The decision from the AMA’s CPT panel will help health systems and hospitals scale and sustain smaller and more inclusive RPM programs.
(Editor's note: This article was corrected to note that the change will go into effect in 2026, not 2025)
A key deterrent to the development of remote patient monitoring programs is being removed, giving healthcare organizations a better opportunity to scale and sustain those services.
The American Medical Association’s CPT Editorial Panel has removed a requirement that RPM providers collect data on at least 16 of 30 days to qualify for Medicare reimbursement, opening the door to short-term and less frequent programs and coverage for a wider range of patients. The change is slated to go into effect at the beginning of 2026.
The panel’s decision, made during its September meeting, is a pleasant surprise for telehealth and RPM advocates, who had supported a proposal in May to create new “supply of device” codes that would have allowed providers to be reimbursed for less than 16 days in a 30-day period.
“Since separate payments for [RPM] services were established, industry stakeholders have advocated against this 16-day requirement arguing that it is clinically arbitrary and ignores conditions where a reduced number of days would be more clinically appropriate,” Thomas Ferrante and Rachel Goodman, partners in Foley & Lardner’s Telemedicine & Digital Health Industry Team, said in a 2023 blog.
The panel declined to support the proposal at its May meeting, leading to concerns that it wouldn’t be brought up again until next year. How or why the panel changed its mind at the September meeting isn’t clear, though it should be noted the change won't take place until the beginning of 2026.
RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services (CMS) through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting. CMS has slowly amended and expanded those codes since then, adding codes for remote therapeutic monitoring.
Advocates have long argued that the codes are too restrictive on everything from what devices can be used to what conditions are covered to what data can be gathered. In all, providers can only expect to receive about $170 in Medicare reimbursements per patient per month.
Here are some ways nurses can take care of themselves, says this nurse educator.
Nurses have a stressful job, between caring for patients, communicating with families, and being on their feet for several hours at a time.
According to Maryn Moreni, associate professor of nursing faculty at the Arizona College of Nursing, prioritizing self-care is crucial for maintaining well-being and can help reduce compassion fatigue and lower stress levels, allowing nurses to approach each shift with renewed energy and focus. Self-care can enhance mental and physical health, ultimately leading to improved patient care.
It's also important that CNOs encourage self-care in their workforces to promote wellness and a healthy work environment.
Here are 10 self care tips for nurses, according to Moreni.
Click here to view the accompanying contributed article.
New research on the value of digital health in hypertension care finds that these devices work best when they connect the patient to a care provider or team who can provide medication management.
A new analysis of digital health tools for hypertension tracking says they are truly effective if they include medication management features, such as a virtual care link.
The report, from the Peterson Health Technology Institute (PHTI), finds that devices that only transmit data to a care provider or focus on behavior change “are less effective and do not provide clinically meaningful improvements,” whereas devices that enable patients to connect with a care team to manage prescribing and dosing “deliver rapid and clinically meaningful improvements in blood pressure that outperforms usual care.”
The research highlights a crucial aspect of remote patient monitoring that has long plagued health systems and hospitals. RPM devices might be great at gathering data in between healthcare visits, but unless that data is used in a meaningful way, it’s wasted.
The key here is that RPM programs need to combine tools with access to care providers who can help patients act on the data being gathered. That may be through an app or other virtual care link, and it could be synchronous or asynchronous.
The results hold true for any chronic condition. In this case it’s hypertension, which affects roughly 120 million Americans, of half of the country, and only about 27 million, or one-quarter, are managing their blood pressure. The rest are at high risk of a variety of health emergencies, like heart attack and stroke.
“Too many people are living with uncontrolled hypertension, but there are effective digital solutions to help patients improve their cardiovascular health, save lives, and lower spending over the long run,” Caroline Pearson, the PHTI’s executive director, said in a press release accompanying the study. “Digital medication management solutions support healthcare providers with virtual teams to monitor blood pressure and adjust medications to help bring patients into control within months rather than years.”
PHTI evaluated 11 digital health tools: Blood pressure monitoring devices from AMC Health, HRS and VitalSight; medication management tools from Cadence, Ochsner Digital Medicine and Story Health; and behavior change tools from Dario, Hello Heart, Lark, Omada and Teladoc (Livongo). The three categories were evaluated for clinical effectiveness and economic impact.
All three categories were found to increase net health spending initially, though the medication management tools had the best potential to offset those costs with improved clinical outcomes over the long term.
