Did you know that many hospitals have special supervision requirements for their outpatient services – including nursing care? Special requirements for “direct” supervision by physicians and other health care providers particularly affect nursing services, observation units, and critical access hospitals (CAHs). ANA has advocated to rescind or improve these requirements, which can affect nurses’ ability to provide IV therapy, chemotherapy, and other nursing care in hospital outpatient and observation units. The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule maintaining the requirement, with minor changes.

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A new Medicare policy went into effect in 2010, requiring physicians to be physically present in order to reimburse care given to patients in hospital outpatient and observation units. The rule is causing severe hardship for nurses and their patients who need to receive chemotherapy, IV therapy, and other treatments in observation and other hospital outpatient units — particularly in rural areas where patients and physicians must travel long distances.

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