The Medical Assistant as Office Manager



The Medical Assistant as Office Manager



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LEARNING OBJECTIVES PROCEDURES
1. Describe routine maintenance activities in the medical office.  
2. Identify methods to maintain a safe environment and prevent injury to patients and employees. Create an environmental checklist and perform a safety inspection.
3. Describe an efficient system of maintaining equipment inventory lists and operator manuals.  
4. Maintain administrative and clinical equipment. Perform routine maintenance of equipment.
5. Describe the process of obtaining new equipment.  
6. Explain procedures for taking inventory. Take a supply or equipment inventory.
7. Describe an effective method for ordering, receiving, and storing supplies.  
8. Explain how to manage office payroll.  
9. Describe ways to enhance teamwork in the medical office.  
10. Describe the medical assistant’s role in orienting and training new employees.  
11. Manage the physician’s professional schedule.  
12. Differentiate between medical office policies and procedures.  
13. Create and/or revise medical office policies and procedures as needed to promote smooth office functioning.  
14. Locate community resources to assist patients and medical office staff. Locate community resources.
15. Describe how incident reports should be used to protect the medical office. Complete an incident report.
16. List types of liability protection for physicians, the medical office, and medical assistants.  
17. Describe the various components of risk management in the medical office.  



Introduction to Medical Office Management


The medical assistant performs many tasks that promote the smooth running of the medical office. These tasks include maintaining the physical space, taking inventory, ordering supplies, monitoring programs such as risk management and employee safety programs, orienting new employees, and processing employee payroll. The responsibility for these management functions may be primarily that of the medical assistant in a small office, or primarily that of an office manager in a larger setting. Office management always provides the basis for effective patient care, and its importance cannot be overestimated.



Maintaining the Office


In many medical practices, a medical assistant assumes responsibility for maintaining the physical space of the medical office and performing general maintenance. Heavy cleaning and equipment repair are usually not performed by office staff, but rather by contractors. Thus the medical assistant may also be responsible for managing the relationship between the office and contractors or vendors of services, as well as medical, pharmaceutical, and office supply companies.



Administrative Area


When sitting at the front desk, the medical assistant must be able to effectively and efficiently answer two or three incoming calls, greet patients, and handle paperwork.


Depending on the size of the administrative area, supplies and equipment for correspondence and billing may be stored in this area, including stationery, envelopes, billing forms, and coding reference books. In addition to the telephone (discussed in detail in Chapter 39), the reception area usually contains a personal computer, which is usually linked to the office’s computer network. Materials for creating new patient folders should also be at hand if a paper medical record system is used.


The administrative area needs to have enough room to perform the required activities without the patient files and other papers becoming mixed up, and it must also allow the medical assistant to maintain patient confidentiality (Figure 48-1).


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Figure 48-1 Well organized front office.

Again, depending on the size of the office, business operations will either take place in the front office close to the reception area or in a separate area in the office. In the business office are the rest of the pieces of equipment necessary for administering the office, including the photocopy machine, fax machine, and postage meter or electronic mailing system. In small offices, an all-in-one printer-copier-fax may be used.


Patient billing records are available either in hard-copy files in the business office or on the computer. Charge slips, patient statements, and other documents are usually printed using a laser printer or ink jet printer.


The medical assistant should be familiar not only with the office equipment’s operation, but also with the maintenance responsibilities, such as reloading paper and adding toner or printer cartridges. In addition, the medical assistant may need to follow the terms of any maintenance agreements when scheduling maintenance or repairs.


Offices should also have a paper shredder for disposing of confidential documents. Although medical records must be maintained indefinitely, old telephone logs, old payroll records, canceled checks more than 7 years old, and minutes of practice management meetings should all be shredded rather than simply thrown away in the wastebasket or in a wastepaper-recycling bin. Any documents with patient information that have been scanned into the electronic medical record should be shredded if they are not retained. Shredded paper can still be recycled, and there is no danger that sensitive personal or business information will be seen by anyone who should not have access to it.



Examination and Treatment Rooms


Each examination or treatment room also needs approximately 100 square feet of floor space to hold an examination or treatment table, cabinets and countertop, patient chair and physician stool, and a small surface for the physician to write on. The room should be laid out so that a physician and medical assistant can move freely about the room. Equipment and supplies should be within easy reach or stored in drawers or cabinets easy to reach.


