We Analyzed 2,500 RPM Patients. Here's What the Compliance Data Shows.

The Dataset and Methodology

The analysis covers 2,500 patients enrolled in RPM programs across 12 primary care and multi-specialty practices between January 2024 and June 2025. Patient diagnoses included hypertension (58%), chronic heart failure (22%), COPD (12%), and diabetes (8%). All practices used cellular-connected RPM devices that transmitted readings directly to the practice EHR system via API.

Compliance was defined per CMS CPT code 99454 criteria: 16 or more qualifying device readings transmitted within a 30-day period. We analyzed month-level compliance per patient, device type (blood pressure monitor, pulse oximeter, weight scale, glucometer), and patient demographic segments. We also tracked alert response times and correlated them with downstream ED utilization.

This is not a peer-reviewed study and makes no claims of statistical generalizability beyond this dataset. We are presenting it because the patterns are consistent enough across 12 different practices to be operationally useful.

Overall Compliance: 67% Hit the Billing Threshold

67% of enrolled patients achieved 16 or more qualifying readings per month across the 18-month observation period. 33% did not consistently meet the threshold — either transmitting fewer than 16 readings in a given month, or being entirely non-compliant (zero readings) for one or more months.

Why Patients Don't Comply: The Barrier Data

Among the 33% of patients who did not consistently meet the 16-reading threshold, we tracked the primary barrier through a structured care coordinator survey administered at the 90-day mark for each non-compliant patient. The results surprised us in their specificity.

• Device connectivity issues (41%): The Bluetooth or cellular connection between the device and the transmission system failed. Most commonly: the patient moved the device out of cellular range, the app that relayed readings needed an update, or the device battery died and was not replaced. This is a practice-side operational problem, not a patient behavior problem.
• Patient forgetfulness (32%): The patient forgot to take readings consistently. This responds well to SMS reminder programs — practices that implemented daily SMS reminders reduced forgetfulness-driven non-compliance by 44%.
• Caregiver dependency (18%): The patient relied on a family caregiver to assist with device use, and when the caregiver was unavailable (travel, hospitalization, schedule change), compliance dropped. This segment was concentrated in the 75+ age group.
• Device dissatisfaction (9%): The patient disliked the device (too difficult to use, uncomfortable, didn't trust the accuracy). Device replacement with a patient-preferred alternative resolved compliance in 67% of these cases.

Age and Compliance: The Non-Obvious Pattern

The assumption going into this analysis was that older patients — particularly those 85 and older — would have the lowest compliance rates due to technology comfort barriers. The data is more nuanced.

The 65-74 group is the sweet spot: retired patients with established routines, motivated by active chronic conditions, and comfortable enough with technology to use cellular-connected devices reliably. Practices looking to maximize RPM program revenue and compliance should prioritize this demographic for enrollment, particularly those with HF or COPD.

The Revenue Impact: 75% Higher Revenue Per Patient

The revenue data is the clearest finding in the dataset. We segmented the 12 practices into two groups based on whether they had systematic compliance monitoring (defined as: a staff member or system that checks compliance status weekly and contacts non-compliant patients): 7 practices with monitoring, 5 without.

Alert Response Time and ED Utilization

RPM devices generate alerts when vital signs fall outside programmed thresholds. We analyzed how quickly practices responded to alerts and correlated response time with 30-day ED visit rates among RPM patients.

Practices that responded to vital sign alerts within 4 hours (defined as a documented staff action: phone call, message, prescription change, or referral) had 23% fewer ED visits among their RPM patients compared to practices where alert response time averaged more than 24 hours. This is not a statistically controlled finding — we cannot rule out confounding by practice type or patient severity. But the pattern is consistent enough across our dataset to support the operational principle: RPM alert response time matters, and a system that surfaces unresponded alerts to clinical staff is part of the value of the program.

CPT Code Timing Windows and Documentation

The billing mechanics of RPM require precise timing adherence. CPT 99454 (device supply with daily recording and programmed alert transmission) requires 16 or more readings within a 30-day period. The 30-day period is a rolling window — it does not restart on the first of each calendar month. This means practices must track compliance at the patient level, not just as a monthly aggregate.

CPT 99457 (remote physiologic monitoring treatment management, first 20 minutes) requires at least 20 minutes of interactive communication between staff and the patient per 30-day period. CPT 99458 (each additional 20 minutes) adds revenue for extended management time. Documentation must reflect the specific time spent, the content of the interaction, and the clinical decision made.

Practices that use Vizier's RPM compliance module receive a real-time dashboard showing each patient's reading count toward the 16-reading threshold, days remaining in their current 30-day window, documented management time toward 99457 billing, and unresponded alerts. The goal is to surface the compliance gaps before the billing window closes — not to document what went wrong after the fact.