CMS Concedes to Relax Outpatient Physician Supervision Requirements for 2010 – FINAL RULE

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GREAT NEWS!!!!! Just when we all thought CMS was going to continue their draconian requirements for physician supervision of outpatient hyperbaric treatments (i.e. Physician needs to be in the department while HBO treatments were ongoing), they actually went the opposite direction. It didn’t come easy, it took much protest from some of the largest physician groups and health care organizations in the country to convince CMS that the rules were going to make access to care almost impossible for Medicare beneficiaries.

From CMS:
Supervision of Hospital Outpatient Services:

* Supervision requirements for outpatient services – In order to ensure that hospital outpatient services are appropriately supervised by qualified practitioners while not impeding beneficiary access to these services, and in response to concerns raised by the hospital community, CMS is revising or further defining several current policies for the supervision of outpatient services. First, in CY 2010, CMS will allow certain nonphysician practitioners ‑ specifically physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers ‑ to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.

For purposes of on-campus hospital outpatient therapeutic services, CMS is defining “direct supervision” to mean that the physician or nonphysician practitioner must be present anywhere on the hospital campus and immediately available to furnish assistance and direction throughout the performance of the procedure. For services furnished in an off-campus provider-based department, “direct supervision” would continue to mean that the physician or nonphysician practitioner must be present in the off-campus provider-based department and immediately available to furnish assistance and direction throughout the performance of the procedure.

READ THE ORIGINAL POST HERE (AUG 2009)

READ THE NEW UPDATE HERE (NOV 2009)

READ IT STRAIGHT FROM THE HORSES MOUTH HERE (CMS LINK)

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2 thoughts on “CMS Concedes to Relax Outpatient Physician Supervision Requirements for 2010 – FINAL RULE

  1. I’d be interested in getting peoples thoughts on this ruling(how about a poll Roque). Is it a good idea , in that it gives you the HBO MD a little more flexibilty, if he/she needs to go somewhere in the hospital for say a consult(carrying a pager of course. Or are we never going to see the attending physician again.

    • People should be happy with this ruling because in 2009 someone (Medicare/CMS) snuck in a new rule that required physicians to physically be in the department in order to supervise HBO treatments. The rule (thankfully) did not just cover outpatient HBOT, it covered a wide variety of outpatient therapies in all hospitals across the USA. This prompted the AMA and large hospital associations to fight back and request a restructuring of the rule. The 2009 rule would have broken the bank of every hospital, physician, and outpatient department because it required the MD’s to sit in one place and waste time (time is still money) and not be very productive.

      HBO MD’s have always been pretty flexible when it comes down to supervising HBO treatments – at times a bit too flexible. The problem arises when the supervising MD is in surgery or in the Emergency Room while supervising the HBO treatments, this is a problem because one cannot possibly leave in the middle of surgery or a life saving event in the ER if a patient in the chamber has an emergency or complication that requires the physicians direction.

      The new rules are very specific and it clears up any confusion of where a physician that supervises HBOT can and cannot be. More so than that, it creates a little more flexibility for other non-physicians to cover HBOT (I still do not get why they did not add Podiatrists to the list). Where a major problem will arise is if the HBO department is across town or not located on the hospitals campus, supervising MDs need to be in the department in order to supervise these treatments. This part may hurt physicians in a hospital outpatient center not located on the hospitals campus or it may increase the potential for a non-physician practitioner depending on how you see things.

      I hope this helps,

      Roque Wicker

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