Each examination or treatment room needs to have a sink, as well as soap and paper towel dispensers. Hand sanitizer may be in a wall-mounted or freestanding dispenser. The examination room must also contain a wall-mounted rigid container for the disposal of sharps, such as needles, scalpel blades, or other objects that might puncture a plastic bag. Biohazard wastebaskets with a biohazard plastic liner for materials that contain body fluids, such as blood, mucus, or pus, are located either in each examination room or in the hall. Containers for hazardous waste must be covered, except when adding waste. A foot pedal to open the cover facilitates use. The examination room usually contains an ordinary wastebasket for used paper towels and table paper.


For safety reasons, examination rooms should not contain syringes, needles, or medication samples. Cleaning materials and chemical solutions should never be stored under the counter in an examination room, especially if it is used for children.



Waiting Room


The waiting room makes a first impression on a new patient. It must be neat and welcoming. The waiting room needs two to four chairs for each physician in the office at one time, current magazines, and a table or magazine stand to hold them. If the practice sees children, some toys should be available in a separate play area. One person should be assigned to tidy up the waiting room a couple of times during the day.


A waiting room should have signs that inform patients about office policies. The signs depend on the policies of the individual office. Common signs include the following:



Some offices have a display rack with health information brochures. Brochures are available from government agencies, public agencies, and many companies. With the approval of the physician(s), these brochures are often provided to help educate patients about health promotion and disease prevention.


Sometimes there is a television or DVD player in the waiting room. In some practices, health information videos are playing. Other practices have a radio tuned to an easy-listening station or a CD player with quiet pop or light classical music. The medical assistant may need to turn on this equipment at the beginning of the day.



Security Systems


A medical office maintains a number of different security systems.


First, if the office is entered from a corridor in an office building, the building owner or office condominium association most likely has an electronic security system for the building itself.


Second, regardless of whether the office is entered from a corridor or directly from the outside, the practice should maintain an electronic security system against break-ins to the office itself.


The office’s security and safety alarm system is monitored by an alarm company and may or may not also be tied to the local police and fire departments. Whether or not the system is tied into the police and fire departments, the alarm company will call the practice’s liaison to the company whenever the alarm goes off.


This designated person is often the practice administrator or “managing partner.” However, two or three people are always listed as backups in case the liaison is not available.


Third, various places within the office require another layer of security. Medication cabinets—with all medications and prescription pads inside—should be locked, and a limited number of people should have keys to the medication cabinet lock. The laboratory, physicians’ private offices, medical records cabinet or room, and business office are other areas that often have a lock and limited access.


If controlled substances are stored in the office, they should be “double-locked” (in a locked drawer within a locked cabinet). Two separate keys should open the two different locks.



Routine Maintenance


It is important to maintain the physical space of the medical office. Depending on the size of the office, many if not most routine maintenance activities are undertaken by staff. These include controlling the temperature, cleaning cabinets and drawers, changing lightbulbs and replacing batteries in battery-powered equipment, turning the security system on and off, making sure fire protection equipment is in working order, and performing some daily cleaning. In all activities, medical assistants and other staff must be sure to protect themselves and patients from hazards and injury. Good body mechanics should be used to move supplies and equipment and when cleaning, as well as when working with patients. The workplace should be arranged to minimize strain during all routine and maintenance activities.



Temperature and Ventilation


The reception area and examination rooms should be kept at a comfortable temperature. People who are ill are sensitive to cold and drafts. The reception and patient waiting areas and examination rooms should be about 70° to 72° F. The temperature in treatment rooms, the laboratory, and physicians’ offices should be about 68° to 70° F. A room used for procedures or minor surgery can be kept a little cooler because the physician and medical assistant may be wearing gowns, masks, and hair covers.


Ventilation is also important. Keeping air circulating is important both to dissipate odors and to allow germs to escape from the office atmosphere.



Putting It All Into Practice


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My name is Kelsey Whitman, and I am a registered medical assistant. I usually work in one of the satellite offices of a large medical group that includes primary care providers and medical specialists. The office where I usually work was formerly a house. They are planning to close it next spring, tear it down, and build a modern office building. Even though there are some disadvantages to the current setting, it has a lot of charm. The waiting room and three small examination rooms are on the first floor with the physicians’ office, and we use the rooms upstairs for storage, a break room, and meeting rooms. I have a small office upstairs, but I never have time to sit in it. Usually we have only one physician in the office. I work with one other medical assistant, but since I have been in the practice longer, I am responsible for making sure that everything runs smoothly. I have to go to the main office once a month for a staff meeting. The meetings are held once a month late on Wednesday afternoon. We discuss issues affecting all work areas. We have also been reviewing some of the procedures done by medical assistants to be sure that every medical assistant in every office does things the same way. The other medical assistant will be going out for maternity leave in a few weeks, and we have been interviewing for a replacement. After an initial screening interview, I have been asked to talk to three applicants, to give them a tour of our office, and to give my feedback about how they might fit into this setting. One of the applicants seemed like a real team player, and I hope they hire her. It is so important for everyone to be able to work well together. image



General Cleaning


Larger offices may contract for cleaning services, or office cleaning may be included in the monthly rent, especially in buildings that are dedicated to medical offices. Contracted cleaning is usually done one or two times a week, so even if the major cleaning is contracted out, daily cleaning tasks still must be performed.


