On November 2, 2010, the Centers for Medicare and Medicaid Services ("CMS") released a display copy of its FY 2011 Outpatient Prospective Payment System ("OPPS") final rule.  In the 2011 OPPS Final Rule, CMS included a significant change relative to the definition of direct supervision of outpatient therapeutic services.  Starting in 2011, a physician will no longer need to be within certain hospital boundaries in order to provide supervision.  For example, a physician may now supervise an off-campus infusion department from his/her adjacent office suite.

The new definition of direct supervision reads as follows:

For services furnished in the hospital or CAH or in an outpatient department of the hospital or CAH, both on- and off-campus...'direct supervision' means that the physician or nonphysician practitioner must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician or nonphysician practitioner must be present in the room when the procedure is performed.

Immediately available is defined as physically present, interruptible, and able to furnish assistance and direction throughout the performance of the procedure.  By removing terms such as "on the same campus" or "in the off-campus provider-based department," CMS has removed the boundaries that previously challenged providers when trying to meet the physician supervision rules, particularly in off-campus departments located adjacent to physician offices.

What does this mean for hospitals?  Provided that the physician or non-physician practitioner meets the immediate availability criteria discussed above, then he/she may be located in a non-hospital building or office during the procedure.  This is particularly helpful for off-campus infusion centers.

We anticipate that this change will positively impact a significant amount of providers.  Therefore, we urge you to review your current supervision structures in light of the new rule.  If you have questions, please feel free to call Lyndean Brick or Kyle Vasquezat (815) 727-3355.  Murer Consultants, Inc. is happy to work with providers to assess the impact of the final rule and to implement changes, as necessary.