Comment on CMS-2026-2377-0002

Subject: Comments on CY 2027 Physician Fee Schedule Proposed Rule – Adverse Impacts of Proposed Remote Patient Monitoring (RPM) and Clinical Staff Provisions on Patient Access and Care Quality Reference file code CMS-1848-P Dear Administrator, As a technology vendor deeply invested in the infrastructure of digital health, Esvyda Inc. writes to express strong opposition to several key provisions in the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule regarding Remote Patient Monitoring (RPM). While we share the Centers for Medicare & Medicaid Services’ (CMS) commitment to fiscal responsibility and high-quality care, the proposed changes will actively harm Medicare beneficiaries, dismantle continuous care models, and create insurmountable administrative and financial roadblocks for clinical practices. We urge CMS to reconsider and withdraw the following damaging proposals: 1. Reverting RPM Supervision from "General" to "Direct" Supervision •The Proposal: CMS is proposing to shift RPM supervision requirements back from general supervision to direct supervision. •Why It Harms Patients: RPM is, by definition, a continuous, out-of-office modality designed to track patient vitals in real-time, often managed in coordination with specialized third-party clinical staff or monitoring centers. Forcing physicians or immediate supervisors to maintain "direct supervision" (requiring their physical presence or immediate real-time virtual availability in a strict sense) introduces artificial bottlenecks. •Patient Impact: This restriction will slow down timely clinical reviews of acute physiological anomalies, discourage primary care providers from adopting RPM, and ultimately lead to delayed interventions for vulnerable patients managing chronic conditions like hypertension, heart failure, and diabetes. 2. Bundling RPM Codes and Conversion Factor Reductions •The Proposal: CMS's ongoing conversion factor reductions—compounded by the expiration of temporary statutory updates—coupled with proposals to bundle RPM and related codes, severely devalue remote care. •Why It Harms Patients: Squeezing reimbursement rates while increasing administrative friction sends the wrong signal to a healthcare system that desperately needs to lean into preventative, home-based digital health. When practices face financial penalties or administrative gridlock for providing remote care, they drop these programs. •Patient Impact: Medicare beneficiaries—particularly those in rural or underserved areas with mobility challenges—will lose access to the continuous physiological tracking that keeps them out of emergency rooms and hospital readmission cycles. 3. Reduced Rates for Additional Advanced Care Planning (ACP) Clinical Staff Codes •The Proposal: Creating separate HCPCS codes for clinical staff-led Advance Care Planning (ACP) at reduced valuation rates. •Why It Harms Patients: ACP is a deeply sensitive, time-intensive discussion that requires extensive trust-building and coordination. Devaluing work performed by clinical staff creates a disincentive for practices to comprehensively integrate these vital conversations into routine chronic care workflows. •Patient Impact: Patients and their families will be deprived of timely, guided opportunities to document their care preferences and end-of-desired treatment pathways, shifting the burden back to crisis-driven acute care settings where patient autonomy is harder to protect. Conclusion and Call to Action As a technology vendor, we witness firsthand how RPM bridges the gap between patient homes and clinical teams, preventing catastrophic medical events through early detection. The combination of restrictive supervision rules, code bundling, and reduced valuations threatens to roll back years of progress in digital health innovation. We strongly urge CMS to: 1.Maintain general supervision standards for RPM to support scalable, team-based chronic disease management. 2.Preserve robust, unbundled valuations for remote monitoring services to ensure providers can sustain these vital programs. 3.Re-evaluate payment structures to encourage, rather than penalize, technology-enabled preventative care. Thank you for the opportunity to comment on the CY 2027 PFS Proposed Rule and for your consideration of these critical patient-access issues. Sincerely, Elias Lozano CEO and founder Esvyda Inc.