The proposed rule would relax several physician supervision requirements, especially for small critical access hospitals, rural health clinics and federally qualified health centers. For example, those facilities would no longer need a physician onsite once every two weeks. The administration recognizes that geographical location makes this difficult and that advances in telemedicine allow physicians to provide care without being physically present. “Today’s proposed rule is an important step forward in further reducing burdensome requirements to hospitals,” said AHA President and CEO Rich Umbdenstock in a statement. He added that the changes will be particularly welcomed by small and rural hospitals. This past October, the American Hospital Association (AHA) called on the Centers for Medicare & Medicaid Services (CMS) to relax direct supervision requirements for specific procedures. In the proposed rule, CMS removes the word “direct” from supervision requirements for the in-house preparation of radiopharmaceuticals. Other key provisions include:
- Permitting registered dietitians to order patient diets independently, without requiring the supervision or approval of a physician or other practitioner. This frees up time for physicians and other practitioners to care for patients.
- Eliminate unnecessary requirements that ambulatory surgical centers must meet in order to provide radiological services that are an integral part of their surgical procedures, permitting them greater flexibility for physician supervision requirements.
- Eliminate a redundant data submission requirement and an unnecessary survey process for transplant centers while maintaining strong federal oversight.
The AHA also applauded CMS for proposing to rescind a regulation requiring that hospital governing boards include a member of the medical staff. “While most hospitals have physicians on their governing boards, CMS recognized that the requirement was not feasible for all hospitals,” Umbdenstock said. “CMS revamped the requirements to focus on the need for good communication between governing boards and medical staff members about patient care.” The AHA did have one complaint. The association is disappointed the proposed rule does not allow hospitals in multi-hospital systems to have single integrated medical staff structures. “Hospitals are delivering more coordinated, patient-centered care and CMS should not let antiquated organizational structures stand in the way,” Umbdenstock said.
