The preamble language in the 2009 OPPS rule generated numerous comments and requests for clarification, which CMS addressed in part in the 2010 OPPS final rule.
In the 2010 OPPS final rule, CMS provided a somewhat more flexible approach than the 2009 OPPS preamble, permitting supervision by certain non-physician practitioners and interpreting direct supervision on the hospital campus or in an on-campus provider-based department (PBD) to mean that “the supervisory physician or non-physician practitioner must be present on the same campus and immediately available to furnish assistance and direction throughout the performance of the procedure." However, for off-campus PBDs of hospitals, CMS continued to require that the physician or non-physician practitioner must be present in the off-campus PBD and immediately available to furnish assistance and direction throughout the performance of the procedure.
Although the 2010 OPPS rule addressed some of the provider community’s concerns, many hospitals commented that, particularly in rural and critical access hospitals (CAHs), requiring a physician or non-physician practitioner to be available at all times is excessively burdensome and difficult to staff if there is no other activity to occupy the physician in the hospital. Further, physicians or non-physician practitioners are not always available when therapeutic services need to be provided, particularly services of long duration.
In response to these concerns, CMS is revising its definition of direct supervision for hospital outpatient therapeutic services to remove reference to “on the same campus" or “in the off-campus provider-based department of the hospital." The revised definition of direct supervision requires immediate availability, meaning the physician must be physically present, interruptible and able to furnish assistance and direction throughout the performance of the procedure, but does not include reference to a particular physical boundary.