In terms of clinical effectiveness, the blood pressure monitoring devices were found to be slightly better than usual care in reducing blood pressure but not enough to be clinically meaningful, while the behavior change tools saw limited incremental declines in blood pressure.
Health systems should partner with their local and international communities to build their workforce, says this CNO.
On this episode of HL Shorts, we hear from Dr. Rachel Miles chief nursing officer of AdventHealth, Rocky Mountain Region, about strategies for recruiting nurses both locally and internationally. Tune in to hear her insights.
Executives in HealthLeaders' Mastermind program on AI in RCM and finance operations say the technology will help them integrate with other departments in the health system and even work with patients to pay their bills.
Imagine an AI tool that can calculate a patient’s bill factoring in insurance coverage, a health plan’s tendency to deny a certain claim, and social determinants of health that may factor into the patient’s ability to pay. Then imagine that tool helping a hospital to work with the patient on a payment plan, compare its pricing structure with competitors and track social media mentions.
AI is seen as a tool to reduce administrative work and help clinicians get in front of their patients, but in the revenue cycle management and finance space, sometimes it’s hard to see beyond the dollars and cents and measure AI’s true impact.
Participants in HealthLeaders’ Mastermind program on the use of AI in RCM and financial operations connected those dots during a recent roundtable in Chicago, where they discussed the evolution of a technology already well-entrenched in their departments. One aspect of that conversation was to use AI to bridge the financial and clinical sides of the hospital.
AI has been put to work in the RCM and finance space over the past few years to address administrative tasks and do the number-crunching and data retrieval that would normally occupy staff time. Now the focus has shifted to generative AI, in which RCM and financial data is used to give staff pathways to better results; and on the horizon is predictive AI, which will give staff better ideas about where those pathways end.
Not only will the technology evolve, but how health systems and hospitals use it will change as well.
Beyond the applications in coding and denials management, executives see an opportunity for AI to learn how payers deny claims and help RCM staff proactively address, even avoid, those denials, or to tackle the complexities of the prior authorization process to reduce friction. As these tools evolve, Jane Lombardo, director of revenue cycle optimization at Stanford Health Care, said RCM staff will become “stewards” of the technology, overseeing how it’s applied and monitoring its effectiveness.
Steven Kos, MSHCA, CHCIO, senior director of revenue cycle applications at Florida’s Baptist Health, said the development of AI tools will also compel healthcare organizations to rethink RCM and finance skillsets, perhaps adding staff who are skilled at revenue cycle informatics, revenue integrity and patient advocacy or engagement.
Shannan Bolton, Stanford Health Care’s vice president of optimization and performance improvement, sees AI becoming a powerful tool for education and financial counseling, helping patients to both understand their financial responsibilities and the options available to them for paying their bills.
“That’s where we fall short with patients,” she said.
And Christina Slemp, MHA, MSHI, vice president of revenue cycle for Tennessee-based Community Health Systems, added that AI can help reduce the stress for patients by giving them the information they need quickly, rather than waiting around for explanations.
In fact, RCM are in the unique position to integrate clinical and financial data, helping both patients and their care teams. Some health systems are already experimenting with ambient AI to capture the doctor-patient encounter and code that encounter at the same time.
That strategy can also apply to patient scheduling, Bolton says, identifying a key element of the revenue cycle and a hotspot. Patient scheduling drives revenues when handled in an efficient manner, but it can also cause headaches when patients struggle to schedule their appointments or miss them. Ai tools that enable patients to self-schedule and help providers coordinate their workflows.
Beyond helping patients to schedule their appointments, RCM and financial executives say AI will become critical in reducing the complexity around billing and collections. That includes working with payers to fine-tune coverage and reduce denials and working with patients to make sure they understand and can pay their bills.
And that’s where the technology may make the biggest impact in the future.
Kos and Clark Casarella, PhD, senior data scientist at Sanford Health, said Ai will be used to improve the way hospitals and health systems work with patients on their financial responsibilities, creating a patient scorecard of sorts that researches in real time their ability to pay a bill. And Bolton pointed out that the technology can help organizations better understand why a patient has financial insecurity, thereby addressing the underlying social determinants of health that affect the revenue cycle process.
At the end of the day, patient financial responsibility is just one small part of a healthcare organization’s RCM and financial operations, but it’s an important and often-overlooked part. And it’s one that will become more important as the healthcare landscape shifts closer to patient-centered and value-based care. AI has the potential to help, giving both patients and providers the data and tools they need to work together.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
Prioritizing self-care is crucial for maintaining well-being and can help reduce compassion fatigue and lower stress levels, says this nurse educator.
