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 is how to capture the recurring care-management revenue the practice leaves 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 remote monitoring or care-management program, 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 remote monitoring or care-management 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.
A named, governed remote-care service line with its own owner, P&L, and scorecard, following the Medicare cardiac patient between visits across every diagnosis the group manages. 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 opens 2–15-day post-PCI windows |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, titration, escalation |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | The principal cardiac condition — HF, CAD, resistant HTN — ≥3 months |
National non-facility magnitudes. The Value Analysis below uses MAC-locality rates auto-resolved for zip 95355 (California locality 01112-60).
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, and the operating model behind the ~117 modeled hospitalizations avoided.
Every reading — device-based or check-in — routes through a single decision logic, so the same discipline applies across both programs.
Every RPM and PCM reading enters the same escalation engine — one set of rules, not two.
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. The service line is RPM + PCM — physiologic monitoring plus Principal Care Management on the principal cardiac condition. Avoided-hospitalization savings are shown as clinical value, not revenue; they are upside on top of the reimbursement below.
| 24-month, by program | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| RPM | $1,823,754 | $1,043,054 | $780,700 |
| PCM | $809,546 | $442,332 | $367,214 |
| Implementation & ancillary | — | $26,464 | −$26,464 |
| Total, 24 months | $2,633,300 | $1,511,850 | $1,121,450 |
| By period | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| Year 1 | $713,364 | $414,220 | $299,144 |
| Year 2 | $1,919,936 | $1,097,630 | $822,306 |
| 24 months | $2,633,300 | $1,511,850 | $1,121,450 |
| Enrollment, device logistics, 24/7 monitoring, and billing capture are delivered by CoachCare, including an on-site enrollment specialist at CoachCare's expense — embedded value, never subtracted from practice margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 41.9%, Year 2 42.8%). 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.
≈ $1.76M in avoided acute cost at $15K per admission — clinical value on top of the reimbursement.
~21,518 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; the PCM wrapper layered onto the principal-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.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs day to day.
Successful program implementations.
Care-plan coding and billing behind more than 5 million claims.
Over 100 million vitals recorded and 4 million+ care actions enabled.
CMS's CY2027 Physician Fee Schedule proposed rule, published July 16, 2026, proposes to reprice remote physiologic monitoring. Here is what it reaches, what it leaves alone, and how the operating model behind this service line absorbs it.
CMS's remote-monitoring proposals sit in one code family: RPM. CCM, PCM, and TCM are not part of them. That distinction lands directly on this forecast — PCM carries $809,547 of the modeled $2,633,301 in 24-month net reimbursement, and the TCM touch at discharge is outside the proposal entirely. Neither is in scope.
The delivery model has more than one shape, and CoachCare is preparing each so the service line's economics hold wherever the rule settles. One unbundles the program into its parts — SaaS platform, device logistics, and program enablement — priced as components. Another engages CoachCare to run the staffing itself, an MSO-style arrangement in which the practice owns the clinical program and the billing while CoachCare carries the labor model. Neither requires re-architecting the service line described on this page.
Alongside the fee schedule, CMS's ACCESS Model pays remote care as a risk-based per-member-per-month arrangement rather than per code: recurring per-beneficiary payments, half of each one withheld and reconciled against outcome attainment. Cardiometabolic care is among its four clinical tracks. What earns under that structure — controlled pressures, titrated therapy, decompensations caught early — is what this service line is built to produce.
This forecast repriced code by code at CMS's CY2027 proposed values, at this practice's own MAC locality rather than national averages. Same enrollment, same phasing plan — only the rates move.
Both bars run on the same dollar scale, so the red slice is nearly the same width in each — the same dollars, measured against a larger base. The empty track on the top bar is the care-management revenue RPM alone does not include.
Repriced at this locality's own geographic adjusters. The RPM reductions fall almost entirely on practice expense, so the untouched work component carries more weight in some localities than others; the same repricing at national rates would be −8.8% on RPM. Of the $170,265, RPM accounts for $169,353 and the care-management arm for $912.
CY2026 versus CMS's published CY2027 proposed values, shown at national non-facility amounts so they can be read against CMS's own tables. This practice's locality-adjusted amounts differ; the repricing above uses the local figures.
| Code family | What CMS proposed | CY2026 | CY2027 proposed | Change |
|---|---|---|---|---|
| In scope — remote physiologic monitoring | ||||
| 99454 / 99445 · device supply | Practice expense recrosswalked | $52.11 | $41.38 | −21% |
| 99457 · management, first 20 min | Direct practice expense removed | $51.77 | $49.59 | −4% |
| 99458 · management, each addl 20 min | Direct practice expense removed | $41.42 | $40.39 | −2% |
| 99453 · setup and patient education | Crosswalked; one-time per patient | $21.71 | $20.03 | −8% |
| Not in scope — the codes the proposal does not reach | ||||
| 99424–99427 · PCM | No structural change proposed | $67.80 | $67.00 | −1% |
| 99495 / 99496 · TCM | Not addressed by the proposal | Outside the remote-monitoring provisions entirely | ||
National non-facility amounts; CY2027 values are CMS's own published proposals in Addendum B of CMS-1848-P. The care-management rows show the lead code in each family; every code in those families moves within about 4% in either direction, which is ordinary annual movement rather than a repricing. The RPM reductions are also phased — section 1848(c)(7) of the Act caps any one code's total-RVU reduction at 19% in a single year, and CMS publishes the affected codes, so CY2027 is a single-digit year for a typical program and the remainder arrives no earlier than CY2028.
Six reasons this fits Stanislaus Cardiology Group specifically, not remote care in general.
CoachCare integrates directly and bi-directionally with Greenway: your team enrolls and monitors remote-care patients inside the chart it already uses. One record for clinicians, and one workflow for the billing team.
Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. The practice inherits a running program at a 42.6% practice margin with no hiring cycle. On-site enrollment is our expense, because telephonic outreach converts about 8%.
The group's cardiologists set the protocols, sign the care plans and make every clinical decision, and claims go out under the group's own entity. CoachCare runs the engine; your physicians govern the care.
The market runs 58% Medicare Advantage. The fee-for-service quarter bills per claim every month, and the MA majority is protected by the statutory floor that pays a non-contracted plan no less than original Medicare — recurring professional-fee revenue with no risk-model exposure.
Four of five cardiologists are FSCAI interventionalists, and every high-volume PCI case opens a post-procedure window. One remote care service line — RPM and PCM — turns heart failure, coronary artery disease, hypertension and post-PCI recovery into a single billable spine, with one escalation engine across both.
There is no remote monitoring, care-management program, device clinic, patient app or telehealth in the practice today, and the group is in no MSSP ACO or shared-savings arrangement on record. This is a clean build with nothing to displace, so every enrolled patient is net-new recurring revenue.