At the beginning of the COVID-19 pandemic, in an attempt to reduce resource strain on the healthcare industry, CMS altered the definition of direct supervision to allow for virtual presence through real-time audio/video communication. Given the absence of evidence that patient safety is compromised by virtual direct supervision, CMS finalized the extension of virtual supervision through at least December 31st, 2024 - signaling their recognition of the safety and efficacy of virtual direct supervision.
In April 2020, CMS published the Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency. In that publication, among other policy changes, CMS altered the definition of direct supervision, the type of supervision required under Medicare Part B for Level II exams (i.e. contrast-enhanced exams), to include virtual presence through audio/video real-time technology.
In August 2023, CMS published the 2024 Medicare Physician Fee Schedule (MPFS) Proposed Rule. In that publication, CMS stated:
“...In the absence of evidence that patient safety is compromised by virtual direct supervision, we believe that an immediate reversion to the pre-PHE definition of direct supervision would prohibit virtual direct supervision, which may present a barrier to access to many services, such as those furnished incident-to a physician's service. We believe physicians and practitioners will need time to reorganize their practice patterns established during the PHE to reimplement the pre-PHE approach to direct supervision without the use of audio/video technology. Recognizing these concerns, we are proposing continue to define direct supervision to permit the presence and “immediate availability” of the supervising practitioner through real-time audio and visual interactive telecommunications through December 31, 2024...”
Furthermore, CMS cited concern about an abrupt transition to the pre-PHE (Public Health Emergency) policy given that imaging centers and practitioners have established new patterns of practice during the COVID-19 PHE.
Finally, in October 2023, CMS published the 2024 calendar year Medicare Physician Fee Schedule (MPFS) Final Rule. In that publication, CMS reaffirmed and finalized the expanded definition of direct supervision to include virtual presence through real-time audio/video real-time technology, and will continue to meet CMS’ direct supervision requirements through at least December 31st, 2024
While the altered definition of direct supervision is set to expire at the end of 2024, CMS has now extended the policy twice since April of 2020. Advocates in favor of virtual supervision believe the repeated policy extensions symbolize a gradual and imminent shift toward permanently allowing virtual direct supervision. Allowing virtual direct supervision has many positive implications for both patients and imaging centers. For patients, virtual direct supervision allows for more options when it comes to getting their imaging studies in rural and underserved areas where access to healthcare has historically been challenging. For imaging centers, allowing virtual direct supervision alleviates logistical difficulties and increases the number of patients a facility can scan if taking advantage of extended scan hours.
In support of its rule, CMS noted the new patterns of practice many practitioners established during the COVID-19 pandemic, the absence of evidence that patient safety is compromised, and the agency's concern that an immediate reversion to the pre-COVID-19 policy could limit access to services for many people. Further, the extension aligns with many other pandemic-related telehealth policies enacted and extended by Congress.
CMS' Final Rule illustrates their continued recognition of the safety and efficacy of virtual direct supervision. While the policy is set to expire at the end of 2024, CMS' continuance of the virtual direct supervision policy hints at a strong possibility of it becoming a permanent part of direct supervision. We firmly believe that the ruling will become permanent given the clear benefits to improved patient access, reduced resource strain, and reduced healthcare costs. The advantages of continuing virtual supervision decisively outweigh any risks.
CMS intends to use the additional time to gather more information as it considers a more permanent approach to its direct supervision policy. To this end, the agency solicits comments on whether it should permanently allow virtual direct supervision beyond December 31, 2024.
