Practice Issues

December 2010 Journal of Family Practice Editorial Encourages MD/NP Collaboration

An editorial in the most recent issue of The Journal of Family Practice by Dr. Jeff Susman, MD, states that the time has come for MDs to collaborate - not compete - with nurse practitioners. The editorial encourages MDs to embrace full partnership with APNs, in part, to develop innovative models of care that will lead to improved health outcomes for patients. Click on the following to open a link to the editorial.
Collaborate_with_NPs_JFP.pdf.

The Institute of Medicine (IOM) consensus report: The Future of Nursing: Leading Change, Advancing Health", referenced in the editorial can be found via the following link: http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.

CMS Clarifies Physician Supervision Requirements for Hospital Outpatients

The Centers for Medicare & Medicaid Services issued a transmittal May 28, 2010
clarifying its policies requiring physician supervision of diagnostic and
therapeutic services provided to hospital outpatients.

CMS updated certain sections to reflect changes in these policies that were
implemented in the calendar year 2010 outpatient prospective payment system
and ambulatory surgical center final rule with comment.

According to the transmittal, "physician assistants, nurse practitioners,
clinical nurse specialists, and certified nurse midwives who operate within
the scope of practice under state law may order and perform diagnostic tests"
outlined in the Medicare manual and previous guidance. However, they "are not
permitted to function as supervisory 'physicians' for the purposes of other
hospital staff performing diagnostic tests."

The transmittal stated that physician assistants, nurse practitioners,
clinical nurse specialists, and certified nurse midwives only require
physician supervision "included in any collaboration or supervision
requirements particular to that type of practitioner when they personally
perform a diagnostic test."

According to CMS, covered diagnostic services to outpatients include the
services of nurses, psychologists, and technicians; drugs and biologicals
necessary for diagnostic study; and the use of supplies and equipment. When a
hospital sends hospital personnel and hospital equipment to a patient's home
to furnish a diagnostic service, Medicare covers the service as if the patient
had received the service in the hospital outpatient department, CMS said in
the transmittal.

For services furnished on or after Jan. 1, 2010, payment is allowed under the
hospital outpatient prospective payment system (OPPS) for diagnostic services
only when those services are furnished under the appropriate level of
physician supervision, CMS said.

The final rule, issued Oct. 30, 2009, allowed certain nonphysician
practitioners (NPPs)-specifically physician assistants, nurse practitioners,
clinical nurse specialists, certified nurse-midwives, and licensed clinical
social workers-to provide direct supervision for all hospital outpatient
therapeutic services that they are authorized to personally perform according
to their state scope of practice rules and hospital-granted privileges. Under
current policy, only physicians may provide the direct supervision of these
services (209 HCDR, 11/2/09).

The agency in the rule also required that all hospital outpatient diagnostic
services furnished directly or under arrangement, whether provided in the
hospital, in a provider-based department, or at a nonhospital location, follow
the Medicare physician fee schedule's physician supervision requirements for
individual tests.

By Nathaniel Weixel

The transmittal is available at http://op.bna.com/hl.nsf/r?Open=sfak-85zrtw.

Jodie A. Curtis

Senior Government Relations Director

Drinker Biddle & Reath

1500 K Street NW

Washington, DC 20005

phone: 202-230-5147

email: jodie.curtis@dbr.com