The 2011 OPPS final rule was released on November 2, 2010, and has made several changes to physician supervision requirements for hospital outpatient services. Most hospitals will welcome the new changes which generally provide some relief to the strict physician supervision requirements. These changes are effective January 1, 2011.

First, the OPPS final rule has changed the definition of "direct supervision" for on-campus hospital outpatient departments and off-campus provider-based departments (PBDs). The definition of direct supervision has been revised simply to require immediate physician availability, meaning that the physician is physically present, interruptible, and able to furnish assistance and direction throughout the performance of the procedure but without reference to any particular physical boundary. As a result of the change, physicians providing direct supervision in on-campus outpatient departments will no longer be limited to the hospital's campus. So long as the physician remains physically available, interruptible and can provide assistance at any notice, the direct supervision requirement will be met. Similarly, physicians providing direct supervision in off-campus PBDs will no longer need to remain within the walls of the off-campus PBD to meet the new definition of direct supervision. This change provides hospitals some additional flexibility with regards to direct supervision requirements. Please note, however, this change does not impact the direct supervision requirements for physician practices, which still require a physician to be within the office suite and immediately available to perform direct supervision services.

Second, the OPPS final rule has stated that CMS will not enforce the direct supervision requirements for therapeutic services furnished in critical access hospitals (CAHs) and certain rural hospitals during 2010 and 2011. This change extends and expands the enforcement delay that CMS previously announced in March.

Third, the OPPS final rule has established a new category of services called "non-surgical extended duration therapeutic services," which require direct physician supervision during the services' "initiation period." The initiation period has been defined as the "beginning portion of the non-surgical extended duration therapeutic service which ends when the patient is stable and the supervising physician believes the remainder of the service can be delivered safely under general supervision without the physician's presence on the hospital campus or in the PBD of the hospital." Some examples of non-surgical extended duration therapeutic services include therapeutic injections, subcutaneous infusion and intravenous infusion.

Finally, the OPPS final rule announced that CMS is considering using CMS’ Federal Advisory Panel on Ambulatory Classification Groups (APC Panel) as the independent technical committee that would review requests for consideration of supervision levels and make recommendations to CMS regarding the appropriate levels.

The changes to the 2011 OPPS final rule prove that provider comments made in response to the 2011 OPPS proposed rule have influenced CMS' view on certain physician supervision requirements. For a copy of the 2011 OPPS final rule, visit