CMS defines "initiation of the service" as the beginning portion of a service. It ends when the patient is stable and the supervising physician or appropriate non-physician practitioner believes the remainder of the service can be delivered safely under his or her general direction and control without the physician's physical presence on the hospital campus or in the PBD of the hospital.
This new category of services does not currently apply to CAHs or rural hospitals because CMS has temporarily suspended enforcing physician supervision requirements for them—which makes its decision to finalize this change a little difficult to understand, Shah says. "Why did CMS really need to move forward with this now given that it is convening a group to look at supervision requirements across services beginning in 2012?"
Convening a panel to determine supervision requirements
In the rule CMS discusses that commenters asked about other services, such as wound debridement and pain management. In addition, commenters suggested that CMS not make the decision about supervision levels in a vacuum. CMS agreed and as a result will form a panel to review the supervision requirements for all outpatient services.
"This adds another layer to the process and may be another case of be careful what you ask for ? providers should seek clarification from CMS what the panel's charge will be when recommending supervision requirements. Is it possible that the advisory panel could also recommend reducing the payment for those services that move to general supervision since they would be considered to be low risk and may use less resources?" Mackaman says.
CMS is seeking comments on who should make up the advisory group and the criteria that they should use when determining supervision levels for outpatient services. "I don't know how many people are going to weigh in, but I think it's critical that we provide feedback on who should be on such a panel and what sort of criteria they should use," Shah says.