Editor's note:Maryn Moreni MSN-FNP, RN, CNE, is the associate professor of nursing faculty at the Arizona College of Nursing.
As a nurse educator, I teach students about wellness, health promotion, and disease prevention for their patients. But what many nurses fail to do is take care of themselves.
Nurses are entrusted with making critical decisions that can profoundly impact our patients' lives. Many of these decisions need to be made quickly, demanding not only clinical skills but also mental sharpness and clarity. Moreover, the physical demands of the role—often requiring 12+ hour shifts— can lead to burnout.
Prioritizing self-care is crucial for maintaining well-being and can help reduce compassion fatigue and lower stress levels, allowing nurses to approach each shift with renewed energy and focus. Self-care can enhance mental and physical health, ultimately leading to improved patient care. It's important that CNOs encourage self-care in their workforces to promote wellness and a healthy work environment.
Self-care is not limited to nursing or healthcare workers. We can all benefit from self-care to improve our mental, physical, and emotional health. Let’s explore simple yet powerful ways to implement self-care amidst the demands of our daily lives.
1. Sensory Meditation: Sometimes, the practice of meditation can seem intimidating. Engage in sensory meditation by focusing on one sense at a time. For example, spend a few minutes appreciating the aroma of your favorite coffee, candle, or essential oil, listening to calming nature sounds, or savoring the taste and texture of a piece of dark chocolate.
2. DIY Spa Day: Create your own spa day at home with DIY treatments such as homemade face masks, luxurious baths with Epsom salts and essential oils, and soothing hand and foot massages. Engage your partner or family members in the experience to foster personal connection.
3. Journaling with Prompts: Reflection and debriefing are important for nursing students and nurses but can also be effective for anyone. Use journaling prompts specifically tailored to you to reflect on your experiences, emotions, and accomplishments. Explore prompts related to gratitude, resilience, and self-compassion to foster personal growth and well-being. An example prompt could be, “What am I proud of myself for today?”
4. Artistic Expression: Explore different forms of artistic expression such as, painting, sketching, or photography, as a creative outlet for processing emotions and promoting self-expression. Need help figuring out where to start or what to try? There are some excellent adult coloring book options out there!
5. Dance Therapy: Incorporate dance therapy into your self-care routine by engaging in spontaneous dancing to your favorite music. Allow yourself to let go of stress and tension as you move freely and express yourself through dance.
6. Mindful Eating: Practice mindful eating by savoring each bite of your meals, paying attention to the flavors, textures, and sensations. Take time to eat without distractions, focusing on nourishing your body and enjoying the culinary experience. You could create a simple rule such as not eating in your car…or not eating from the work vending machines!
7. Laugh Therapy: Dedicate time to watch or listen to comedic content that makes you laugh wholeheartedly. Laughter releases endorphins and reduces stress, offering a natural and enjoyable way to boost your mood and well-being.
8. Nature Immersion: Immerse yourself in nature by spending time outdoors engaging in activities such as hiking, gardening, or birdwatching. Connecting with the natural world can help reduce stress, improve mood, and promote overall well-being.
9. Intuitive Movement: Practice intuitive movement by tuning into your body’s signals and engaging in activities that feel good and energizing. Whether it’s yoga, tai chi, or simply stretching, allow your body to guide you in movement that promotes relaxation and vitality.
10. Community Service: My favorite self-care practice has nothing to do with self! Volunteer your time and skills to support community service initiatives or organizations that align with your values and interests. Giving back to others can foster a sense of purpose, connection, and fulfillment, enriching your own well-being in the process.
These are a few practices I incorporate into my life and share with my nursing students. Any act of self-care can provide meaningful benefits. Remember, self-care is highly personal, so explore and experiment with different practices to find what resonates most with you.
Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content.
Maryn Moreni, MSN, RN, CNE, has dedicated the last five years to nurturing the next generation of nurses, with the most recent two years at Arizona College of Nursing. With a rich background as a registered nurse, certified family nurse practitioner, and a certified nurse educator, Maryn brings a wealth of practical knowledge and academic excellence to her teaching. She is deeply passionate about ensuring her students not only excel academically but also embrace the profession of nursing with empathy, resilience, and a strong desire to make a positive impact on their patients' lives.
