Can a staff member dispense and fit any DME in my office if I am on the premises?

There is no universal answer to this question which applies to all fifty states. There are several issues one must consider:

1) Each state has their own state scope of practice. Hence one needs to defer to your state and how it defines podiatry. Could the medical assistant be practicing podiatry without a license if they alone do the dispensing?

2) Each state has licensure acts for other professions and podiatry does not practice in a vaccum where it is the only entity subject to state scope of practice.

3) Driling down further, in states which have a licensure act on orthotics and prosthetics, the rules may vary based on what is being dispensed. Is it custom fabricated, custom fitted or off the shelf (note the latter two are considered pre-fabricated) but nevertheless, the rules may be different.

4) Custom fit devices require that the person doing the fitting have the commensurate training to dispense a custom fitted device. Perhaps your medical assistant took the orthotic dispensing and fitting course and passed. But that is a rarity in podiatry practices. More likely they did not. This is thus problematic.

5) Patient risk and your liability carrier: Your insurance carrier may suggest you consider what you are dispensing and the patient type before allowing your medical assistant to dispense a device. Consider one example, where your medical assistant dispensing a therapeutic shoe to a Type I IDDM patient with charcot who already has had a partial foot amputation. You never examined the patient leaves the office only to return a few days later with a new ulcer on their contralateral foot. Is that a position you ever want to be in, regardless of the liabilty carrier's position?

Perhaps an alternative to consider is to have the medical assistant do the inital fitting and education. Then the podiatric physician examines the patient while they are wearing the device, makes the corrections or modifies the device for the final fitting and reaffirms the eductional components. All this would need to be documented. In the case of a therapeutic shoe the medical assistant with double check the order and size the patient to see if fits with the inserts. They could also review the instructions for use, etc. The doctor would then check the fit, heat the inserts to be sure they are full contact and/or ensure the custom inserts are full contact, make sure the fit is appropriate and provide a secondary educational review with the patient.

To sum up the above are but 5 issues to consider (there are more), before you delegate the entire dispensing of DME entirely to a medical assistant.