Supervision requirements do not harm rural and critical access hospitals, the Medicare advisers to Congress found.
Staff at critical access hospitals say direct supervision requirements do not put a significant economic burden on hospitals or limit health services, the Medicare Payment Advisory Commission (MedPAC) said in its mandated December report to Congress. The findings contrast with concerns expressed by hospital associations, including the American Hospital Association and Federation of American Hospitals.
Outpatient therapeutic services must be “directly supervised” by an appropriate physician who is “immediately available to furnish assistance and direction,” the Medicare agency clarified in 2009. Hospital groups have stressed that critical access and small rural hospitals have insufficient staff to properly comply with the policy.
In contrast to hospital association statements, MedPAC said: “The representatives we spoke with indicated that [critical access hospitals] face challenges recruiting physicians to staff their hospitals, but they said that the direct supervision requirements for outpatient therapeutic services are not limiting the types of services they provide.”
For several years, the requirement was unenforced, with the latest moratorium on enforcement expiring in 2016. In November 2017, the Centers for Medicare & Medicaid Services again placed a two-year moratorium on enforcement of the requirement.
Audrey Smith, executive director of the Critical Access Hospital Coalition in Washington, told me she disagrees with the commission’s findings and added that proper physicians may not always be available.
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