The Parkland Center for Clinical Innovation has developed a new tool that enables providers to better understand the challenges that a specific neighborhood faces in accessing healthcare services.
The Dallas-based innovation center, which was spun out of Parkland Health in 2012, recently debuted the Community Vulnerability Compass (CVC), a data tool that pulls in ZIP codes, census information, and neighborhood-level information to better understand the health, resiliency and economic vibrancy of a particular neighborhood.
The goal, says Steve Miff, PCCI’s president and CEO, is to dig down deep into the many barriers that effect healthcare access and help health systems and hospitals design care pathways to boost clinical outcomes in underserved populations.
“Our health does not really become, doesn't start and doesn't end in our clinics [or] in our hospitals,” Miff said during a recent HealthLeaders podcast. “It really starts and continues in where we live, where we work, where we play, [and] where we pray. [This helps in] understanding and knowing [how to] be able to address those elements that oftentimes are barriers to access the health of communities.”
The CVC analyzes 26 different factors, including food insecurity, paycheck predictability, insurance coverage, education, internet availability, mobility, transportation, sidewalks, affordable housing, green space, clean air and crime statistics, to give providers a picture of a neighborhood’s healthcare options. And that, in turn, gives providers a roadmap to improving care for a specific patient.
“Now we have much richer information about that individual [that is put] into those databases that these organizations use,” he said. “It’s being used for planning, it's being used for patient outreach, it’s being used for placement of resources, and it’s being used to be able to coordinate activities and resources specific to that community on how individuals can be helped in their journey.”
Miff said the tool will not only help providers improve care management, but enable them to collaborate with various public and community health organizations on projects that can improve entire neighborhoods, even towns and cities. That might include public housing developments with better access to healthcare, food programs in areas where access to healthy food is limited, or mobile health programs in areas with a high percentage of cancer or chronic diseases.
“To understand vulnerability, we need to be able to collaborate and create those connected communities, and we need to use [this data] at scale,” he said.
To listen to the HealthLeaders podcast with Steve Miff, click here.
Nurse leaders should run with their strengths, according to this CNO.
As a passionate advocate for nurses, Dr. Rachel Miles is committed to ensuring caregivers and patients have a positive experience. Miles earned a Doctor of Nursing Practice degree from Regis University in Denver and her Master’s and Bachelor’s degrees in Nursing from the University of Central Florida. She recently served in executive roles within the Centura Health system, including Chief Nursing Officer for the Denver Metro Group and Vice President of Nursing Operations.
Miles was recently named chief nursing officer at AdventHealth Colorado and AdventHealth Porter in Denver. Miles has a track record of improving nurse engagement and retention while achieving strategic growth, and her leadership philosophy includes keeping frontline caregivers in mind when making decisions.
On our latest installment of The Exec, HealthLeaders sat down with Miles to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
The annual healthcare innovation event had plenty of heady conversation and high-profile speakers, but execs were more focused on how new ideas are now being put to use.
As HLTH sinks into the Nevada sunset and attendees (and their spouses/partners) figure out just how much they spent in the casinos, a look back reveals some interesting insights into how healthcare innovation is evolving.
AI was, of course, the dominant topic, indicative of the emphasis that everyone is placing on this technology to, in essence, "save healthcare." But we've been talking about AI for a few years now, and the conversations are shifting from what it can do to what we should be doing with it now. Anyone still talking about the low-hanging fruit is behind the curve and in danger of losing out to competitors who are using mature tools.
Ai governance is, of course, a separate conversation, and one that many healthcare execs should be following. Healthcare organizations are embracing AI so rapidly that they're in many cases making the rules on the fly, while collaborative efforts like CHAI and TRAIN are playing catch-up with standards and best practices. Sadly, a main stage session featuring Brian Anderson of CHAI, David Rhew of Microsoft, Christine Silvers of Amazon One Medical and Melanie Fontes Rainer of the Health and Human Services Department's Office of Civil Rights drew a small audience (much less than the session featuring Lenny Kravitz just a short while later).
Getting More Specific About AI
On the exhibit hall floor, healthcare executives and others were talking about what they're doing now with AI, especially generative and predictive tools. Dan Shoenthal, VP and chief innovation officer at the University of Texas MD Anderson Cancer Center, said he was finding value in conversations with other executives and in the smaller, more focused sessions taking place in meeting rooms outside the exhibit hall.
