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In the words of one of the great poets "Everybody's runnin', but half of them ain't lookin'; it's goin' on in the kitchen, but I don't know what's cookin'." I didn't see this one on the stovetop let me just be the first to admit. The murses and midhusbands can now supervise the radiotherapying completely. I'm reading it in black & white from ASTRO:
"In the 2021 MPFS final rule, CMS is finalizing policy revisions related to the scope of practice for physician fee schedule services that would allow [nurse practitioners, certified nurse specialists, physician assistants, certified nurse midhusbands/midwives] to provide the appropriate level of supervision assigned to [IGRT], to the extent authorized under State law and scope of practice. In accordance with statute, these [non-physician practitioners] would be working either under physician supervision or in collaboration with a physician. According to CMS, this flexibility is designed to increase the capacity and availability of practitioners who can supervise [IGRT], which would alleviate some of the demand on physicians as the only source to perform this specific function.
ASTRO provided CMS with comments expressing concern about patient safety related to this policy. ASTRO has long expressed that the existing supervision levels associated with IGRT services (i.e., codes G6001 (previously 76950), 77014, G6002 (previously 77421), and 76965) should remain in place and require the physician’s presence and participation due to the irreversible nature of radiation therapy. Despite these concerns, the Agency did not feel compelled to change the scope of practice policy for 2021."
My how the specialty of therapeutic radiology, my beloved specialty, has changed in just the last couple of years. I was having some of the minions here do some Googling and the Student Doctor's page on this appears right near the top. (I love time capsuling. It makes me feel young.) Here's what people were saying in 2019 when supervision changed direct to general:
"Bottom line, you want to be as busy as possible with consults, planning and otvs, and you don't need to be physically present for the daily professional igrt charges is how I interpret it. THis is my understanding."
"From my first glance this seems like a seismic shift in language from CMS on this issue - which used to be kind of gray - seeming to give more of an endorsement to mid level coverage. I have this exact scenario - hospital based pro group - and it presents a major change potentially for our group and our multiple hospital based centers."
"'That’s it folks - we are ****ed. Those 150 kids in the match this year should get out while they still can.' You know, it's hard to say that's hyperbole, because I don't see how this ends well for anyone getting out of training now.... We may need <100 graduating residents from here on out assuming CMS follows through with the plan to change things from Direct to General supervision in hospital based RO."
"If that includes freestanding one day, we'll need even less. You won't need locums if you have another partner around, even if they are in a different center, geographically."
Later, ASTRO came out and said (regarding IGRT) that the changes were "more limited than they appear." Toss all that dissembling out the window because CMS just comes right back and is like "Yeah, sorry, they are not limited."
Fortunately I can report based on my ears on the ground and spies that there is still some pretty reliable and predictable ignoring of reality for the time-being. Ignoring reality is of course most therapeutic radiology leaders' favorite pastime. Let's hope it stays this way. For your sake.
"In the 2021 MPFS final rule, CMS is finalizing policy revisions related to the scope of practice for physician fee schedule services that would allow [nurse practitioners, certified nurse specialists, physician assistants, certified nurse midhusbands/midwives] to provide the appropriate level of supervision assigned to [IGRT], to the extent authorized under State law and scope of practice. In accordance with statute, these [non-physician practitioners] would be working either under physician supervision or in collaboration with a physician. According to CMS, this flexibility is designed to increase the capacity and availability of practitioners who can supervise [IGRT], which would alleviate some of the demand on physicians as the only source to perform this specific function.
ASTRO provided CMS with comments expressing concern about patient safety related to this policy. ASTRO has long expressed that the existing supervision levels associated with IGRT services (i.e., codes G6001 (previously 76950), 77014, G6002 (previously 77421), and 76965) should remain in place and require the physician’s presence and participation due to the irreversible nature of radiation therapy. Despite these concerns, the Agency did not feel compelled to change the scope of practice policy for 2021."
My how the specialty of therapeutic radiology, my beloved specialty, has changed in just the last couple of years. I was having some of the minions here do some Googling and the Student Doctor's page on this appears right near the top. (I love time capsuling. It makes me feel young.) Here's what people were saying in 2019 when supervision changed direct to general:
"Bottom line, you want to be as busy as possible with consults, planning and otvs, and you don't need to be physically present for the daily professional igrt charges is how I interpret it. THis is my understanding."
"From my first glance this seems like a seismic shift in language from CMS on this issue - which used to be kind of gray - seeming to give more of an endorsement to mid level coverage. I have this exact scenario - hospital based pro group - and it presents a major change potentially for our group and our multiple hospital based centers."
"'That’s it folks - we are ****ed. Those 150 kids in the match this year should get out while they still can.' You know, it's hard to say that's hyperbole, because I don't see how this ends well for anyone getting out of training now.... We may need <100 graduating residents from here on out assuming CMS follows through with the plan to change things from Direct to General supervision in hospital based RO."
"If that includes freestanding one day, we'll need even less. You won't need locums if you have another partner around, even if they are in a different center, geographically."
Later, ASTRO came out and said (regarding IGRT) that the changes were "more limited than they appear." Toss all that dissembling out the window because CMS just comes right back and is like "Yeah, sorry, they are not limited."
Fortunately I can report based on my ears on the ground and spies that there is still some pretty reliable and predictable ignoring of reality for the time-being. Ignoring reality is of course most therapeutic radiology leaders' favorite pastime. Let's hope it stays this way. For your sake.