Todd Scarbrough, Radiation Oncologist at Northeast Alabama Regional Medical Center, shared on X/Twitter:

“As of yesterday new policy went in place for freestanding RT centers, and IGRT in hospitals, for AL, GA, TN, NC, SC, and VA: Radonc needs to be 1-2 mins from the linac. Up in air is virtual supervision and other differing CMS policies.

As a reminder, ASTRO said no virtual supv after PHE ends in 2020, but supported extending past PHE (at least for some time) come 2023.

Now what are we left with We have supv levels in hosps (none=general) different fr freestanding (direct or virtual direct) and some “freestands” are hosp! We have IGRT supv by RNs, midwives, NPs, PAs in hosp. Direct is now 1-2mins in some states, and tele-OTVs are canceled?

Supervision is big ‘ol smelly mess, a patchwork of conflicting rules and regulations with an accompanying miasma of opinions (especially with this new LCD). ASTRO differs from CMS, and the LCD “from CMS” differs from CMS guidance. LCA A59350

I am not saying outright this is smoking gun.
But the gun is hot.
Below you have the new LCA guidance, and a 2019 opinion from ASTRO about supervision.
They are identical, so ASTRO did “help” (directly or indirectly) to write this (weird) policy. This is problematical in my opinion.

Again, made all the more problematical by ASTRO now being (at least temporarily) in favor of virtual direct for everyone. Also don’t forget OTV telehealths (ok in this LCD/LCA? Not ok?)
ASTRO (essentially) saying that this LCD and LCA as written will be “confusing” at least.

Stay tuned to Jason Beckta‘s podcasts “Out of the Basement” to stay up to date on the current and present histories of supervision in Radonc (although integral calculus is may be easier to understand, digest).”

For more details click here.
Source: Todd Scarbrough/X