During an exhibit hall session on Monday titled "Payer-Provider Arms Race," executives from Providence, Ardent Health, Sanford Health Plan and Doximity talked primarily about how they're using AI now, rather than how the technology might improve that often-testy relationship between providers and payers. Sara Vaezy, EVP and chief strategy and digital officer at Providence, did note that AI will help to "level the playing field" for providers and payers, and by giving both sides—and, more importantly, consumers—transparency, they'll be able to have more meaningful interactions.
The changing discussion on AI may have also led to a subtle shift in the mood at HLTH as well. Two years ago the celebrations were turned up a notch or two, buoyed by larger happy hours and food carts in the exhibit hall, vendors flush with cash from financing rounds and larger, more colorful booths. This year the atmosphere was (for the most part) less showy and more focused. The optimism is still there, due in large part to AI, but there's less attention to putting on a splashy display at a time when the industry is dealing with cost, quality and workforce issues. Even the celebrities who graced the stage in larger numbers were there to discuss important issues, not just give HLTH extra cachet.
And it's not all about AI, either. The Food as Medicine/Food is Health movement still had a significant presence in the exhibit hall, as well as a few interesting panels, though it's a bit disappointing that the effort hasn't grown much. Maternal health, behavioral health, environmental issues, global health and nursing innovation all staked their claim to the innovation landscape.
Moving Care Out of the Hospital and Into the Home
The acute care at home/hospital at home strategy also had its moments, starting with the continued presence of Best Buy and its Geek Squad for Healthcare booth. Caroline Yang, MD, associate clinical director of Mass General Brigham Healthcare at Home—one of the more advanced programs in the country—noted that health systems and hospitals are beginning to move beyond the rigid Medicare model and experiment with new ideas and patient populations. That may be a critical strategy as healthcare leaders look to move more services into the home setting and experiment with remote patient monitoring (RPM), telehealth, mobile-integrated health (MIH) and home health services.
Of course, innovative concepts like hospital at home need support from payers to be scalable and sustainable—at least in the early stages. The hospital at home movement saw a surge during the pandemic, as hospitals sought to isolate infectious patients and reduce the strain on overwhelmed clinical staff. That surge was supported by waivers from the Centers for Medicare & Medicaid Services (CMS) reducing restrictions on telehealth and RPM use and boosting Medicare reimbursements.
Those waivers are set to expire at the end of this year, but the rumor around HLTH is that the waivers will be extended, perhaps for another five years. Yang said an extension would be good for the industry, giving health systems and hospitals more time to gather the data needed to prove that these programs reduce costs and improve clinical outcomes.
Another extension may be on the table for the somewhat controversial effort to expand virtual prescribing for controlled medications. Prescribing by telehealth has been severely limited for years under the Ryan Haight Act, passed in 2008. That legislation put the onus on the U.S. Drug Enforcement Agency (DEA) to create a special pathway so that provider could be approved to prescribe controlled drugs for treatment of substance abuse, mental health, and other issues.
HHS unveiled a waiver during the pandemic so that providers could use telehealth, with the idea that the DEA would get around to setting up that registration process. The DEA still has not set up that pathway, despite pressure from a large group of providers and telehealth advocates as well as lawmakers. The rumor out of HLTH is that the waiver will be extended perhaps one more year, and that advocates will look at either having Congress force the DEA to establish that process or perhaps bypass the DEA altogether and a find a different means of enabling provider to prescribe by virtual channels.
Beyond those issues, healthcare's innovation executives came away from HLTH with a good idea of where the industry is heading. Scott Arnold, EVP and chief digital and innovation officer at Tampa General Hospital, and Rachel Feinman, vice president of innovation for Tampa General's TGH InnoVentures arm, said execs are looking beyond the next great widget or piece of technology to create and sustain a patient's entire healthcare journey. That means embracing new ideas on care management and coordination, as well as SDOH and navigation.
"There are parts [of this journey] that we may not be able to do as well," Feinman said. In order to become experts—and, in fact, stewards—of the patient journey, she said, they need to keep looking for inspiration from all angles inside and outside the healthcare industry.
Nurses should engage patients in their care plan, according to this CNO.
Nurses wear many hats in the industry, but their primary focus is on patient interaction and care delivery.
According to Cassie Lewis, chief nursing officer at Bon Secours’ Richmond market, part of Bon Secours Mercy Health, and HealthLeaders Exchange member, improving patient engagement begins with the day-to-day interactions between the patient and the bedside nurses who care for them.
Here are some tips on how nurses can engage with patients and make them feel more comfortable.
