Where’s the ROI in RPM? Hint: It’s Not the Reimbursement

In recent conversations with healthcare providers across the country, we’ve heard the same refrains over and over again: “Reimbursements for Remote Patient Monitoring (RPM) don’t really provide much ROI,” and “We get pushback from patients about the monthly copay.”

These are valid concerns. But they may also be the result of a common misunderstanding about where the real value of RPM lies.

Remote Patient Monitoring (RPM) was first introduced into the Medicare program in 2018 with the creation of CPT codes 99453 for initial setup, 99454 for data transmission, and 99457 for time spent monitoring and interacting with patients using connected health devices. Since then, 99458 has been added, allowing for additional time spent each month. 

These codes have evolved to support the broader adoption of RPM, providing a reimbursement framework that can offset some of the costs of running a program—particularly staffing and device infrastructure. But increasingly, it’s clear that the real return on investment in RPM isn’t in the billing. It’s in the outcomes.

The Real ROI: Outcomes, Not Codes

As highlighted in a recent blog post by Rimidi, a new report from the Peterson Health Technology Institute (PHTI) brought national attention to the limitations of RPM programs that aren’t structured around clinical effectiveness. The report raised concerns that many digital health solutions fail to improve outcomes—and underscored the importance of measuring RPM success not just in dollars reimbursed, but in lives improved.

That’s where the real ROI lies. When RPM is thoughtfully implemented, targeting the right patients and aligned with care team workflows, it can lead to fewer hospitalizations, improved chronic disease control, better patient engagement and quality of life, and ultimately, reduced total cost of care.

Reimbursement Supports the Program—Outcomes Sustain It

Reimbursement can help support the operational costs of RPM—things like nursing time, device management, and administrative tasks. But if your program is centered only around billing for as many patients as possible, you’re likely to run into two problems: lack of impact on outcomes and poor retention.

Instead, consider starting with a high-need population. For example, rather than enrolling all patients with a hypertension diagnosis, focus first on those whose blood pressure is persistently above or approaching 140/90 mmHg or patients who are newly diagnosed. These are the patients most at risk of adverse outcomes—and most likely to benefit from more frequent monitoring and intervention. Targeting this group can also help practices succeed in value-based care arrangements that reward hypertension control—such as Medicare’s Merit-based Incentive Payment System (MIPS) quality measures (like Quality ID #236: Controlling High Blood Pressure), or in payer contracts that tie shared savings or bonuses to chronic disease outcomes. Many ACOs negotiate tens of thousands of dollars in shared savings bonuses tied to achieving benchmarks like population-wide hypertension control, especially when paired with reduced total cost of care. Some commercial payers also offer per-member incentives or supplemental payments when hypertension and other chronic conditions are consistently well-managed across a panel. UnitedHealthcare's Medicare Advantage Intermediate Physician Incentive program for 2025, for example, offers a $10 Quality Care Bonus per member for Controlling High Blood Pressure (CBP) and an additional $20 Quality Target Bonus per member for meeting or exceeding a target of 83%. This means a practice could earn up to $30 per patient meeting the criteria under this specific program.

Enrolling everyone may sound comprehensive and like a broader net for reimbursement ROI, but it can lead to lack of focus, disengagement, and unnecessary upfront device costs.

When patients don’t see the value of the program—or are surprised by copays—they’re more likely to opt out, and you’re left holding the costs. Educating patients on the front end about the why behind RPM, what to expect, and how it supports their long-term health is critical to enrollment and engagement.

Conclusion: Use RPM as a Clinical Strategy, Not Just a Revenue Stream 

At its core, RPM is a clinical tool—not just a revenue stream. Programs that treat it as such, focusing on enrolling the right patients and measuring success by health outcomes, are the ones that realize the true return on investment.