YUUKI EDGE — The Read · Issue #28 · September 22, 2026
How you get paid decides what a rule can do to you
Last week I wrote about the new AI certification for hospitals. It grades the hospital, not the software, so the burden of proof lands on whoever is accountable. This week Medicare did something similar to remote patient monitoring. It wants the practice that sends the bill to own the work, including employing the people who do it.
In July, Medicare proposed a rule that gives one remote monitoring company a small raise and takes away the main thing another one sells. Both companies monitor patients at home. The only real difference between them is who sends the bill to Medicare.
I've watched a lot of teams spend years on their technology and very little time on how they'll be paid. This week is a good example of why that's backwards.
Three questions I'd ask about any company when payment rules change
You can use these on your own company, a vendor you're evaluating, or a company you're thinking about investing in.
1. Whose name is on the bill? If your customer bills Medicare and you do the work behind it, the rules about who's allowed to do that work can change, and you have very little say. If you bill Medicare yourself, the government usually has to cut your rate to hurt you, and that's something you'll see coming.
2. If a rule took away your staff, what would customers still pay you for? If the honest answer is a device and a dashboard, then you were selling labor with some technology around it. That can be a fine business right up until someone regulates the labor.
3. If you hand the work back to your customer, can they actually do it? People skip this one. "We'll just sell the software" sounds like an easy fix, but it assumes your customer can suddenly hire the people they were paying you to provide. In healthcare, most can't, at least not quickly.
None of these three questions is about AI, and that's on purpose. In anything Medicare pays for, the technology is rarely what decides whether a company survives.
What happened, and how the field splits
Here's how remote monitoring usually works today. A patient goes home with a connected blood pressure cuff or scale, the readings go to a care team, and a nurse follows up when something looks wrong. Medicare pays the doctor's practice a monthly fee. Because most practices don't have spare nurses, many hire an outside company to supply the devices, the software and the nurses, and the practice sends the bill.
Medicare now wants those nurses to be the practice's own employees, starting January 1, 2027. Outside nurses would stop counting. Practices could still buy devices and software from outside vendors, so the rule only goes after the staffing.
Medicare has its reasons. Spending hit $536 million in 2024, up 31% in a year, and Medicare's own watchdog found 43% of patients weren't getting everything Medicare paid for. More than 230 organizations objected before comments closed on September 14, and the final rule is expected around November.
The question every company in this space now has to answer is simple: if Medicare changes who's allowed to do the work, does our revenue survive?
The field splits into three groups:
Companies that supply nurses to other people's practices. They have a deadline, and not much time to change how they make money.
Companies that sell devices and software for a practice's own staff to use. They're allowed to keep going, as long as their customers can find the staff.
Companies that bill Medicare themselves for a service they run start to finish. The rule barely touches them, and one of them is getting a raise out of it.
The paid issue names the companies in each group and gives my call on each one.
Also this week
Four digital health companies raised a combined $848 million: Angle Health ($600 million), Thatch ($108 million), Tandem Health ($100 million) and women's health testing company Evvy ($40 million).
Angle Health and Thatch both help employers give workers a set budget to buy their own health coverage. Both are now valued at $1 billion or more, and payroll companies ADP and Paychex invested in Thatch.
Tandem Health builds an AI assistant that handles notes and paperwork for clinicians. It says more than 10,000 care organizations across 14 European countries use it.
UW Health says a single upgrade to one of its core software systems came with more than 100 new AI features for its team to review. For big health systems, checking AI tools is turning into a staffing problem of its own.
Where I might be wrong
This is a proposed rule, and a lot of people are fighting it. Medicare could soften it in November, maybe by letting approved outside companies keep supplying nurses. If it does, the first group above has much more time than I'm giving it credit for. I'd still ask the three questions, though, because the next rule might not get softened.
If you want the names
Yuuki Institutional, the paid edition, names the companies in each of the three groups above. I score each one on six things, including how much proof it has that it works and how exposed it is to rules like this one, and I say whether I'd back it, watch it or pass.
This week it also includes one call where I went against my own scoring system, and I explain why and what would prove me wrong.
It's written for investors and strategy teams who evaluate these companies for a living. The founding rate stays locked for as long as you're subscribed.