Radiology Business Management Association urges CMS to permanently allow remote supervision of imaging exams

The Radiology Business Management Association is urging the federal government to permanently allow for the virtual supervision of certain diagnostic imaging exams. 

The Centers for Medicare & Medicaid Services first started allowing this perk in response to the COVID-19 pandemic, with providers able to oversee exams using real-time audio and visual technology. CMS extended this flexibility through 2025 under the proposed physician fee schedule released in July.  

However, in comments submitted to the federal agency Sept. 3, RBMA made the case for permanent remote supervision, citing workforce challenges as a key factor. 

“During this time, radiologists across the country have used this flexibility to enable patients access to safe and reliable imaging services, despite the nationwide radiologist labor shortage, which continues to worsen,” RBMA’s president and co-executive directors wrote to CMS Administrator Chiquita Brooks-Lasure. “It should also be noted that without this flexibility in place, the continuing national radiologist labor shortage will require imaging providers to reduce imaging center hours of operation, or even close centers, restricting or delaying patient care.”

RBMA leaders said permanent virtual oversight should apply to all diagnostic exams that require direct supervision (i.e., level 2 tests).  Over the past four years since the pandemic started, hospitals, physician offices and freestanding imaging centers have safely made this practice change. They see remote supervision as an “excellent innovation that drives patient access” without leading to imaging overutilization. CMS currently requires supervision by a physician or other advanced practice provider, if state law permits. This applies to all settings except for independent diagnostic testing facilities, which require a radiologist or other physician proficient in the performance and interpretation of level 2 tests. 

“If CMS is concerned about patient safety in making the policy permanent due to contrast reactions, RBMA supports additionally amending Section 410.32(b)(3)(ii) to require that virtual direct supervision be coupled with a qualified person…,” RBMA leaders wrote, noting that this could be a rad tech, nurse or nonphysician practitioner with certification and training in responding to adverse reactions. 

RBMA recently conducted an informal survey of members, which found that many are making use of virtual direct supervision for imaging exams that use contrast. Zero respondents reported a negative impact to patient care or reduction in their ability to respond to reactions. About 30% of those surveyed said the response time was faster in virtual scenarios than exams using on-site supervision. 

“RBMA would like to note that program integrity and utilization is not going to be negatively impacted by making the virtual direct supervision for imaging services permanent,” RBMA noted. “That risk is guarded by the requirements at 42 CFR 410.32(a) that limit the test ordering authority only to the patient’s treating physician or practitioner (and not the supervising physician or other staff of the imaging services provider).”

The American College of Radiology also recently urged CMS to make remote supervision of level 2 tests permanent. ACR said it recognizes that flexibility is needed for practices that deliver care to rural or underserved populations that may experience access issues. In its Sept. 6 comment letter, the college also emphasized the importance of having a trained professional available on-site to oversee contrast administration. 

CEO Dana Smetherman, MD, MBA, noted that on-site personnel should continue to be “part of radiologist-led teams.” ACR believes the feds should ensure that any advanced practice registered nurses or physician assistants are working alongside physicians to ensure patient safety. 

“Making the definition of direct supervision to permit the presence and ‘immediate availability’ of the supervising practitioner through real-time audio and visual interactive telecommunications permanent will help ensure after-hours access to radiology services,” Smetherman wrote. “Additionally, virtual supervision services will allow for better access to services across rural areas where access issues persist. The ACR maintains the importance of patient safety while allowing for access in underserved areas.” 

Read previous coverage of this issue at the links below.