A proposed Medicare rule would stop paying doctors who use outside companies to run remote blood pressure monitoring, a change that could leave many older adults without home devices and nurse coaching. Rural patients may be among the hardest hit.

Dianne Williams, who lives in rural Georgia, said quarterly doctor visits, monthly nurse calls and a home cuff that sends readings to her care team helped her lose weight and lower her blood pressure. She said the programme encourages her to take her medication.

'It's good to have somebody talk to you and tell you what your progress is like,' she said of her nurse. The coaching encouraged her to walk daily at a local track and switch from fried to baked fish.

She said the government should keep remote monitoring accessible. 'It looks like they're cutting off everybody, and that's not right,' she said.

What the Rule Would Change

The Centers for Medicare & Medicaid Services (CMS) proposal would allow Medicare reimbursement for remote monitoring only when the services are provided by clinical staff directly employed by the billing practitioner or their practice, rather than outside contractors. It would apply to traditional Medicare and take effect on 1 January 2027, if finalised as proposed.

The agency responded to 2024 and 2025 reports from the Department of Health and Human Services' Office of Inspector General. They raised concerns about fraud, a lack of data collection and patients not being treated by the prescribing doctor.

The 2024 report found that 43 per cent of Medicare beneficiaries receiving remote patient monitoring did not receive all three components: patient education and device setup, device supply, and treatment management. CMS spokesperson Timothy Foster said more safeguards are needed.

Read more

Rural Patients Among Hardest Hit

Caroline Pearson, executive director of the non-profit Peterson Center on Healthcare, said 'the rule would virtually eliminate the use of remote monitoring services, or dramatically reduce the use'. Rural communities may be among the hardest hit.

She said the programmes can help rural patients who struggle to travel to in-person visits. Most rural facilities that offer them use outside vendors because they lack the capacity to run their own.

Edward Vance, chief medical officer of Albany Area Primary Health Care, which includes Williams' clinic, said the system could not offer remote monitoring without an outside vendor. He said many community health centres operate with 'shoestring budgets'.

Dr Ateev Mehrotra, a Brown University School of Public Health department chair, said practices that cannot staff programmes in-house may give up remote monitoring entirely. He said the rule, if implemented as proposed, would have a 'huge chilling effect'.

Medical Value and Growing Use

Remote monitoring can help patients recovering from surgery or living with conditions such as diabetes or heart disease. It aims to prevent complications and emergency room visits.

The American Heart Association recommends home blood pressure monitoring for everyone with high blood pressure. It says home checks do not replace doctor visits and patients should not stop medication without medical advice.

An April 2025 report from the same non-profit found enrolment in remote monitoring among traditional Medicare patients grew tenfold from 2019 to 2023. Spending on it rose from just under $7million to more than $194million.

The report also found average enrolment time rose from 1.7 to 5.2 months over that period. The non-profit's executive director said monitoring helps most when doctors use the data to adjust treatment until a patient stabilises.

Industry Divided Over Proposal

More than 230 vendors, health systems and advocacy groups signed a letter opposing the rule as of 14 September. Humana, the Blue Cross Blue Shield Association and Sutter Health largely support it.

CMS launched its Advancing Chronic Care with Scalable Solutions (ACCESS) model, which tests paying technology firms for better outcomes in conditions including high blood pressure. Mehrotra said the rule and ACCESS send mixed signals about vendors.

Read more