The relationship between remote patient monitoring and COVID-19 is one of the clearest cases of a crisis reshaping how care gets delivered. When the pandemic arrived in early 2020, remote patient monitoring (RPM) moved from a niche service into a core part of how health systems kept patients safe at home. RPM uses connected devices to collect health data from patients where they live, then transmits it automatically to a care team for review and follow-up.
Before 2020, most RPM programs focused on chronic conditions like hypertension, diabetes, and heart failure. COVID-19 forced a rapid expansion into acute care, and the results were documented in a growing body of research. This article traces that history: what changed when the pandemic started, the studies that measured whether RPM actually worked for COVID-19, and where the rules stand now that the public health emergency has ended.
Why COVID-19 Pushed Providers Toward Remote Care
In the first months of the pandemic, hospitals faced two problems at once. Beds filled quickly, and every in-person visit carried infection risk for patients and staff. Sending lower-acuity patients home with monitoring tools solved both. Care teams could watch for warning signs remotely and bring patients in only when the data justified it.
The scale of the shift was large. One analysis of remote monitoring reimbursement during the pandemic reported that remote monitoring, telemedicine, and virtual care saw roughly a 20-fold increase in use as patients lost access to in-person appointments. Industry estimates later suggested the pandemic advanced RPM adoption by three to five years compared to its pre-2020 trajectory.
A second driver was reimbursement flexibility. To ease the burden on clinics, the Centers for Medicare and Medicaid Services (CMS) temporarily relaxed several rules. Providers could waive the 20% patient copay, enroll new patients without a prior in-person visit, and, for patients with or suspected of having COVID-19, bill RPM after just two days of device use instead of the standard 16. These changes lowered the barrier to starting a program and helped clinics recruit patients quickly.
What the Research Showed About RPM for COVID-19
The pandemic produced something earlier RPM adoption never had at scale: a large set of studies measuring outcomes. A 2025 narrative review in the journal Electronics synthesized 13 studies from 2020 to 2024 and described how the pandemic accelerated both telemedicine and wearable-device monitoring while exposing gaps in access and integration.
Several individual programs stand out.
The Mayo Clinic Ambulatory RPM Program
Researchers at Mayo Clinic published one of the most cited outcome studies in Mayo Clinic Proceedings in December 2022. The analysis matched 1,128 pairs of high-risk COVID-19 patients who were enrolled in an RPM program. Patients who engaged with the technology had significantly lower rates across every measure studied. Their 30-day, all-cause hospitalization rate was 13.7% versus 18.0% for enrolled patients who did not engage. Intensive care unit admission was 2.3% versus 4.2%, and 30-day mortality was 0.5% versus 1.7%. Cost of care was lower as well, at about $2,306 per engaged patient versus $3,566 for those who were not engaged. You can read the full study in Mayo Clinic Proceedings.
[INSERT CHART: mayo-rpm-covid-outcomes-chart — grouped bar chart, engaged vs. not engaged across hospitalization, prolonged stay, ICU admission, and mortality. Alt text: “Bar chart of 30-day COVID-19 outcomes in Mayo Clinic’s RPM program, showing lower hospitalization, ICU admission, and mortality for engaged patients.”]
The researchers also noted that racial and ethnic minority patients engaged with the technology at rates comparable to non-Hispanic White patients, which ran counter to earlier telehealth adoption patterns.
A Multisite Program Across 41 States
A study published in npj Digital Medicine in 2021 evaluated 7,074 patients managed through a multisite RPM program spanning 41 states. The technology engagement rate was 78.9%, the 30-day mortality rate was 0.4%, and the program was judged feasible and safe for managing acute COVID-19 illness at home. The full paper is available in npj Digital Medicine.
Pulse Oximetry and the Limits of the Data
Not every study showed a clear benefit, which is worth stating plainly. A pragmatic randomized trial from the COVID Watch program at Penn Medicine, published in the New England Journal of Medicine in 2022, found that adding home pulse oximetry to a text-based symptom-monitoring program did not increase the number of days patients stayed alive and out of the hospital compared to symptom checks alone. The finding did not argue against remote monitoring itself. It suggested that structured symptom follow-up carried much of the value, and that the device was one part of a larger care model.
In England, the national COVID Oximetry @home (CO@h) program produced mixed but informative results. Observational analyses using national hospital data found lower odds of 28-day mortality among some monitored groups, alongside higher rates of appropriate hospital attendance, consistent with the goal of catching deterioration early.
Taken together, the studies show that remote patient monitoring for COVID-19 worked best when the device data fed into a defined clinical workflow, not when hardware was handed out on its own.
How RPM Evolved After the First Wave
Early COVID-19 monitoring leaned heavily on pulse oximeters, since silent hypoxia was a known danger. As programs matured, they folded in blood pressure cuffs, thermometers, and weight scales to support the chronic conditions that put patients at higher risk in the first place. Programs also split into tiers, with low-intensity monitoring for stable patients and high-intensity monitoring for those at greater risk of deterioration.
This period taught health systems a durable lesson. The infrastructure built for COVID-19, including device logistics, data platforms, and nursing workflows, applied directly to chronic care management once the acute crisis eased. Many programs that started with COVID-19 patients kept running for heart failure, chronic obstructive pulmonary disease (COPD), and hypertension.
What Changed Permanently, and What Expired
The federal COVID-19 public health emergency (PHE) ended on May 11, 2023. That date mattered because many of the flexibilities that made pandemic RPM easy were tied to the emergency declaration.
Some changes were temporary and have expired. The copay waiver protection under the Office of Inspector General policy statement ended with the PHE. The reduced two-day billing threshold for COVID-19 patients also expired, so the standard 16-day device-use requirement for CPT codes 99453 and 99454 applies again for most RPM billing.
Other flexibilities were extended by Congress rather than ended abruptly. The Consolidated Appropriations Act of 2023 carried several telehealth provisions past the PHE, and patients who began remote monitoring during the emergency were treated as established patients for continued services. Broader Medicare telehealth flexibilities, including the removal of geographic and originating-site restrictions, have been extended repeatedly through short-term legislation rather than made permanent, so their status continues to shift.
For an accessible reference to how these RPM CPT codes and billing rules work today, see Tenovi’s guide to remote patient monitoring.
Where Remote Patient Monitoring Stands Now
The pandemic did not create remote patient monitoring, but it proved the model at a scale no chronic-care rollout had reached. Adoption stayed elevated after the acute crisis passed. The research base that COVID-19 generated now supports RPM programs across cardiology, pulmonology, endocrinology, and post-discharge care. Health systems that treat monitoring as a continuous service, rather than a device shipped to a patient’s door, are the ones seeing sustained results.
The throughline from 2020 to today is simple. Remote patient monitoring is proactive, preventive care. When device data connects to a real clinical response, it keeps patients out of the hospital, lowers total cost of care, and extends access to people who cannot easily travel for treatment.
Understanding Remote Patient Monitoring and COVID-19
Remote patient monitoring and COVID-19 became linked because the pandemic gave health systems both the reason and the reimbursement flexibility to move care into the home at scale. The studies that followed, from Mayo Clinic to the NHS, measured what earlier adoption never could, and they showed that monitoring paired with a clinical response can lower hospitalization, reduce cost, and improve outcomes. Many pandemic-era billing flexibilities have since expired, but the model itself became a permanent part of how chronic and post-acute care is delivered.
Tenovi provides the connected devices, cellular Gateway, and data infrastructure that let care organizations run remote patient monitoring programs without the setup burden that slowed early adoption. If you want to see how it works for your patient population, request a free demo and consultation.
