"We considered a wide variety of potential modifications to our physician supervision policies in response to this information about current health care delivery practices and challenges. The dialogue with interested stakeholders provided us with sufficient information to develop proposals for certain changes to the supervision policies for hospital outpatient services for CY 2010 in order to take into full consideration current clinical practice and patterns of care, the need to ensure patient access, the associated hospital and physician responsibilities, consistency among requirements for different sites of services, and other important factors."
"Services and supplies must be furnished on a physician’s order and delivered under physician/non physician supervision. Each occasion of a service does not need to also be the occasion of the actual rendition of a personal professional service by the physician responsible for the care of the patient. However, during the course of treatment rendered by auxiliary personnel, the physician/non physician practitioner must personally see the patient periodically and sufficiently often enough to assess the course of treatment and the patient’s progress and, where necessary, to change the treatment regimen."
"For services provided in the hospital or on-campus PBD of the hospital, 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."
"The physician or non physician practitioner must be prepared to step in and perform the service, not just to respond to an emergency. This includes the ability to take over the performance of a procedure and, as appropriate to both the supervising physician or non physician practitioner and the patient, to change a procedure or the course of treatment being provided to a particular patient. The physician or non physician practitioner is not required to be in the room where the procedure is performed."
"For 2010, non physician practitioners (clinical psychologists, licensed clinical social workers, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives) may directly supervise all hospital outpatient therapeutic services that they may perform themselves within their State law and scope of practice and hospital-granted privileges, provided that they meet all additional requirements, including any collaboration or supervision requirements, as specified in the regulations at §§410.74 through 410.77."
"For off-campus PBDs of hospitals or CAH’s, 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. This requirement does not mean that the physician or non physician practitioner must be in the room when the procedure is performed."