Can non-privileged providers order outpatient tests?

For years, hospitals have honored the orders written by physicians that are not on their staff – especially for noninvasive outpatient labs and imaging studies. The results would be sent back to the physician who ordered the test. These tests had minimal risk, if any, and it was of benefit to the patient, to the ordering physician, and to the hospital performing the test.

Earlier this year, CMS clarified its position on outpatient testing and how these tests may be ordered. The February 17 outpatient services Condition of Participation clarifications states:
           
We therefore believe it is appropriate to interpret §482.54, (the CoP governing outpatient services, which is also silent on the issue of who may order such services), to mean that orders for outpatient services (as well as patient referrals for hospital outpatient services) may be made by any practitioner who is:

• Responsible for the care of the patient;
• Licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient;
• Acting within his/her scope of practice under State law; and
• Authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body. This includes both practitioners who are on the hospital medical staff and who hold medical staff privileges that include ordering the services, as well as other practitioners who are not on the hospital medical staff, but who satisfy the hospital’s policies for ordering applicable outpatient services and for referring patients for hospital outpatient services.

The operative words in the last bullet point are "authorized by the medical staff" and "under a written hospital policy." This allows for a policy to assign responsibility between the hospital and the medical staff regarding non-staff physicians ordering outpatient services.

Most of the burden is on the hospital side to verify the appropriate licensure. Rarely is this a function of the medical staff office since these capabilities are needed during non-traditional business hours. Hospitals have already been checking for parts of this as part of a policy which usually states as long as the practitioner is licensed, the testing is appropriate for their license, and they have a valid UPIN/NPI number they are allowed to order the test. 

What is needed now is for the medical staff to authorize these actions through policy or their rules and regulations which can state that the medical staff ‘authorizes those practitioners who are not medical staff members to be able to order non-invasive laboratory and radiologic tests per hospital protocol’.

Following these simple guidelines can allow appropriate testing to be done for the patient and still remain within compliance.

Mary J. Hoppa, MD, MBA, is a senior consultant with The Greeley Company.