ASTRO has releaed some more formal guidance on the physician supervision requirements specific to radiation oncology - it's structured as a Q&A, and responds to some of their members most frequently asked questions. You can access it here.
Notably, they still hedge on some of the biggest questions, namely when it comes to suprevision of radiation oncology, does the supervising clinical HAVE to be a radiation oncologist? Their approach is to say that if it is a radiation oncologist, you know you're okay, but that it can be other clinicians if it is "clinically appropriate" and within their scope of practice. Unfortunately, they do not provide any additional guidance on what is required to be "clinically appropriate." Those of you that read this blog regularly know that this is the main grey area (see our webconference on Complying with Physician Supervision Requirements)
CAH Hospitals Exempt
Notably, CMS has also released notice that critical access hospitals are exempt from these requirements (more specifically that CMS will not be enforcing the supervision provisions at CAH hospitals).
Those of you who attended our 2009-2010 National Meeting series know that we profiled the work of the Patient Advocacy Foundation (PAF) for their efforts assisting uninsured and underinsured patients. PAF has just recently launched a new tool that "is intended to help underinsured individuals and families locate valuable resources and seek alternative coverage options or methods for better reimbursement." The tool, which is called the National Underinsured Resource Directory, is available free of charge from PAF's web site.
Users can search for assistance programs with key words (e.g. cancer) or by completing a questionnaire with information about the patient. The questionnaire prompts users to input basic information including demographics, insurance status, diagnosis and financial needs. As each question is answered, the tool displays the number of assistance programs for which the patient is eligible. Once the questionnaire is complete, the tool generates a report listing all matching assistance programs and their contact information.
The NAPBC has announced some changes to their standards which will be effective January 1, 2011. The one that caught my eye is they will require 80% of appropriate patients be referred for a plastic surgery consult. Unfortunately I can't find any additional details on the new standard, but this could raise the bar for programs seeking certification as securing access to plastic surgery consults can be particularly challenging, a fact we highlighted in our most recent work on breast cancer, Next-Generation Breast Cancer Strategy. Increasingly, plastic surgeons prefer to spend more of their time on cosmetic procedures, and thus are reluctant to dedicate time to reconstruction consults. Those programs seeking accreditation will likely need to start planning now to ensure they can achieve this new standard.