Dianne Williams said she lost weight and lowered her blood pressure thanks to quarterly doctor appointments, monthly phone calls with a nurse, and a blood pressure cuff she uses at home that transmits data to her care team.
“It’s good to have somebody talk to you and tell you what your progress is like. And she’s a very nice person,” Williams said of her nurse.
Williams, who lives in rural Georgia, said these services — referred to as remote patient monitoring — encourage her to take her medication and inspired her to revamp her diet and exercise.
Many Medicare patients, especially those in rural areas
But many Medicare patients, especially those in rural areas like Williams, soon may no longer be able to use devices and receive coaching from the comfort of their homes.
That’s because a proposed federal rule would halt Medicare reimbursements for providers who use health technology companies to administer remote monitoring for their patients. Medicare would pay clinicians only when the service is provided by someone at the facility where they work.
The Centers for Medicare & Medicaid Services’ proposed rule is a response to reports on remote monitoring from the Department of Health and Human Services’ Office of Inspector General, an independent federal oversight agency. The 2024 and 2025 reports raised concerns about fraud, a lack of data collection, and patients’ not receiving treatment from the clinician who prescribed the device.
Caroline Pearson, executive director of the nonprofit Peterson
But Caroline Pearson, executive director of the nonprofit Peterson Center on Healthcare, said “the rule would virtually eliminate the use of remote monitoring services, or dramatically reduce the use,” for many Medicare patients.
“I think the rural communities will be some of the hardest hit,” said Pearson, whose organization focuses on healthcare affordability.
She said remote monitoring programs can be especially helpful in rural areas, where it can be difficult for patients to travel to in-person appointments. Most rural healthcare facilities that offer these programs use third-party vendors since they don’t have the capacity to launch and oversee their own, she said.
CMS spokesperson Timothy Foster said the agency recognizes
CMS spokesperson Timothy Foster said the agency “recognizes the important role that technology-enabled care can play in improving access to care, including in rural communities.” But more safeguards are needed, he said.
The proposed rule says outside vendors may “have little to no established relationship” with patients and their clinicians, which it says can “fragment care.” It also says the clinicians may not be involved enough to warrant being paid by Medicare. Pearson, other health policy experts, and vendors agree with the Trump administration that these programs need further regulation. But public comments show widespread strong disagreement with CMS’ approach.
The proposal “took us by such surprise,” said Andrew Van Ostrand, senior vice president at the Alliance for Connected Care, a group that advocates for wider adoption of health tech, including remote monitoring, on behalf of healthcare organizations and tech companies.
Van Ostrand said many vendors have already made
Van Ostrand said many vendors have already made changes inspired by the “very well-reasoned recommendations” from HHS’ Office of Inspector General and were surprised that the proposed Medicare rule didn’t mandate all its suggestions.
The proposed rule would apply only to patients enrolled in traditional Medicare, not those with privately run Medicare Advantage plans, which cover more than half of Medicare participants. But Van Ostrand and Pearson said Medicare Advantage plans, Medicaid programs, and private insurers could end up adopting the same change, further limiting access.
Van Ostrand said the vendor rule and other proposed changes — including a “draconian” cut in reimbursement rates — are in “deep misalignment” with one of President Donald Trump’s signature initiatives: the five-year, $50 billion Rural Health Transformation Program, which encourages states to adopt tech solutions to improve rural healthcare.
States have earmarked at least $240 million
States have earmarked at least $240 million from their first-year rural health funding for remote monitoring, according to a report by the Alliance for Connected Care, which also wrote to CMS to oppose the rule change.
More than 230 health tech vendors, healthcare systems, and patient and medical advocacy groups had signed the opposition letter as of Sept. 14.
A few organizations largely support the proposed rule, including major health industry players Humana, Blue Cross Blue Shield Association, and Sutter Health, a large health system that offers its own remote monitoring program.
Remote monitoring can be used for patients who
Remote monitoring can be used for patients who are in physical therapy, recovering from surgery or hospitalization, or living with a chronic condition such as diabetes or heart disease.
The idea is to help patients manage their health and prevent dangerous complications or pricey emergency room visits. Remote monitoring can also make it easier to obtain care for patients who struggle to travel to in-person appointments — such as those with disabilities, without cars, or from rural areas far from hospitals.
To track her blood pressure, Williams straps a cuff to her arm and presses a button. The device automatically sends her data to CoachCare, a private company whose staff monitor patients.
I don’t have to wait until I go
“I don’t have to wait until I go to the doctor’s office when I can do it every day,” Williams said.
Other patients are given devices such as scales, blood glucose monitors, and fitness bands that transmit data that’s monitored by nurses or other staffers, and, increasingly, with the help of artificial intelligence.
Some large academic health systems create their own devices or use their own employees to review data and check in with patients. But most health facilities contract with health tech companies.
If staff notice — or are alerted
If staff notice — or are alerted by AI to — patient data trending in the wrong direction, they can call patients to offer advice or schedule a follow-up appointment with their doctor. If vitals indicate life-threatening problems, staff urge patients to call 911.
Williams said she was frustrated when her medication wasn’t lowering her blood pressure. She said that’s when her CoachCare nurse suggested she start exercising and eating healthier.
“That made me feel better, because they gave me encouragement,” she said. “They just didn’t just take my blood pressure and that was it.”
Williams said she now walks at a local
Williams said she now walks at a local track each day and made diet changes, such as switching from fried to baked fish.
Edward Vance is the chief medical officer of Albany Area Primary Health Care, which includes Williams’ clinic. He said the health system, which serves many rural and low-income patients, couldn’t offer remote monitoring without an outside vendor.
“We already run at a borderline understaffed situation,” and many community health centers operate with “shoestring budgets,” Vance said.
The federal government created Medicare billing codes
The federal government created Medicare billing codes for remote patient monitoring during Trump’s first presidency. That allowed providers to be reimbursed for initiating and overseeing such services. Health facilities often use part of that revenue to pay vendors for their devices and monitoring.
Only 1% of patients on traditional Medicare use remote physiologic monitoring, the more common type of remote monitoring, and the cost is a small fraction of overall spending. But both measures are rapidly growing.
The number of traditional Medicare patients enrolled in such programs grew tenfold from 2019 to 2023, while program spending on them increased from just under $7 million to more than $194 million, according to an April 2025 report from the Peterson Center on Healthcare.
Pearson said evidence shows remote monitoring is most
Pearson said evidence shows remote monitoring is most helpful when providers use the data to inform how they treat patients — such as adjusting medications — and only until the patient is stabilized.
“We shouldn’t be paying for doctors to be reviewing huge numbers of readings, for years on end, for patients that have controlled blood pressure,” Pearson said.
“That doesn’t feel like a clinically driven decision. That feels like a revenue decision,” she said, adding that some vendors explicitly pitch their services as an opportunity for health facilities to generate income.
Traditional Medicare patients are enrolling in remote physiologic
But traditional Medicare patients are enrolling in remote physiologic monitoring programs for longer periods of time. From 2019 to 2023, average duration increased from 1.7 months to 5.2 months, the Peterson report found.
Pearson said Medicare should limit how long patients can be prescribed remote monitoring unless there’s proof treatment is still needed. The agency also should require clinicians to report more data, including outcomes, she said.
She said Medicare should eventually transition to a reimbursement system that pays based on whether programs improve patients’ health. Pearson said CMS has already begun to do so through its new ACCESS program, which pays not only clinicians but also vendors.
But Pearson said the program, which launched in July, reimburses less than traditional models.
Williams said the government should keep remote monitoring accessible.
“It looks like they’re cutting off everybody, and that’s not right,” she said.
