CMS Verbal Order 48 Hour Signing Rule In Hospitals Rescinded July 2012!

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services have issued a final rule rescinding the hospital requirement mandating physicians sign  their verbal orders within 48 hours.  I never understood this rule.  By the time a physician signed off the verbal order, the nurse or pharmacist had already implemented the order.

In my 10 years as a hospitalist, I had  never seen a bad outcome that could have been prevented by signing a verbal order within 48 hours instead of 48 days.  Hospitals were spending enormous amounts of  labor and resources trying to stay in compliance with this requirement by diverting  clinical nurses away from the bedside to hunt down doctors for a scribbly signature.  There was a time where I even got woken up from a deep sleep at 3 am to sign a verbal order before the 48 hours was up.  I kindly declined to participate in that madness.

I'm thrilled  to see that CMS has removed this requirement that had become an albatross for doctors everywhere. If your doctor was ever called or paged out of a room while they were evaluating you, don't be surprised if there was someone from the hospital documentation team interrupting your doctor's course of business to stay in compliance with yet another CMS mandate.  Unfortunately, every year they replace one bad rule with 100 others.

This ruling was published in the May 16th, 2012 Federal Register Vol. 77, No. 95 page 29034 in their Rules and Regulations.  As per the publication, the change was implemented as a result of President Obama's executive order in 2011.
Purpose In Executive Order 13563, ‘‘Improving Regulations and Regulatory Review’, the President recognized the importance of a streamlined, effective, and efficient regulatory framework designed to promote economic growth, innovation, job-creation, and competitiveness. To achieve a more robust and effective regulatory framework, the President has directed each executive agency to establish a plan for ongoing retrospective review of existing significant regulations to identify those rules that can be eliminated as obsolete, unnecessary, burdensome, or counterproductive or that can be modified to be more effective, efficient, flexible, and streamlined. This final rule responds directly to the President’s instructions in Executive Order 13563 by reducing outmoded or unnecessarily.
As a result of that Executive Order, CMS implemented multiple changes to their regulatory requirements, one of which was removal of the 48 hour verbal order signing requirement.  These changes became effective on July 16th, 2012.
This final rule revises the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. These changes are an integral part of our efforts to reduce procedural burdens on providers. This rule reflects the Centers for Medicare and Medicaid Services’ (CMS) commitment to the general principles of the President’s Executive Order 13563, released January 18, 2011, entitled ‘‘Improving Regulation and Regulatory Review.’’ DATES: These regulations are effective on July 16, 2012. FOR FURTHER INFORMATION CONTACT: CDR Scott Cooper, USPHS, (410) 786–9465; Jeannie Miller, (410) 786–3164; Lisa Parker, (410) 786–4665; Mary Collins, (410) 786–3189; Diane Corning, (410) 786–8486; and Sarah Fahrendorf, (410) 786–3112.
Here is a screen shot of the Federal Register I  linked above to the  numerous changes implemented in this final ruling.  In text form, it states:
Verbal Orders: We have eliminated the requirement for authentication of verbal orders within 48-hours and have deferred to applicable State law to establish authentication time frames

How much money is this ruling expected to save? In monetary terms, CMS suggests removal of this regulatory burden from the Medical Record Services will save 80 million dollars a year, or 400 million dollars over 5 years.


This is one of those few situations where I can honestly say God Bless the CMS.  Now I can just wait until my verbal orders go into the EHR  and become delinquent before I am forced to take action. Make sure to look at other great resources in my hospitalist resource center for hospitalists. 

With all that crazy policy stuff established, we're left with the really important clinical question to answer. In the old days, or so I'm told, nurses would scribe for physicians' every whim.  But that all changed when the official release of the 2012 New York Times' Best Seller  How To Be That One Nurse With Attitude hit the shelves.  Nurses are no longer accepting verbal orders at the bedside.  Nope.  The new nurse of the 21st century has a bold new attitude on how to approach patient care and physician management.  This nursing ecard below helps explain the transformation of American health care right infront of our eyes.  Instead of blindly writing out doctors' orders and taking a verbal order, nurses of have been instructed to throw the chart in fron of the doctor and have them write their own orders.  Any questions?

"Verbal orders are best handled by throwing the chart in front of the doctor and telling him to write his own damn orders."

Verbal orders are best handled by throwing the chart in front of the doctor and telling him to write his own orders nursing ecard humor photo

"Ever since my hospital implemented computerized physician verbal order entry, my life has been great!"

Ever since my hospital implemented computerized physician verbal order entry, my life has been great doctor ecard humor photo.

These ecards are for entertainment purposes only and likely contain humor only understood by those in a healthcare profession. Read at your own risk. 

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