Some Answers and a Hopeful Future: Making Sense of CMS’ Proposed 2021 Physician Fee Schedule

In June I wrote about how the Centers for Medicare and Medicaid (CMS) vowed to expand telehealth services for all Medicare beneficiaries. Although CMS Administrator Seema Verma acknowledged the effectiveness of relaxed telehealth requirements during the COVID-19 Public Health Emergency, analysts were eager to see if these changes would be reflected permanently via the new physician fee schedule.

On August 17, 2020, CMS released its proposed 2021 Physician Fee Schedule for the 2021 calendar. Clocking in at over one thousand pages, the Proposed Rule reflects CMS’ commitment to permanent patient-centric change when it comes to remote and virtual health services. At Vynca, the most exciting proposal is around the expanded definition of direct supervision.

Changes to Direct Supervision

Previously, direct supervision meant that a physician had to be physically present in the office suite and readily available to provide assistance and/or direction to the clinical staff. For advance care planning conversations, this meant that a doctor had to be in the office when a patient wanted to discuss their end-of-life wishes. Although we hope to live in a world where patients can readily connect with physicians, the reality is that many folks forego having these conversations because either the wait-time to see a family doctor is months long, or a doctor simply isn’t available on a non-emergent basis.

With this proposed new rule, a physician can directly supervise his or her clinical staff remotely, through real-time audio-visual technology. A physician can train clinical personnel in advance care planning, and the staff can ensure all new and established patients have updated advance directives, even when the doctor is not “in.” This would instantly provide patients the ability to see their providers and have a discussion around advance care planning. If a question arises during the conversation that cannot be answered by a nurse practitioner or physician’s assistant, the doctor would be available through audio-visual means. Although we may be sick of Zoom and Skype by now, having access to a physician for advance care planning gives patients a tremendous peace of mind during these tumultuous times.

It is important to remember that the document released by CMS on August 17, 2020 is only a proposed rule. The agency is currently soliciting comments from the public through October, at which point the rule will either be adopted, amended, or rejected. If finalized, the change would be in place through either the end of the Public Health Emergency, or the end of 2021, whichever date is later. Regardless of what happens, this proposed rule represents innovation and a renewed commitment to telehealth services.

Alex Paris is legal intern at Vynca. He is a third year law student at Michigan State University College of Law where he is the Notes Editor of the Law Review.