CMS's proposed CY2027 Physician Fee Schedule has put remote patient monitoring (RPM) squarely in the spotlight. Proposed changes like requiring employed clinical staff, mandating an initiating visit, re-evaluating device reimbursement, and potentially collapsing 17 RPM/RTM CPT codes into four G-codes have providers asking a fair question: is now the time to invest in virtual care, or pull back?
That was the premise of Health Recovery Solutions (HRS) and Becker's recent webinar, "How Providers Are Operationalizing Remote Patient Care for Better Outcomes Amidst Proposed Reimbursement Changes." Moderated by Lucienne Ide, MD, PhD, Chief Medical Officer at HRS, the panel featured Lindsey Valenzuela, PharmD, VP of Population Health Integration at Desert Oasis Healthcare, and Zsolt Kulcsar, DO, VP of Virtual Health at Emory Healthcare. The consensus: with proposed changes to RPM reimbursement, providers should be thinking less about whether to build virtual care programs and more about how to design them so they hold up regardless of which way the payment rules move.
A recurring theme was that RPM isn't an either/or bet on a single payment model. It performs well in both worlds, just for different reasons. Desert Oasis Healthcare, a full-risk medical group serving 60,000 Medicare Advantage and commercial HMO members, layers clinical pharmacists with RPM (cellular-enabled glucometers and BP cuffs) for its highest-need diabetes patients.
The results were striking: a 2.8-point A1C reduction in a 12-week program, a 43% reduction in disease-specific utilization compared to standard pharmacist-only care, and sustained cost reductions of nearly $2,900 per member over two years in all-cause utilization. In a full-risk model, that utilization and quality improvement flows straight to the bottom line.
Emory Healthcare, largely a fee-for-service academic health system, is using RPM differently: to close a documented quality gap. Discharged patients were struggling to meet 7-day post-discharge touchpoint requirements, a metric where Emory ranked low on Vizient's care coordination benchmark. Its Virtual APP Clinic now layers advance practice providers and RNs on top of RPM to hit those touchpoints for CHF, COPD, pneumonia, UTI, and diabetes patients, billing E&M visits directly while building toward broader RPM and CCM wraparound services. In just two months, active patients grew from 343 to over 400, with 87 patients "graduating" the program in June alone.
Panelists were direct about what it takes to get budget approval: pair the reimbursement story with the value-based story. HRS framed this as a "dual value model." Fee-for-service RPM, CCM, PCM, and TCM codes cover operating expenses, while value-based savings (reduced total cost of care, shared savings performance, and quality metric improvement) drive margin. The point for CFOs is that RPM shouldn't be modeled as a single revenue line. It should be modeled across the full patient journey, from acute transition (TCM/RPM setup) to stabilization (intensive RPM monitoring) to goal attainment (CCM/PCM/APCM), with both billing codes and downstream utilization avoidance attached to each phase.
Desert Oasis's utilization and cost tables offered a template other systems can use with their own CFOs: track all-cause and disease-specific utilization and cost pre- and post-enrollment in structured time windows, and show the accumulated savings trend over 24 months rather than a single snapshot.
Strong outcomes data doesn't mean much if clinicians won't refer patients into the program, and panelists agreed that provider adoption is often the harder half of the equation. As Dr. Zsolt Kulcsar put it, "If you build it, they won't come." A well-designed RPM program still has to be actively sold into clinical workflows, not just made available.
At Emory, that meant meeting providers where they already work: sending RPM referrals directly through an order in Epic, so enrollment doesn't require a separate system or extra clicks. It also meant proving the model works clinic by clinic before scaling. Emory has now onboarded 20 primary care clinics and trained more than 100 primary care providers, growing steadily by demonstrating results rather than mandating adoption. Desert Oasis took a similar approach, positioning its pharmacists as an extension of the PCP rather than a replacement, which helped physicians see the program as something that supported their patients (and reserved specialist referrals for when they were truly needed) instead of adding to their workload.
The shared lesson: clear, low-friction referral pathways and early wins that clinicians can see firsthand do more for adoption than any amount of top-down messaging.
Across the discussion, three additional practices came up repeatedly:
Regardless of how CMS finalizes the CY2027 rule, the organizations on this panel show that RPM's value case doesn't rest on any single code. Programs designed around patient risk, integrated workflows, provider buy-in, and a dual reimbursement/value-based ROI story are positioned to keep delivering results, and keep making the CFO case, no matter which direction reimbursement moves next.
HRS is equipped to support providers as they evaluate the best model for their organization, with an EHR-integrated platform that supports every staffing structure a final rule could require: fully in-house programs, hybrid models, and supported programs. Providers do not need to lock into a single program design while the rule is pending.
Interested in learning more? Contact us today to speak with our Digital Health Advocates about the proposed changes, and how our flexible models can support your program’s sustainability.