthorization Act (MACRA) begins to be implemented on Jan. 1, 2017.

Physicians and mid-level clinicians, such as nurse practitioners and physician assistants, are licensed to perform their care. Medical Scribes are direct personnel working under the physician’s license. The Centers for Medicaid and Medicare Services (CMS) acknowledges appropriately credentialed Certified Medical Scribe Specialists in any specialty discipline meeting its standards and regulations. If not the licensed clinicians themselves, personnel must attest for Meaningful Use (now under MACRA’s Advancing Care Information category) and be certified. Certification is available through the CMS-approved Certified Medical Scribe Specialist credential, successfully attesting for Meaningful Use. ACMSS offers several pathways for Physician/CMSS, Physician/CMSA certification.

In CMS FAQ 9058, CMS approved high-performing, niche Certified Medical Scribe Specialists (CMSS) appropriately certified and credentialed with ACMSS, toward meeting CEHRT measures and personnel measure of “who” may document in the EHR, if not the licensed clinician themselves. See full scope of CMSS Credential.

“If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a medical assistant but carries a more specific title due to either specialization of their duties or to the specialty of the medical professional they assist, he or she can use the CPOE function of CEHRT and have it count towards the measure. This determination must be made by the eligible provider based on individual workflow and the duties performed by the staff member in question. Whether a staff member carries the title of medical assistant or another job title, he or she must be credentialed to perform the medical assistant services by an organization other than the employing organization. Also, each provider must evaluate his or her own ordering workflow, including the use of CPOE, to ensure compliance with all applicable federal, state, and local law and professional guidelines.”

Growing Need, Demand, Roles and Responsibilities for Certified Medical Scribe Specialists

One of the Certified Medical Scribe Specialist’s core responsibilities is to capture accurate and detailed documentation of the physician/mid-level encounter and increase clinical workflow efficiencies, creating time and space for clinicians to appropriately care for patients.

“The current credential, or ‘crosswalk’ for Certified Medical Scribe Specialists goes far beyond the definition above, allowing certified scribes to become more valuable members of the healthcare team,” said ACMSS Executive Director Kristin Hagen. “They’re helping to create the patient-centric, patient-safety oriented healthcare system we are all seeking.”

The following are just some of the expanded duties of the medical scribe under the CMSS credential:

Clinical Duties

  • Explain treatment procedures to patients
  • Prepare patients for examination
  • Set up procedure trays, as directed by a physician
  • Enter pended CPOE, including medication, diagnostic and laboratory orders, as directed by a physician
  • And many more secure duties, available with paid membership only through secure licensing of products and attestations accessibility

Non-Clinical Duties

  • Scheduling and receiving patients
  • Using computer applications and assisting physicians in using the EHR and researching information in the EHR
  • Serving as a liaison between the patient and the physician

What Clinicians Need to Know: (Outpatient, Hospital, Emergency Department): CMS has requested the following, implemented into Polices & Procedures:

CMS has asked that each provider or practice retain a copy of the crosswalk documentation in their files, just as they would retain documentation outlining their individual approach and method, as well as staffing protocols for audit purposes. ~CMS

All individuals entering electronic data must be certified or licensed, if not the licensed clinicians entering data themselves, documenting patient care records. Together, with CMS, appropriate repositories enable care improvement toward improved patient-centric care and health and wellness amongst our nation.

Expanded Curriculum Now in the Works for Certified Medical Scribe Specialists

Along with the expanded credential, national curriculum standards for medical scribe specialists are being broadened. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) Medical Scribe Specialist Education Review Board (MSSRB) recently released revised standards that reflect the growing roles scribes are taking in practices across the country. Called “Appendix B, Curriculum in the Standards and Guidelines for the Accreditation of Educational Programs,” it revises standards, which were initially adopted in 2015 by CAAHEP, MSSRB, and ACMSS.

To view the proposed Appendix B Curriculum requirements, which are anticipated to go into effect at the end of January, click here.

“CAAHEP is the premiere ‘gold’ standard in leading academic allied health education professions through third-party programmatic accreditation and is the current standard for institutions and universities,” said Hagen.

The new medical scribe specialist curriculum guidelines go into far more detail than the 2015 version, including delving into national standards such as MACRA and its Merit-based Incentive Payment System (MIPS), and the Health Information Technology for Economic and Clinical Health (HITECH) Act. The standards also contain a sharper focus on the certified scribe’s role in wellness, prevention, integrative medicine, integrative care, and complementary and alternative medicine.

