How an independent, interventional-heavy cardiology group turns continuous care for heart failure, coronary artery disease, hypertension, and post-PCI recovery into a billable, margin-positive service line — on Fee-for-Service, in a 58% Medicare Advantage market, with no risk-model exposure.
This is not a turnaround story. Stanislaus Cardiology enters the remote-care era as an owner-operated, single-specialty group that just invested in its own future — a new ~11,460 sq ft medical office — with a heavily interventional practice and zero risk-model baggage. The strategic question isn't how to survive a payment shift. It's how to capture recurring care-management revenue the practice is leaving entirely on the table today.
Owns its group NPI (1902828841) and a new ~11,460 sq ft office at 3621 Forest Glenn Dr — an independent investment, no PE or MSO rollup on record.
Four of five cardiologists are FSCAI interventionalists — a high-volume PCI group whose post-procedure and heart-failure patients are the natural remote-monitoring cohort.
No RPM, CCM/PCM, device clinic, patient app, or telehealth anywhere in the practice — a clean build with no incumbent vendor to displace.
Not in an MSSP ACO or shared-savings arrangement on record. Care-management reimbursement accrues cleanly to the practice on Fee-for-Service.
One structural advantage sits underneath all of this: a single practice, a single chart, a single billing layer — exactly the substrate a remote-care service line needs. What's missing is the service line itself: no RPM, CCM, or PCM program is billed anywhere in the group today.
Three forces make now the right time to stand up a cardiology remote-care service line — and none of them require taking on downside risk.
Modesto runs roughly 58.4% Medicare Advantage penetration (2025/26), well above the national ~54%. An aging Central Valley panel plus an MA-heavy payer mix is the ideal demand base for continuous cardiac management — the single most important market fact behind this model.
New CY2026 codes 99445 (2–15-day device supply) and 99470 (first 10 minutes of management) make post-PCI and transitional monitoring windows cleanly billable — removing the 16-day floor that previously blocked episodic remote care for interventional patients.
With no existing remote-care program, every enrolled patient is net-new, recurring professional-fee revenue. No vendor to rip out, no sunk cost, no re-implementation — the whitespace is total.
Not a point solution bolted onto one diagnosis — a named, governed remote-care service line with its own owner, P&L, and scorecard, following the Medicare cardiac patient between visits. CoachCare runs the engine; your physicians govern every clinical decision.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use |
|---|---|---|---|
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 unlocks 2–15-day post-PCI windows |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, titration, escalation |
| Chronic Care Management | 99490 · 99439 | ~$60 + ~$47 add'l | 2+ chronic conditions under the cardiac diagnosis |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | Single high-risk condition (e.g., HF) ≥3 months |
Illustrative national non-facility magnitudes. The Value Analysis below uses MAC-locality rates auto-resolved for zip 95355 (California locality 01112-60). Verify against the current CY Physician Fee Schedule.
CoachCare integrates directly and bi-directionally with Greenway — your team enrolls and monitors remote-care patients inside the EHR workflows they already use, with discrete vitals flowing to the chart and claims auto-generated every month. No new system to learn.
Greenway integration setup (one-time), $0 monthly, $0 per-patient — the catalog pricing carried in the Value Analysis. Confirm the Greenway product (Intergy vs Prime Suite) and pricing in contracting.
CoachCare is the only care-management platform that provides automated claims creation via its billing engine — the reason capture holds as the panel scales.
"Key to achieving a program that is efficient, effective and sustainable is creating a seamless, intuitive user experience for the patient and provider — and that's what our EHR integration accomplishes."
A remote-care service line has to earn its place two ways at once — it must pay for itself, and it must be clinically disciplined enough to protect the practice's standing. In a market where roughly 58% of seniors are in Medicare Advantage, and where quality reputation drives both referrals and plan relationships, a documented escalation protocol is the safety layer beneath the recurring-revenue story — the operating model behind the ~77 hospitalizations avoided.
Every reading — device-based or check-in — routes through a single decision logic, so the same discipline applies across all three programs.
Every RPM, CCM, and PCM reading enters the same escalation engine — one set of rules, not three.
A critical reading escalates immediately, regardless of whether the patient reports any symptoms.