Daily cleaning includes tidying up all areas of the office—reception and waiting rooms, administrative space, physicians’ offices, examination and treatment rooms, and the laboratory.


Sinks should all be toweled dry, and rest rooms should be checked to make sure ample toilet and facial tissue, soap, and paper towels are available. Any spills or puddles on the floor of the rest room should be mopped up using gloves as needed.


Waste containers and recycling containers should be checked daily and emptied as needed. Biohazard sharps containers should be checked daily and replaced when they are three-quarters full. The plastic liners of biohazard waste containers should be changed as needed. Contracted cleaning services will usually not empty biohazard waste containers because they contain regulated medical waste. The medical assistant must handle biohazard waste containers carefully to prevent an exposure incident. The OSHA Bloodborne Pathogen Standard outlines specific actions to take when handling regulated medical waste. These are outlined in Chapter 17.


If the office staff must do more intense cleaning, this should be done at least weekly. These tasks include mopping linoleum floors and vacuuming carpets, cleaning the glass at the reception area, polishing furniture and accessories, dusting, and thoroughly cleaning the rest rooms.


It is important to try to avoid a “medical smell” in the office. This is done by maintaining proper ventilation, as well as by cleaning up spills and accidents immediately, using light or unscented air fresheners in rest rooms and examination rooms, and keeping disinfectants and cleaning materials closed tightly when not in use and out of patients’ reach.



Cleaning Cabinets and Drawers


Storage cabinets, drawers, and bookcases are cleaned less frequently, often on a day when the physician or some of the physicians in the practice are absent so that the room is not in use. After cleaning, the medical assistant should check labels on all items before putting them back on shelves. This is a good time to check for the expiration date on supplies and make a list of any items that need to be ordered or restocked from the general supply area to the cabinet. Outdated supplies must be disposed of properly (Figure 48-2).


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Figure 48-2 Well organized supply cabinet.


What Would You Do? What Would You Not Do?




Miscellaneous Tasks


Among the miscellaneous tasks that have to be performed daily are rearranging the waiting room chairs and replacing magazines in their racks (as well as toys if toys are available); cleaning mirrors in the rest rooms and examination rooms; and cleaning the tops, fronts, and undersides of cabinets and paper towel dispensers. Toys must be cleaned and disinfected on a regular basis, because they can harbor microorganisms.


The medical assistant may be responsible for replacing lightbulbs in gooseneck lamps and other special lighting. Ceiling lighting is usually a responsibility of the maintenance staff employed by the building owner. If the space is owned by the practice, this may be a staff responsibility or may be covered by the cleaning or maintenance contract with an outside service.



Patient and Employee Safety


In addition to maintaining the physical environment of the medical office, it is also vital for all medical facilities to maintain a safe environment both for patients and for employees. This involves several measures.



The following are general guidelines for workplace safety as recommended by the Occupational Safety and Health Administration (OSHA):




Safe Work Practices


The office should have a safety plan, and all employees in the medical office should receive training so that they can carry out their duties correctly. The prevention of the spread of infection is always important. This is discussed in detail in Chapter 17. Equipment should always be checked for frayed electrical cords and used correctly to prevent injury. Hazardous chemicals should be handled and discarded safely as discussed in Chapter 18. Laboratory safety should be maintained according to guidelines in Chapter 29. There should be a plan to respond to spills of blood, body fluids, or chemicals. Areas that are restricted for safety reasons (such as the medical laboratory) should be clearly marked. Employees should report any unsafe condition to their supervisors. Protective equipment is provided by the employer and should always be used by each employee. Chapter 49 will discuss emergency and disaster response in detail.



Highlight on Ergonomics and Worker Safety


A typical working day in a medical office puts a lot of physical stress on personnel. Bending, lifting, reaching, squatting, having a telephone stuck in the crook of the neck, and repeatedly using a typing keyboard put stress on the body. The human body was not designed by nature to perform such activities so frequently.


