For those of you who hang on my every word
(I think that's 3 of you. :) I told you last week that I would be doing an in depth
detailed review of the 1900+ pages in the 2010 OPPS Final Rule which was published
on 10/30/2009. Considering some of what I've researched, it may have been more
appropriately released a day later, but I digress.
One of the 'treats' that you my kind reader can expect for 2010 is in the “direct
supervision” requirement for on-campus and off-campus Hospital Outpatient Departments
(HOPD). I'll get to some of the 'tricks' next week.
You should remember (or lets hope you do) that the 2009 OPPS Final Rule greatly affected
wound clinics that were operating without any direct physician supervision.
Those which were directly supervised by non physician practitioners (NPPs, Nurse Practitioners,
Physicians Assistants, etc) or, worse yet, those which were staffed by wound care
nurses
without any direct supervision
could not bill a facility fee.
Go ahead, do a double-take. If this is *still* the way you practice, PLEASE
STOP. You are committing fraud. If a physician was not present in the 'footprint'
of the wound care department, not the hospital campus, the doctors' lounge doesn't
count, its been clear for over a year that you out of compliance with the regulation
if you drop the facility fee. Now, if a NPP provided the service, they could
still bill for their professional fee, but the hospital could
not bill the
facility fee.
Well, this 2009 clarification to the 2000 rule was not well received by the industry.
You made your voices heard and listening occurred. From the Final Rule:
"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."
Translation: We listened, we changed things.
Remember, for the full text of the Final Rule, browse on over to
http://federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf.
If reading 2000 pages of dry text isn't your thing, head on over to
http://www.Intellicure.com and
give our sales team a ring. We have some great options on our Business Consulting
Services. Ok, enough with the shameless plug, back to Direct Physician Supervision.
Great, so what's that mean to me?
So, in summary, there are three points of clarification in this rule pertaining to
direct supervision all of which will be effective January 1, 2010:
1. Physicians Orders"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."
Ok, so it can be a NPP, big change, but what's the first question on most people's
minds? Exactly, what does immediately available mean? Those of you who have been operating
hyperbaric departments for more than a few years will remember that "immediately available"
most directly translates into that person cannot be performing another procedure or
service that he or she could not immediately interrupt.
"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."
Still looking for it to be spelled out more clearly in black and white?
"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."
Ok, for those of you operating a HOPD off-campus, don't expect any miracles.
Medicare only made a minor modification to also allow NPPs to provide direct supervision
of the services that they may perform themselves in those locations.
"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."
That's all for this week. Check back next week to hear what is being planned
for enforcement for those HOPDs not in compliance for the last decade.
