You just saved a patient an emergency room visit with a three-minute portal message. You reviewed their connected blood pressure cuff data, saw a concerning trend, and tweaked their medication. It was efficient, high-quality, proactive care.

Your reward? Zero dollars.

Worse than that, your contribution was invisible. It didn’t count toward your productivity. It didn’t show up on a dashboard. In the eyes of our current health care system, that high-value interaction might as well have never happened. This isn’t a glitch in the system; it is the system. And it’s failing us.

We are clinicians operating in a digital-first world, armed with incredible tools for remote monitoring, asynchronous communication, and data-driven insights. Yet, we are still being measured and paid by an analog-era rulebook. The system’s obsession with fee-for-service (FFS) and its outdated Key Performance Indicators (KPIs), like Relative Value Units (RVUs) and visit volume, are the greatest economic barriers to care in modern medicine. Our current metrics don’t measure quality, value, or efficiency. They measure activity. They reward clicks, visits, and procedures, regardless of the outcome. This flawed model actively discourages innovation and penalizes physicians for doing the right thing. If we want to unlock the true potential of digital health, we must stop letting these broken metrics dictate our actions. We must rethink how we measure quality and how we get paid for it.

From “visits per day” to “problems solved per month”

The first step is to define new, meaningful KPIs that actually reflect quality of care in the digital age. While the fee-for-service system isn’t tracking these, you should be. Think of them as your “Shadow KPIs”, the metrics that prove your real value. Here are three examples:

• Old KPI: Patient visit volume. New KPI: Patient time-to-resolution. Instead of measuring how many patients we can churn through in a day, what if we measured the total time from a patient’s initial complaint to its successful resolution, regardless of how many “visits” it took? A single telehealth call, two portal messages, and an RPM check-in that solves a problem in 48 hours is infinitely more valuable than three in-person visits over three weeks.
• Old KPI: RVUs billed. New KPI: Time in tight glycemic range. For a patient with diabetes, an RVU is a meaningless abstraction. What matters is their health. By leveraging remote patient monitoring (RPM) and CGM data, we can measure the percentage of time a patient is in their target glucose range. This is a direct, tangible measure of health and quality, worlds away from a billing code.
• Old KPI: Number of procedures. New KPI: Reduction in preventable hospitalizations. Chronic care management (CCM) programs are a perfect example. The billable code itself is small, but its impact is massive. By tracking how your CCM program (powered by digital check-ins and care coordination) reduces emergency room visits and hospital admissions for your high-risk patients, you are demonstrating value that dwarfs the fee-for-service revenue.

Hack the system to prove your value

Of course, we can’t just invent new KPIs and expect payers to magically adopt them. We all have bills to pay. This is where we get practical. We must use the flawed fee-for-service system to our advantage as a bridge to a value-based future. In my own work, I often advise health tech startups and clinical leaders who are frustrated by this exact problem. My advice is a two-step “hack”: Step 1: Master the fee-for-service codes we have. Become an expert at billing for the digital work you’re already doing. Use the codes for remote patient monitoring, chronic care management, and telehealth visits. This generates the revenue to make your digital health programs sustainable today. Step 2: Use your “Shadow KPIs” as a business case. While you’re billing fee-for-service with one hand, you’re tracking your new, meaningful KPIs with the other. After three, six, or twelve months, you will have a powerful dataset. You can now walk into a meeting with a local employer or a regional payer not as a cost center, but as a value generator. The pitch sounds like this: “Over the last year, our RPM program for your diabetic employees generated $100,000 in fee-for-service revenue. But our real data shows we also reduced emergency room visits by 40 percent and saved you an estimated $500,000 in hospital costs. Let’s create a shared savings initiative so we can both benefit from this proven value.” You stop asking for permission and start proving your worth.

Don’t wait to make changes

This isn’t a futuristic fantasy. This is a practical, actionable strategy you can start today. The fee-for-service system is a relic. It’s slow, reactive, and rewards the wrong behaviors. It’s time to stop letting it dictate our patients’ futures. It’s time to start measuring what matters, proving our value, and building the health care system we and our patients deserve.

Sarah Matt is a surgeon and health tech strategist.