The Centers for Medicare and Medicaid Services (CMS) has covered remote patient monitoring (RPM) since 2018, with payments totaling more than $500 million in 2024, according to a recent article in STAT.
Remote patient monitoring tracks patients’ health through technology outside of clinical settings–such as an electronic blood pressure cuff or continuous glucose monitor–and intervenes when necessary. Many providers use third-party vendors to manage these services. However, a proposed rule from CMS would bar Medicare payment for remote monitoring services delivered by external vendors starting Jan. 1, 2027. Physicians could only get reimbursed if they or other employees working directly for the medical entity doing the billing are performing the services.
With so many physician offices using outside vendors to help perform these services, the rule could significantly change how remote patient monitoring is delivered and paid for.
Why this matters for journalists
Some of the media coverage on the proposed rule has been “really in the weeds” on policy and hasn’t necessarily resonated with readers, said Ateev Mehrotra, M.D., MPH, chair of the Department of Health Services, Policy and Practice at the Brown University School of Public Health, in Providence, R.I. But there are ways health care journalists can help the public understand the potential impacts:
- Talk to physician offices about how this change could affect them if it goes through. For example, review the comments (More than 20,000 have been posted as of Sept. 1) to the proposed rule to see what practitioners and others are saying. The comments include the person’s name and city so journalists can look them up and use them as sources.
- Talk to patients who participate in remote monitoring programs. How helpful have they been for keeping their health in check? What would they do if their doctors stopped the program or passed on additional fees to them to keep it going?
- Take a business angle: Interview remote patient monitoring vendors about their concerns and plans to weather the proposed rule.
- Talk to clinicians who embrace remote monitoring to monitor patients with chronic conditions. What do they think this will do to patient outcomes? How much of an additional burden will this place on practice staff? How do they feel about big tech potentially taking over and using AI to support clinical decision-making?
What’s changing
Health systems and other primary care providers can currently bill for remote patient monitoring when they use an outside vendor to help patients manage conditions like hypertension or diabetes, according to the STAT article. Arrangements vary, but vendors could collect information and relay it to the clinician for patient outreach, or the vendor’s staff could conduct direct patient outreach to provide guidance and refer patients back to their doctor as needed.
In particular, Medicare regulators cited a 2024 report from the Office of Inspector General that found billing irregularities around remote patient monitoring services, the STAT article said. It found that 43% of beneficiaries who received remote monitoring did not receive all of its three components: device setup, data monitoring and treatment management.
The proposal would also require that remote patient monitoring services be for established patients only and mandate a separate initial visit before billing, Becker’s Health IT reported.
Additionally, the proposed rule would collapse the current CPT billing codes for RPM into four new codes, according to MedCity News.
CMS is accepting public comments on the proposed rule through Sept. 14.
How could this impact the future of remote patient monitoring?
If implemented as proposed, the rule “would have a huge chilling effect on remote monitoring. Largely in some ways it’ll probably impact the high value stuff and the low value stuff because practices might just say this isn’t worth it anymore,” Mehrotra said in an interview.
Remote patient monitoring vendors can play many different roles according to Mehrotra:
- Small physician offices may contract with vendors to supply devices and teach patients how to use them. They may field patient calls after hours.
- They may parse data sent to EHRs to help providers better understand and respond, like making medication adjustments.
CMS is especially concerned about who is actually making clinical decisions based on collected data
Remote patient monitoring itself is also complex, said Mehrotra, who has co-authored several studies on the growth and the effects of RPM. It is useful for some patients, like those with poorly controlled blood sugar; it’s less helpful for those already managing chronic conditions well.
Still, he said, if the rule is “fully implemented as [proposed], I think it would really have a huge negative impact in terms of the number of practices in the United States offering remote monitoring of any kind,” noting that if physician offices don’t have the capacity to handle RPM in-house, they may give it up entirely.
RPM payment has long been too low to cover not just data collection, but the clinician time needed to interpret readings and intervene. As a result, many programs don’t rely on remote patient monitoring billing codes and instead bill a flat fee. CMS’s monthly billing threshold incentivized vendors to optimize for code volume, not clinical care, according to Dan Shields, CEO of Ochsner Digital Medicine in New Orleans. That led some vendors to build programs around hitting the reading count rather than delivering good outcomes. He acknowledges this abuse is real, but blames the code design as much as the vendors.
“What’s proposed is going to make it very difficult, actually impossible, for external vendors to support providers in offering RPM,” Shields said. His division runs its own RPM programs for patients of Ochsner Health, staffed by its employees, so it would not be impacted by the proposed rule.
“A lot of providers are seeing the value in these [RPM] programs and saying I need to stand them up,” Shields said. “But frankly, the hardest thing to do is to staff it appropriately and have the employees do it, so those programs that say, ‘I’ll take that off your plate’ are attractive. Now you’re saying you can’t do that, or at least you can’t do it and [bill] for it, so the whole financial model falls apart.”
Almost every major health system Shields and his colleagues have spoken with is trying to increase access to remote care, he said, either through remote patient monitoring, hospital-at-home programs or other means, and the CMS proposed rule plus the ACCESS model are giving them “a little bit of mixed signals.”
Mixed messaging: CMS’ ACCESS Model
CMS also recently launched its Advancing Chronic Care with Scalable Solutions, or ACCESS model, which tests paying for better health outcomes — not just services delivered — to expand technology-supported chronic care in Original Medicare. It targets common conditions affecting more than two-thirds of Medicare beneficiaries, including high blood pressure, diabetes, chronic pain, and depression, according to CMS.
“The basic premise under ACCESS is the need to leverage technology and encourage technology companies and their AI to really enter health care and start using their capacity to improve the quality of care that Americans receive,” Mehrotra said. But enrollment in the program is only allowed for entities that don’t provide clinical care. Primary care practices, hospitals, and health systems can’t participate because they already bill Medicare for other services. Rather than various remote monitoring vendors, ACCESS relies on tech firms to gather patient data and demonstrate improvements in chronic conditions before they get paid.
Using AI helps lower costs, he said. But CMS is sending mixed messages: Medicare is anti-vendor under the proposed remote patient monitoring rule, but they’re also going to be very pro-vendor under ACCESS.
Resources
- In a major policy shift, Medicare proposes to ban vendors from providing remote monitoring services – STAT
- CMS proposes ban on third-party remote patient monitoring: 6 notes – Becker’s Health IT
- CMS’ proposed remote patient monitoring ban, explained – Becker’s Health IT
- Why CMS is trying to ban third-party remote patient monitoring – MedCity News
- Remote patient monitoring the next wave in telehealth – AHCJ blog post
