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April 9, 2020

Supervision Requirements in the 2020 Hospital Outpatient Prospective Payment System: Implications for Cancer Care in the United States

Author Affiliations
  • 1Department of Radiation Oncology, University of North Carolina at Chapel Hill
  • 2Division of Hematology and Oncology, University of North Carolina at Chapel Hill
  • 3Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Oncol. Published online April 9, 2020. doi:10.1001/jamaoncol.2020.0092

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final 2020 rule for the Hospital Outpatient Prospective Payment System (HOPPS), which updates payment policy for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPD).1 Although the policy update is often comprised of incremental refinements, this year’s HOPPS update contains a notable change with potentially widespread effects on cancer care delivery in the US: the final rule lowers the minimum level of supervision for hospital outpatient therapeutic services from “direct supervision” to “general supervision.” Herein we review the impetus behind this change and consider its effect on cancer care in regard to access, safety, and scope of practice.

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