Syed Mir Athar M. Ahmed, MD, serves as the chair of the board of the CAAHEP Medical Scribe Specialist Review Board (MSSRB). Dr. Ahmed is the Medical Scribe Learning Manager for CityMD, an urgent care company that employs more than 350 Certified Medical Scribe Specialists within its nearly 60 locations in the New York, New Jersey and Seattle. Dr. Ahmed teaches the medical scribe curriculum from an urgent care perspective and teaches the CityMD electronic health record (EHR) system to all of the physicians and Certified Medical Scribe Specialists who come on board. CityMD is ACMSS’s first Clinical Corporate Partner, read story here.

Dr. Ahmed says the new CAAHEP standards are more reflective of the expanded Certified Medical Scribe Specialist credential, and of the way scribes are utilized at CityMD. Certified scribes working at CityMD go far beyond basic scribe roles, such as looking up lab reports or filling out documents. They are seen, and serve, as healthcare team members who perform such duties as setting up procedure trays for clinicians, participating in assisting and informing patients, and much more. Certified Medical Scribe Specialists are cross-trained in many functions that help improve efficiency and the quality of patient care in the organization.

“We train them in such a way that they are well-balanced in not only documentation but also performing certain clinical and healthcare functions and doing setups for the clinician—it’s a well-rounded approach,” says Dr. Ahmed. “The first thing we tell our scribe trainees when they come on board is that ‘you will be the go-to person for the clinicians.’”

An increasing body of research is showing that the use of Certified Medical Scribe Specialists is resulting improved physician/licensed independent practitioner productivity, cost and time savings, better patient satisfaction, and patient safety especially when the physician/licensed independent practitioner is not electronically savvy, and data entry causes fatigue and dissatisfaction. This will be a mainstay moving into MACRA and its Merit-based Incentive Payment System (MIPS) and the Quality Payment Program (QPP). Clinicians will be greatly assisted by the use of Certified Medical Scribe Specialists (CMSS) in reporting positive results in the four major QPP categories:

  • Quality
  • Advancing Care Information
  • Clinical Improvement Activities
  • Cost

The clinical documentation and practice efficiencies Certified Medical Scribe Specialists provide have been shown to ease the clerical burdens, up to and including CPOE, and give physicians back the time and attention they need to focus on their patients toward integrative healthcare focused on disease reversal, wellness and prevention. ACMSS sees Certified Medical Scribe Specialists playing an ever-evolving role in the MACRA-enabled, precision medicine healthcare system, both here enabled through Integrative Medicine and of the future, which is:

  • tailored to and individualized for each patient
  • rely on a partnership between patients and medical practitioners
  • require a complete picture of the patient, including health history, environment, lifestyle, genetic make-up, diet and host of other factors
  • focus on the entire patient, not just on disease, symptoms and illness or injury
  • involve patients and clinicians spending much more time together focused on wellness, prevention and disease reversal

“America has two systems designs building on each other—our evolving public healthcare system, and Integrative Precision Medicine, which are both valid and complementary,” says Hagen. “ACMSS understands MACRA, given the expertise and understanding coming through the two systems in respect of the patient, client, and healthcare practitioner viewpoints.”

Certified Medical Scribe Specialists are enabled through a clinical/non-clinical skill set that includes appropriate attestation, certification and credentialing through the Medical Scribe Certification & Aptitude Test (MSCAT). The ACMSS certification program meets current and proposed CMS certification requirements toward use of electronic health records. ACMSS is independent from all scribe companies and organizations and works in compliance with CMS to meet national goals and initiatives of MIPS, MACRA, and Meaningful Use. Appropriately credentialed and Certified Medical Scribe Specialists (CMSS) also meet the qualified personnel measure in Certified Electronic Health Record Technology (CEHRT).

ACMSS offers several pathways for Certified Medical Scribe Specialists. Please contact ACMSS Executive Director Kristin Hagen directly, phone (657) 888-2158, or email support@acmss.zendesk.com, if you have any questions regarding the ACMSS program and/or materials. Learn more of Certification Packages, currently on 40% discount of 2 or more purchased enabling America daily to reap the benefits of truly transformative patient-centric care systems.

RESOURCES, For Information On:

Purchasing Standardized CMSS Certification Packages: (https://theacmss.org/store/acmss-volume-packages/)

Learn More: MACRA QPP, ACMSS leading CMSS to innovation, (https://theacmss.org/for-macra/)

Become a CAAHEP MSSRB Program, (http://caahep.org/mssrb)

View CAAHEP MSSRB Proposed Curriculum – anticipated release January 2017
(http://caahep.org/documents/file/Webiste%20Curriculum%20Proposed(1).pdf)