A non-critical out-of-range reading triggers a retake and symptom check first, filtering false alarms before anything reaches the practice.
Three consecutive out-of-range readings at least an hour apart (blood pressure, glucose), or three within seven days (heart rate) — not a subjective call.
If the patient can't be reached: voicemail plus a scheduled callback — and escalation proceeds anyway when a critical value or a trend exists.
A complete record is written for each event:
An active, emergent symptom reported during any outreach call triggers the emergency pathway:
A recent but no-longer-active symptom (within 72 hours) is handled per the practice's stated preference.
An ER visit or hospitalization in the last 60 days triggers a fixed three-touch cadence across the highest-risk two weeks. Each touch is documented and escalates on any red flag.
Identify precipitating factors · medication reconciliation · confirm PCP / specialist follow-up is booked within 7–14 days · symptom assessment.
Confirm medication adherence · re-evaluate triggers · confirm the follow-up appointment was kept · verify labs.
Medication and risk review · review visit outcomes · symptom re-assessment.
A 24-month forecast for the cardiology service line — an estimated ~4,146 total Medicare patients (roughly ~1,711 FFS Part B plus ~2,435 Medicare Advantage, reimbursed at federally-set FFS rates), six referring physicians, one CoachCare-funded on-site enrollment specialist, MAC-locality rates for zip 95355, Greenway integration. Avoided-hospitalization savings are shown as clinical value, not revenue; they are upside on top of the reimbursement below.
| Program | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $314,446 | $876,873 | $1,191,319 |
| CCM net reimbursement | $307,622 | $899,347 | $1,206,969 |
| PCM net reimbursement | $124,307 | $373,005 | $497,312 |
| Total net reimbursement | $746,375 | $2,149,225 | $2,895,600 |
| Practice margin (after fees) | $311,392 | $923,922 | $1,235,314 |
| Enrollment, device logistics, 24/7 monitoring, and billing capture are delivered by CoachCare — no new practice headcount required. | |||
Figures are illustrative and modeled — verify against practice data. Full model available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months.
A continuous clinical picture of the HF, CAD, and hypertension panels between visits.
≈ $1.15M in avoided acute cost at $15K per admission — clinical value on top of the reimbursement.
24,590 care-team hours of monitoring, outreach, and documentation handled by the service line.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while Stanislaus physicians govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount; staffing formalizes only as census grows.
Named owner, P&L, scorecard; Greenway integration and billing configuration; protocol sign-off for HF, CAD, hypertension, and post-PCI pathways.
Post-PCI / interventional discharges and heart-failure patients enroll first; device logistics and 24/7 monitoring live; first billable claims by day 45.
Full referral engine across all six physicians; CCM and PCM layered onto the multi-condition panel; monthly scorecard to practice leadership.
~1,175 active enrollments by month 12, recurring professional-fee revenue, and a continuous clinical picture of the cardiac panel between visits — scaling toward ~1,897 by month 24.
A single-site, interventional-heavy group has one obvious first cohort — the post-procedure and heart-failure patients already flowing through the Forest Glenn office. Concentrating enrollment there lets the practice shake out the workflow on the highest-value patients first.
A cohort-first launch produces the internal evidence — census, capture rate, revenue per patient-month, readmission signal — that makes the full-panel rollout a data decision, not a leap.
| Milestone | Target |
|---|---|
| Greenway integration + protocol sign-off | Day 30 |
| First billable enrollments | Day 30–45 |
| Device dispatch + monitoring live | Day 45 |
| Active enrollments by Day 90* | ~181 patients |
| Go / scale review with unit economics | Day 90 |
*Modeled months 1–3 active census (37 → 97 → 181), ramping via physician referral, a CoachCare-funded on-site enrollment specialist, and telephonic outreach. Illustrative — the actual funnel is set in protocol design.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers committed to remote care excellence.
Successful program implementations.
Care plan coding and billing generating over 5 million claims.
Over 100 million vitals recorded and 4 million+ care actions enabled.
Every number on this page traces to the CoachCare Value Analysis workbook or cited public and caller data. The key assumptions — and the items to confirm in discovery: