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Last month, CMS threw a wrench into the remote patient monitoring arena by announcing plans to end Medicare payment for third-party RPM services. This proposal, if finalized, would mean significant changes for providers and RPM companies, as partnerships between the two are widespread. And those changes could upend patient access to healthcare
Amid the virtual healthcare boom spurred by the COVID-19 pandemic, the RPM sector has flourished. RPM services have been linked to numerous benefits, including improved patient outcomes and reduced hospitalizations, particularly among patients with chronic diseases. As a result, RPM adoption skyrocketed, with claim volume growing 1,294% from January 2019 to November 2022
RPM utilization among Medicare patients also shot up, with federal data showing that the number of Medicare enrollees receiving RPM grew by 27% from 2023 to 2024. This sent Medicare payments soaring from $408 million to $536 million in the span of one year
However, according to the HHS’ Office of Inspector General, the explosion of RPM has not been without negative consequences. Reports released by the agency highlight instances of fraud, concerning billing practices and improper provision of RPM services, albeit among a relatively small proportion of providers. Still, CMS cited these HHS-OIG findings as the reason for its proposal
For RPM vendors, the potential disruption of third-party billing for Medicare services is highly concerning
Does the proposal go too far?
Though RPM companies are sympathetic to CMS’ overarching goals of rooting out fraud, they question whether the policy proposal would be an effective approach
As Xealth Co-founder and CEO Mike McSherry put it, “it’s like throwing the baby out with the bathwater.” Instead of placing more stringent authorizations or controls around documentation, CMS appears to have taken the more extreme position of ending a key pathway to RPM access entirely, he added
Acquired by Samsung in 2025, Xealth provides a digital health orchestration platform that connects healthcare providers with third-party tools and services. Though the proposal would affect a relatively small part of Xealth’s business — only about 20 companies out of 120 on Xealth’s platform bill for RPM services — it will have a significant impact on other RPM vendors that have built their businesses around providing third-party RPM services, McSherry said
Meryl Holt, general counsel at RPM company Cadence, further noted that the proposal creates a “blanket rule” that would only allow RPM services to be delivered by staff directly employed by the healthcare provider organization
However, RPM programs are operationally complex models that require significant clinical react with third-party vendors to offer high-quality RPM services.
The proposal is especially confusing given the Trump administration’s support of technology-enabled care. Examples of this support include CMS’ ACCESS and TEMPO models, both of which aim to boost health technology adoption and deployment
“So, on one hand, they’re saying RPM doesn’t work, too much fraud, waste, abuse, let’s cut it entirely,” McSherry said. “On the other hand, go forth with RPM. We’re, in fact, reducing the FDA requirements around RPM. And so that’s sort of a baffling conundrum.”
But there could be an unexpected upside for vendors. Though the proposal has the potential to upend the RPM arena, some RPM vendors may actually benefit vice president at Vivalink, which sells RPM technology directly to hospitals and third-party RPM providers
Since the proposal aims to bring RPM clinical workflows in-house, companies like Vivalink may be able to forge new partnerships with hospitals and health systems that previously contracted with third parties for these services
“Even without this proposal, in fact, the hospital-at-home [model], with that reimbursement, we’re already getting approached more by hospitals interested in licensing the technologies in-house,” he said. “So, with this proposal, they may accelerate that or add to it.”
Proposal could create hurdles for providers and patients
The proposal could significantly impact providers’ ability to provide RPM services, thereby potentially cutting off access to RPM for patients across America
One of the main reasons healthcare providers contract with RPM companies for third-party services is to alleared a conversation he had with a CIO of a large health system, who stated that their primary care workforce is already overworked and that adding more tasks to their plate, such as tracking and interpreting RPM data, would impose an undue burden.
“They have found that operationally it is more effective for them to outed clinical staff,” McSherry said
“I just don’t think it’s tenable to fold [RPM] back into existing operations when there are some 24/7 nationwide remote care services that are specifically set up to do virtual care management,” he continued
Not only that, but even among hospitals that can bring RPM services in-house, the process will likely take time, as new clinical workflows will need to be established, Liu noted. This will ultimately impact patient care
“Anytime there’s a disruption, whether it’s budget cuts or whatever it is, it’s going to affect patient care and accessibility for patients to receive care,” Liu said. “So, definitely there’ll be an impact.”
According to Holt, the impact will be most keenly felt by vulnerable populations
“It’s clear that rural and underserved communities and patients living in those communities across the country are going to bear the brunt of this policy if it’s finalized in its current proposed form,” she said. “These types of tech-enabled services have been shown in the peer-reviewed literature to be highly effective at reaching those patients who often face the most challenges in accessing high-quality care.”
Rural and underserved communities with high rates of chronic diseases have come to rely on RPM to manage their conditions in between office visits, she added. Without access to RPM, these patients would receive little to no support between office visits. Worsening chronic conditions with little oversight could increase emergency department visits and hospitalizations
“Our learned experience and what the evolving research in this space shows is that clinically integrated RPM helps prevent avoidable hospitalizations, and restricting access to these crucial preventative services actually risks much higher downstream costs associated with unmanaged chronic disease,” Holt said
She further stated that CMS should consider delaying this proposal and collecting evidence and data to fully understand how these services are being performed and by whom, as well as the unintended consequences that might result. In the meantime, the agency could provide further clarification on the supervision and documentation requirements for demonstrating high-quality RPM services.
Now, the RPM industry must wait to see if the proposal makes it into the final 2027 Physician Fee Schedule as written
While McSherry believes that the proposal will undergo changes before being finalized, he does not mince words about the impact of finalizing it as it is currently written: “It would be a net detriment to patients who don’t get that RPM oversight and monitoring. It would be a detriment to burdened clinicians.”
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers healthcare IT and innovation, including artificial intelligence, digital healthcare, EHRs and interoperability
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