TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic is on how the most recent two-year extension of Medicare telehealth flexibilities necessitate a more robust healthcare infrastructure to better utilize the additional data generated by remote patient monitoring. The author, Jiang Li, Ph.D., is founder and CEO of Vivalink, Inc., a Silicon Valley company developing digital health technology solutions for remote patient monitoring in healthcare and clinical research.
Ensuring equal healthcare access to Americans across the country is an ongoing effort. The latest funding bill from Congress looks to improve access by expanding where and how people receive care through a two-year extension of Medicare telehealth flexibilities. The bill adds to the five-year extension to the CMS Acute Hospital Care at Home (AHCAH) waiver, which allows hospitals to deliver acute inpatient care in patients’ homes with full Medicare reimbursement. Since its launch in 2020, the program has continued to receive extensions in the continued effort to ensure Americans living in rural or remote areas receive the healthcare they need.
Under the current Medicare extensions, telehealth provides real-time medical and mental health appointments over secure video from a patient’s location, along with a wide range of Part B services such as specialist consults, rehab, and psychotherapy. This latest extension allows beneficiaries to continue receiving this care from an expanded list of healthcare providers. While the original waiver was authorized in response to COVID-19, research shows that around 17% of healthcare visits were conducted via telehealth modalities post-2020, with over 116 million global users listed in 2024.
Telehealth helps address a gap in healthcare access felt by many Americans living in rural locations. While the extension provides flexibility for those patients to continue receiving remote care, it isn’t enough to close the gaps in American healthcare on its own. What will define its success is a deliberate investment in infrastructure from health systems, policymakers, and technology developers alike.
Exploring the Access Problem
Nearly 80% of rural America is classified as medically underserved, facing barriers such as provider shortages, high poverty rates, and a rapidly aging population. For Medicare-eligible patients in these communities, the obstacles to consistent care, including transportation limitations to caregiver responsibilities, can often prove to be insurmountable, blocking them from necessary medical care.
We see the direct result of these consequences in the data. One significant example is cardiac rehabilitation — more than one million Americans become eligible each year, yet fewer than 20% participate. Even among those referred, less than 34% enroll, largely because the model still demands repeated clinic visits that many patients simply cannot manage. This has been a slow but sure systemic struggle, embedded in how care has historically been designed and delivered.
We can see these consequences further compounded by issues with traditional monitoring. Episodic, in-clinic measurements offer only brief snapshots of a patient’s health, often missing transient but dangerous events occurring between visits. A study at Brigham and Women’s Hospital found that 27% of cardiac surgery patients experienced new atrial fibrillation episodes after discharge that traditional follow-up would have missed entirely. This post-discharge period, long treated as a clinical blind spot, illustrates the value of supporting remote care.
Making Changes for a Stronger Infrastructure
The outcomes of the AHCAH waiver have been significant: an analysis of over 5,800 patients treated under the waiver at Mass General Brigham found in-care mortality below 1%, compared to a national inpatient average of approximately 2%, with only 7% requiring return hospitalization. The cost savings are notable as well, with one review finding that hospital-at-home (HaH) patients cost approximately 20% less than traditional inpatients, allowing Medicare to spend $1,000 to $3,300 less per case across common conditions like pneumonia, heart failure, and sepsis in the 30 days post-discharge.
To ensure similar outcomes and savings at scale, a stronger infrastructure is needed. We’re already seeing movement in the replacement of traditional, episodic data by medical-grade wearable sensors capable of continuous ECG monitoring, temperature tracking, and real-time data transmission. We’re already seeing solutions for issues such as interrupted data capture during connectivity gaps, simply by expanding the storage capabilities of devices that support rural Medicare populations.
Interoperability is equally important. Biometric data from wearables should flow directly into electronic health records and centralized clinical dashboards, delivering real-time alerts without burdening staff with manual data entry. For regional and mid-sized hospitals that serve the most underserved populations, this means access to modular platforms rather than expensive third-party bundles that absorb reimbursements before they reach patient care.
Supporting a Stronger Future
The decision to extend Medicare telehealth flexibilities is a market signal for health systems. Regulatory uncertainty has been one of the greatest barriers to the advancement of remote patient monitoring platforms, wearable infrastructure, and other programs. When reimbursement timelines are measured in months, it is difficult to justify multi-year infrastructure investments. As the CMS update extends reimbursement by two years, at-home care now has the opportunity to become an evolving standard of Medicare delivery worth investing in.
The opportunity extends well beyond Medicare. The same remote patient monitoring infrastructure enabling home-based acute care is powering decentralized clinical trials, expanding access for older and rural patients historically excluded from research. These opportunities for growth and inclusivity, supported by CMS, signal that at-home care is becoming a permanent feature of how Medicare is delivered.
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