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Medscape Medical News >




ASTRO PUSHES RETURN TO DIRECT SUPERVISION IN RT: NEEDED OR 'BABYSITTING'?

Patricia McKnight

March 13, 2024

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The American Society for Radiation Oncology (ASTRO) recently sent a letter to
the Centers for Medicare and Medicaid Services (CMS) opposing the extension of
virtual supervision for radiation oncology services.

Although serious errors during virtual supervision are rare, ASTRO said
radiation treatments (RT) should be done with a radiation oncologist on site to
ensure high-quality care. But some radiation oncologists do not agree with the
proposal to move back to direct in-person supervision only. 


CHANGES TO DIRECT SUPERVISION

Most radiation oncology treatments are delivered in an outpatient setting under
a physician's direction and control. 





During the COVID-19 pandemic when social distancing mandates were in place, CMS
temporarily changed the definition of "direct supervision" to include
telehealth, specifying that a physician must be immediately available to assist
and direct a procedure virtually using real-time audio and video. In other
words, a physician did not need to be physically present in the room when the
treatment was being performed. 

CMS has extended this rule until the end of 2024 and is considering making it a
permanent change. In the Calendar Year (CY) 2024 Medicare Physician Fee Schedule
(PFS) Final Rule, CMS asked for comments on whether to extend the rule. 

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"We received input from interested parties on potential patient safety or
quality concerns when direct supervision occurs virtually, which we will
consider for future rulemaking," a CMS spokesperson told Medscape Medical News.
"CMS is currently considering the best approach that will protect patient access
and safety as well as quality of care and program integrity concerns following
CY 2024."




CMS also noted its concerns that an abrupt transition back to requiring a
physician's physical presence could interrupt care from practitioners who have
established new patterns of practice with telehealth. 


WHAT ARE ASTRO'S CONCERNS?

Late last month, ASTRO sent CMS a letter, asking the agency to change the rules
back to direct in-person supervision for all radiation services, citing that
virtual supervision jeopardizes patient safety and quality of care. 

Jeff Michalski, MD, MBA, chair of the ASTRO Board of Directors, told Medscape
Medical News that radiation oncologists should be physically present to
supervise the treatments.




"ASTRO is concerned that blanket policies of general or virtual supervision
could lead to patients not having direct, in-person access to their doctors'
care," he said. "While serious errors are rare, real-world experiences of
radiation oncologists across practice settings demonstrate how an in-person
radiation oncology physician is best suited to ensure high-quality care."




WHAT DO RADIATION ONCOLOGISTS THINK?

According to ASTRO, most radiation oncologists would agree that in-person
supervision is best for patients. 

But that might not be the case. 

Radiation oncologists took to X (formerly Twitter) to voice their opinions about
ASTRO's letter. 



Jason Beckta, MD, PhD, of Rutland Regional's Foley Cancer Center, Vermont, said
"the February 26th ASTRO letter reads like an Onion article." 

"I'm struggling to understand the Luddite-level myopia around this topic," he
said in another tweet. "Virtual direct/outpatient general supervision has done
nothing but boost my productivity and in particular, face-to-face patient
contact."

Join Y. Luh, MD, with the Providence Medical Network in Eureka, California, said
he understands the challenges faced by clinicians working in more isolated rural
settings. "For them, it's either having virtual supervision or closing the
center," Luh said.



"Virtual care is definitely at my clinic and is not only an option but is
critical to my patients who are 2+ snowy, mountainous hours away," Luh wrote.
"But I'm still in the clinic directly supervising treatments."

Sidney Roberts, MD, with the CHI St. Luke's Health-Memorial, Texas, tweeted that
supervision does require some face-to-face care but contended that "babysitting
trained therapists for every routine treatment is a farce."

Another issue Luh brought up is reimbursement for virtual supervision, noting
that "the elephant in the room is whether that level of service should be
reimbursed at the same rate. Reimbursement has not changed — but will it stay
that way?"



ASTRO has acknowledged that radiation oncologists will have varying opinions and
says it is working to balance these challenges.

CMS has not reached a decision on whether the change will be implemented
permanently. The organization will assess concern, patient safety, and quality
of care at the end of the year.

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Credit

Lead image: Blend Images/Getty Images
Medscape Medical News © 2024 WebMD, LLC


Send comments and news tips to news@medscape.net.

Cite this: ASTRO Pushes Return to Direct Supervision in RT: Needed or
'Babysitting'? - Medscape - March 13, 2024.

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