Comment on CMS-2026-2377-0001

CMS-1848-P – CY 2027 Medicare Physician Fee Schedule Proposed Rule To Whom It May Concern, I am a physician assistant practicing dermatology in Virginia. My role is to improve access to dermatologic care by evaluating new and established patients, performing skin cancer screenings, treating common skin diseases, and identifying lesions that require biopsy or referral for Mohs surgery. One of the greatest advantages of office-based dermatology is that patients often receive answers and treatment during the same visit. When I identify a suspicious lesion during a skin examination, I can frequently perform a biopsy immediately rather than asking the patient to return on another day. This reduces anxiety, avoids delays in diagnosis, and is especially important for elderly patients who may have transportation or mobility challenges. The proposed payment changes create concern that practices may be forced to separate evaluation and treatment into multiple appointments even when same-day care is medically appropriate. While this may reduce payment to practices, it is patients who will ultimately experience longer waits, additional travel, more time away from family or work, and delayed diagnoses. As a physician assistant, I work closely with a supervising dermatologist. This team-based model allows physicians to focus on complex surgical care while I help provide timely access for routine and urgent dermatologic concerns. Independent dermatology practices rely on this collaboration to care for growing numbers of Medicare beneficiaries. I encourage CMS to carefully consider how these proposals may affect access to dermatology services, particularly in community-based private practices. Policies that support efficient same-day care and strong physician-APP collaboration ultimately benefit Medicare patients. Thank you for considering my comments and for your commitment to improving healthcare for Medicare beneficiaries. Respectfully, Michael Fraykor, PA-C