Adult supervision encouraged.

Top Line: Who’s covering the clinic tomorrow morning? 

The Final Rule: Most of us are familiar with the intricacies of Medicare supervision requirements specifying radiation as a therapeutic service that requires “direct” supervision in both hospital-outpatient departments and free-standing centers. Direct supervision basically means that a provider is “immediately available” to direct the service but doesn’t have to physically be present in the room. Now, CMS has released a final rule for 2020 that relaxes supervision requirements for all hospital-outpatient (as opposed to free-standing) clinics to “general.” General supervision means that the plan of care is directed and overseen by the treating physician, with no specific requirements on his/her presence during treatment. The rationales are 1) a two-tiered system already exists where rural and critical-access hospitals have general supervision requirements and other hospitals have direct supervision requirements, and 2) the quality of therapeutic services at the former doesn’t appear to have been adversely affected by the relaxed requirements. Despite commentators suggesting that highly complex things like radiosurgery might deserve more than general supervision, CMS decided to keep things simple and apply one rule across the board. Instead, they put their faith in the discretion of hospitals and providers to continue requiring higher standards of supervision when called for. While most will likely do just that, there may be some bad actors who take it too far. 

TBL: Based on the CMS HOPPS final rule for 2020, radiation therapy can be delivered in all hospital-outpatient clinics under more lenient “general” supervision. | CMS 2019