September 22, 2026
Every RTM demo looks the same. A clean dashboard. Adherence graphs trending up. A patient list color coded green and yellow and red. A billing summary showing what the practice could have collected last month if it had been running this all along.
The clinic owner signs.
Month one goes well. Somebody is excited, patients get enrolled, the graphs fill in. Month two is quieter. By month three the enrollment has stalled, the outreach calls are not happening, and the billing report that looked so good in the demo is showing a fraction of what it projected. The software is still running perfectly. The revenue is not there.
I have watched this happen to good practices with good intentions more times than I can count. It has almost nothing to do with the software.
Read the codes and the problem becomes obvious
CPT 98980 covers remote therapeutic monitoring treatment management. It requires at least 20 minutes of clinical time in a calendar month and at least one interactive communication with the patient or caregiver during that month. 98981 covers each additional 20 minutes.
Look at what is actually being reimbursed there. Not the app. Not the exercise library. Not the dashboard. A payer is reimbursing a qualified clinician for spending real time reviewing real patient data and then talking to that patient.
The billable event is labor.
So run the arithmetic on a practice with 100 patients enrolled. That is 2,000 minutes a month before anyone documents anything. Thirty-three hours. Add the documentation, add the patients who do not pick up the first time, add the ones who need a second call because their pain flared and the program needs adjusting. You are somewhere north of a full-time position.
Nobody budgeted for a full-time position. They budgeted for a software subscription.
Why nobody tells you this during the demo
Software companies sell licenses. Their model is complete the moment you sign. Whether the platform gets used at scale in month nine is your problem, not theirs, and their pricing reflects that.
This is not cynicism about vendors. It is just how the incentives point. A company that sells you a tool has no structural reason to care whether you have the staffing to pick the tool up. The demo shows you the ceiling. It cannot show you your own schedule.
Two clinics, two different failures
An independent practice fails at RTM because there is no slack. Everyone is booked. The front desk is covering phones and intake and authorizations. The therapists are treating. The owner is doing payroll at nine at night. When RTM monitoring lands on top of that, it gets whatever minutes are left over, and on most days there are none.
A hospital system or large group fails differently. The minutes exist somewhere in the organization. What is missing is an owner. The monitoring lives inside a larger EMR, nobody’s job description says the words remote therapeutic monitoring, and the care sometimes happens without ever being documented in a way that gets captured. Real clinical work, real patient benefit, zero revenue.
Different failure, different fix. Buying more software solves neither one.
What to decide before you sign anything
Answer one question before you evaluate a single platform. Who is doing the 20 minutes?
There are two honest answers. You name a specific person, protect those hours on the schedule the way you would protect a treatment block, and accept that this is now part of your labor cost. Or you buy the labor from someone whose entire job is doing it, which is what a managed monitoring model is.
There is a third answer that everyone gives without meaning to, which is that it will get absorbed. That is the one that produces month three.
Why we built MovementRx the way we did
I run a physical therapy clinic. I bill these codes. I have sat in the chair at nine in the morning trying to figure out which of the eleven patients flagged yellow actually need a call today and which are fine.
That is why MovementRx staffs the monitoring with licensed PTs and PTAs rather than handing a practice a login and wishing them luck. Our adherence runs around 78 percent. The commonly cited national figure for remote monitoring programs is closer to 30. That gap is not because our algorithms are better than anyone else’s.
These adherence figures come from our internal analysis and are preliminary. They have not yet been peer reviewed.
It is because a clinician calls.
Patients do their home program when a person who knows their case checks in and adjusts it. They stop when an app sends a push notification into a phone that already sends them forty of those a day. Everyone in rehab already knows this from the clinic floor. It is strange how quickly we forget it the moment the word platform enters the conversation.
The question to ask your next vendor
When the demo ends and they ask if you have questions, skip the feature list. Ask this instead.
Who on my team is doing the twenty minutes, and what happens in month three when they cannot?
If the answer is a shrug dressed up in the language of workflow efficiency, you are buying a costume.
What this means for your clinic
If you are running RTM and watching utilization slide, or you are evaluating it and want to know what the staffing actually looks like, request a demo and we will walk through your caseload and where the minutes would come from. If you are not ready to talk to anyone yet, start with the RTM calculator and see what the numbers look like against your own patient volume.
Andrew Gorecki, PT, DPT, FAFS is the owner of Superior Physical Therapy in Traverse City, Michigan and co-founder of MovementRx, a remote therapeutic monitoring platform with licensed clinicians handling patient monitoring. He is adjunct faculty at the Gray Institute and has co-authored three books on musculoskeletal pain. He presented on RTM implementation at APTA Private Practice Section in 2024.