CMS eases supervision rules for ASCs, radiopharmaceutical prep

In a final rule intended to reduce unnecessary regulatory burden, CMS has abandoned the radiologist oversight requirement for radiologic services performed in ambulatory surgical centers (ASCs), report attorneys Paul Pitts, JD, and Thomas Greeson, JD, Reed Smith, Falls Church, VA. The new rule instead requires ASCs to appoint a qualified individual under state law who can assure that services performed as integral to surgical procedures are provided under the ASC Conditions of Coverage.

Radiologists are likely to greet the news with relief, Greeson told via email. “We put together medical director agreements for them primarily as an accommodation to the surgeons in their communities,” Greeson said. “Consequently, ACR did not oppose the rule change. The ASCs are likely to appoint a physician member, a surgeon, perhaps, of the ASC medical staff to be responsible for the radiology oversight.”

Currently, ASCs must have procedures in place that meet the hospital Conditions of Participation (CoPs) for radiologic services, which require that a qualified full-time, part-time or consulting radiologist supervise the ionizing radiology services and interpret “only those tests determined by medical staff to require a radiologist’s specialized knowledge.”

Many ASCs have found the oversight requirement overly burdensome due to challenges in finding a radiologist willing to supervise the ASC radiologic services provided, CMS states in the final rule.

Radiologist supervision services cost ASCs an average of $4,000 per quarter, according to CMS estimates. “For some radiologists, the change could result in the loss of revenue,” Pitts said via email.  “However, in our view, the majority of radiologists perform these supervisory services primarily as an accommodation to the surgeons in their communities.”

ASCs are likely to appoint a surgeon from the medical staff—many of whom are owners— to the oversight position, Pitts said via email.

Initially, Pitts and Greeson point out, CMS proposed allowing any MD or DO qualified under state regulations to supervise radiology services. The final rule broadens the pool of potential supervision candidates, but they must be qualified under state law to supervise safety precautions against radiation hazards, regular equipment inspection and hazard correction, regular review of radiation workers for exposure, use of equipment and maintenance of imaging results or records, Pitts and Greeson state in an article posted on the ReedSmith web site.

CMS also heeded recommendations from the Society of Nuclear Medicine and Molecular Imaging to remove the word “direct” from current hospital nuclear medicine services CoPs that require in-house preparation of radiopharmaceuticals to be performed by or under direct supervision of a trained registered pharmacist, MD or DO. According to the article, the presence of a pharmacist, MD or DO will no longer be required during the delivery of off-hours nuclear medicine tests.