Comment Letter on CY 2023 Physician Fee Schedule Proposed Rule

The Alliance for Connected Care submitted comments on the Medicare Physician Fee Schedule (PFS) Proposed Rule for calendar year (CY) 2023, which includes several important reforms with respect to telehealth.

The Alliance emphasized the following overarching priorities:

While we appreciate and support the effort from CMS to create more temporary Category 3 codes (and its proposal to retain these codes through the end of CY 2023), we are disappointed CMS did not find sufficient clinical benefit to add any of the proposed Category 1 or Category 2 codes. We continue to believe these temporary codes do not represent the forward movement on telehealth needed. The Administration should be moving to create the stability and predictability needed for health care providers and patients to plan for future health needs. Additionally, we believe that the lack of forward movement on codes does not align with the significant body of evidence that has developed around the usage of telehealth services and their impact on quality and patient access.
While we recognize statutory requirements exist, we remain concerned with steps taken by CMS around in-person visit requirements and we encourage CMS to apply these requirements to the minimum extent required by law. The Alliance and its members strongly believe that an in-person requirement constrains telehealth from helping individuals that are homebound, have transportation challenges, live in underserved areas, or have other needs. This reduces access for those who need it the most, while allowing access for those capable of in-person care.
There continues to be a misconception among many that telehealth is separate and different from in-person care. It is not. It was shown during the pandemic that Medicare telehealth services were used simply as a different modality for a patient’s existing providers to improve access and maintain continuity of care. Given this evidence, we believe limiting non-facility providers to a lower facility payment rate for telehealth would have the effect of disincentivizing telehealth usage by a patient’s existing in-person provider and undermining opportunities to increase patient access.
We strongly support the continued availability of direct supervision through telehealth. The option for virtual direct supervision has been proven to be a meaningful tool to maintain teams remotely during a public health emergency. However, this expansion of health system capability is needed for more than just public health emergencies – it is also a meaningful tool to meet health care workforce challenges – both in the delivery of care and to grow the workforce through more flexible academic settings.

Please find the full comments below or here.