Cardiac Rehabilitation and physician supervision 

The following question was submitted to Cahaba GBA; the response as stated by Julie Mahony follows:

Must the physician be in the room when cardiac rehabilitation services are performed or may the physician be in the building, or on the campus at the time of service? Would a 24-hour ER physician meet the requirement? Please let me know how Cahaba is interpreting this statement.

Cahaba GBA Response:"According to CMS Pub.6, the Coverage Issues Manual, Section 35-25, cardiac rehabilitation programs may be provided either by the outpatient department of a hospital or in a physician-directed clinic. The facility meets the definition of a hospital outpatient department or a physician-directed clinic, i.e., a physician is on the premises available to perform medical duties at all times the facility is open, and each patient is under the care of a hospital or clinic physician. Services of nonphysician personnel must be furnished under the direct supervision of a physician. Direct supervision means that a physician must be in the exercise program area and immediately available and accessible for an emergency at all times the exercise program is conducted. It does not require that a physician be physically present in the exercise room itself, provided the contractor does not determine that the physician is too remote from the patients' exercise area to be considered immediately available and accessible. An example of where the physician may be considered immediately available and accessible would be the presence of a physician in an office across the hall from the exercise room who is available at all times for an emergency. The presence of a physician in a building other than that containing the exercise room does not meet the requirement that the physician is immediately available and accesible. In reference to the ER physician, would this physician be in the same building? Also, consider whether the physician would be available at all times, even while treating a patient in the ER.

Addendum, January 2004: Dr. John Olds, Medical Director of Cahaba GBA has informed us that a non-physician provider (ARNP, PA) will not suffice for the onsite supervision of cardiac rehabilitation services. This supervision must be either a MD or DO.