Albany Medical Center Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, Sept. 21 -- Peter R Cole, associate professor and chief of Gynecology Division at the Albany Medical Center, New York, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Medicare Program: CY 2021 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; etc". The comment was posted on Sept. 19, 2020:

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I am writing in support of the proposed CMS rules that would expand telehealth services for Medicare eligible patients and make permanent some of the changes implemented by President Trump's Executive Order during the Public Health Emergency related to COVID-19.

According to law firm Holland and Knight, before the public health emergency, according to CMS, approximately 13,000 beneficiaries in fee-for-service (FFS) Medicare received telemedicine in a week. In the last week of April, nearly 1.7 million beneficiaries received telehealth services. The massive increase proves that telehealth care has become a vital link between providers and patients who are unable or unwilling to leave their homes. As the COVID-19 crisis continues, it is imperative that we continue to outreach to our community in new ways that are safe, effective, and supportive.

I am Chief of Gynecology at Albany Medical Center, northeastern New York's only academic medical center and Level 1 trauma center. As a referral center, we care for patients who frequently live great distances from our facility (over 50 miles is common). Furthermore, many of our patients have limited transportation options. At Albany Medical Center, we are committed to attaining the highest standards of quality in care delivery. A significant barrier to patients is transportation and access. Many of the visits can be performed virtually, eliminating that barrier to care.

There are several key areas that CMS' proposed change will have a lasting, positive impact on how I am able to treat my patients and continue to provide substantive, quality care via telehealth:

* Direct Supervision via Telehealth and Incident-to-Billing: This proposed change would not require the physician to be physically present in the building, but instead can continue to support and supervise from a distant location. While CMS has acknowledged that the regulations currently do not forbid providers from billing telehealth services incident-to their services, the definition "direct supervision" requires on-site presence of the billing provider.

* Communications Technology-Based Services (CTBS). CMS is proposing to expand the list of providers able to bill for telehealth services to include licensed clinical social workers, clinical psychologists, physical and occupational therapists and speech language pathologists who bill Medicare directly for their services. This would make permanent coverage now allowed under emergency waiver. Oftentimes patients require multiple avenues of care from an entire team of specialists. Enabling these providers to bill through tele-health will enable a fully comprehensive treatment regimen, and we are fully supportive of this rule change becoming permanent.

* Expanding outpatient surgeries: under this part of the proposal, CMS would eliminate the "Inpatient Only list," where Medicare will only pay for a service if it takes place in the hospital inpatient setting. The decision where a patient would have the surgery would be up to the provider, CMS said. Ambulatory surgery centers would also see 11 additional procedures they are allowed to bill for Medicare beneficiaries. We fully support this proposed change.

* Emergency Limitations for Nursing Facility and Hospital Inpatient Services. CMS is proposing to increase the frequency of nursing facility care services provided via telehealth from once every 30 days to once every three days, to be in line with current rule surrounding Hospital Inpatient Services. However, we believe that the 3 day rule for HIS needs to be eliminated completely, and allowances for telehealth visits to be as needed and determined by the health care provider. Oftentimes there needs to be immediate follow-up between a provider and patient. Not having to wait 3 days will enable the providers to determine how and when a patient needs follow-up without worrying about the 3 day lag.

The health care community has shown through the COVID-19 crisis that we can be adaptable to the many needs of our patient population. The increased use of telehealth during the past months has shown that not only are telehealth services safe, but that they are a creative and efficient way to deliver the best possible care to our community while supporting their desire to stay away from the in-person based scenarios. The new proposed rules will support our mission and ability to deliver care that is second to none.

I appreciate your consideration of these reforms.

Sincerely,

Peter R Cole, MD, FACOG

Associate Professor

Chief, Division of Gynecology

Albany Medical Center

Albany, NY

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The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2020-0088-1604

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