The American College of Radiation Oncology (ACRO) believes standards relating to supervision requirements for Radiation Oncology should be grounded in patient safety as radiation doses potentially could be significantly harmful to a cancer patient without direct supervision. Radiation Oncologists are the only physicians comprehensively trained in radiation treatment and management of patients undergoing radiation therapy. For that reason, ACRO endorses direct supervision in all sites of service at the initiation of radiation therapy, which may then be followed by general supervision at the discretion of the Radiation Oncologist.
We believe we are in good company in this viewpoint given that other specialty societies within the Radiation Oncology community also consider direct supervision critical to patient safety. Moreover, when CMS changed the supervision requirements from direct to general in the hospital outpatient setting in 2020, the American Medical Association subsequently passed the following resolution:
RESOLVED, That our AMA advocate that radiation therapy services should be exempted from the Hospital Outpatient Prospective Payment System (HOPPS) rule requiring only general supervision of hospital therapeutic services; and be it further
RESOLVED, That our AMA advocate that direct supervision of radiation therapy services by a physician trained in Radiation Oncology should be required by the Centers for Medicare and Medicaid Services.
At the same time, ACRO does understand that cancer care practice patterns, particularly in rural or small practices, may necessitate exceptions to direct supervision standard after the initiation of treatment. ACRO believes that such exceptions should be at the discretion of the Radiation Oncologist and in furtherance of optimizing patient care across settings (e.g. emergency room visits, tumor board meetings, etc.).
As technology evolves and care delivery changes, ACRO believes that a thoughtful approach to evaluating any changes to Radiation Oncology supervisions requirements is essential. We believe it is of the utmost importance to ensure that the quality and safety of Radiation Oncology care is supervised and delivered by appropriately qualified personnel.
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