Common causes for disabling workplace injury include the following:




Ergonomics and Good Body Mechanics


The word ergonomics comes from the Greek root ergon, which means “work.” Ergonomics is the study of maximizing work efficiency by adapting the work environment for optimal physical and mental function. For example, office seating should be designed to provide maximum support for the back, and computer keyboards should be positioned to reduce repetitive motion injuries to the hands, wrists, and arms. But ergonomics does not have to be high tech; it can be as simple as placing a small footstool at the side of an examining table, not only so the patient can step up before sitting on the table, but also so the doctor, who stands and performs examinations for hours a day, can rest a foot there and take pressure off his or her lower back. Ergonomics can also affect selection of shelving and storage units to minimize strain when storing items or removing them from storage. In addition to adapting the environment, good body mechanics promote work efficiency and prevent injury. See the discussion in Chapter 22 of ways to use good body mechanics.




Signs and Instructions


The office should post signs to instruct patients and employees as needed. As defined by OSHA, danger signs indicate that there is immediate danger and special precautions should be taken. These signs must be red on the upper panel with black lettering and a white background. They are more common in construction areas than the medical office. Caution signs warn against potential hazards. They should be predominantly yellow with either yellow lettering on a black background or black lettering on a yellow background. Caution signs should be used if potentially hazardous procedures are performed in the medical office such as x-ray examinations or laser treatments (Figure 48-3). Signs should designate areas where access is restricted. Safety instruction signs (if necessary for employees; e.g., at an eyewash station) should have an upper panel that is green with white lettering. Labels or color-coding should also be used for all biohazard boxes, biohazard waste, and flammable gases. Smoking should not be permitted in a physician’s office, and signs advising patients and visitors that the office is a smoke-free environment should be clearly posted in the waiting area. Exits should be clearly marked, and an emergency evacuation map should be posted near the door to the waiting room. Exit signs should be white with red lettering not less than 6 inches high and image inch wide. Lighted exit signs should be tested by shutting off the lights in the room; bulbs should be replaced if necessary.


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Figure 48-3 Examples of caution signs for radiation and laser radiation.


Monitoring Environmental Safety


Because constant attention is required to maintain a safe environment, it is important to create a procedure to check regularly for potential hazards. A safety checklist is a useful tool for regular safety inspections. It should include the categories to be assessed and have a space to write down any action that needs to be taken. Each part of the office should be checked for adequate lighting, clear walkways, proper storage of supplies, and removal of rubbish and biohazard waste. It is especially important to be sure that heavy boxes have not been stored in a high area where they could fall, that electrical cords are in good repair and do not cause a tripping hazard, and that spills have been attended to promptly. Storage of compressed gases, medications, and chemicals should be assessed according to office policies (Procedure 48-1).



Procedure 48-1   Creating an Environmental Checklist and Performing a Safety Inspection



Outcome


Perform and document a safety inspection after creating an environmental checklist.



Equipment/Supplies





1. Procedural Step. Create a checklist of types of hazards to be inspected for, including obstructed walkways and tripping hazards; electrical hazards; improperly stored boxes; inadequate lighting; wet floors; and improperly labeled and stored biohazards, medications, and chemicals.


2. Procedural Step. Moving from room to room in the designated area, first make a general inspection to be sure that floors are dry and all furniture and fixtures are in good repair. Then make a detailed inspection as required for each section on the checklist. If a problem is found, fix it if possible, but always note the problem on the checklist.


3. Procedural Step. Check for walkways that are wide enough for usual traffic without clutter. Be sure that there are no frayed carpets and no items that obstruct the walkway such as boxes, electrical cords, or debris. Be sure that there are no open drawers or cabinet doors.


4. Procedural Step. Check all electrical cords and plugs to ensure there is no fraying or malfunction.


    Principle. Frayed electrical cords are a potential fire hazard and can cause electrical shocks.


5. Procedural Step. Check all storage areas to be sure that the tops of cabinets are clear and that supplies have been stored without potential to fall and cause injury.


6. Procedural Step. Assess each light to be sure that all lightbulbs are in working order. Note any exceptions. Make a note if it seems that any area does not have adequate lighting.


7. Procedural Step. Depending on the type of area, be sure that all biohazards, chemicals, or other potentially hazardous materials are labeled correctly. Be sure that medication cabinets are locked. Be sure that chemicals are stored in secure areas away from patients.


8. Procedural Step. After completing the checklist, create a written plan to respond to any problems that you could not fix during the inspection.

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Apr 16, 2017 | Posted by in NURSING | Comments Off on The Medical Assistant as Office Manager

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