Four cardiologists, two offices, and a Medicare panel where roughly half the patients carry heart failure and half carry atrial fibrillation. The practice already reviews remote data every month for its device patients and bills it. This is the same habit extended to the rest of the panel: transitional care at discharge, remote monitoring and principal care management for the months after, staffed and run by CoachCare inside eClinicalWorks, with the practice keeping 42.6% of net reimbursement over 24 months.
Year 1 margin 41.0%, Year 2 43.3%. Enrollment begins in month 1; month 1 runs −$5,218 while setup posts against a small census, and the practice is positive from month 2 onward. The headline is 848 unique patients; the enrollment chart shows 1,294 active program enrollments, because a patient on both programs is one patient and two enrollments.
This is not a pitch for something new. The practice's own CY2024 Medicare claims show a mature, high-acuity panel and a working remote-data workflow for the patients who have hardware. They also show exactly where that workflow stops.
Across four cardiologists and $1.46M of Medicare allowed in CY2024: heart failure 47–53% · atrial fibrillation 45–53% · chronic kidney disease 39–43% · diabetes 41–43% · COPD 31–36% · ischemic heart disease 62–68%. Hypertension reports at 75%, the ceiling CMS publishes to. About 1,500 established patients were seen for a follow-up visit in the year.
Pacemaker, defibrillator and implantable-loop-recorder transmissions are reviewed on a 30- and 91-day calendar and billed under the remote-interrogation codes, alongside mobile cardiac telemetry. Someone already owns an incoming remote-data queue, works it on a schedule, documents it and bills it. The hard part is solved; it reaches the patients who have hardware.
99453, 99454, 99457, 99458, 99490, 99424–99427 and 99495/99496 are absent from the CY2024 claims for all four physicians: no program at meaningful scale. On a panel where one patient in two carries heart failure, none of the monthly management work between visits is being billed.
The practice's physicians hold privileges at four hospitals. The FY2026 Hospital Readmissions Reduction Program file, the file that sets the penalty, reports a heart-failure excess readmission ratio above 1.00 for two of them. McLaren Flint carries the largest heart-failure volume in the market and is penalized on every one of the six measures it reports, for a 1.01% reduction on every Medicare inpatient payment.
The thirty days after a cardiac discharge are where that ratio is decided, and they are the days this service line is built around: contact within two business days, a visit inside 7 or 14 days, a cuff and a scale transmitting daily, and a nurse who sees a three-pound weight gain on Tuesday and adjusts the diuretic before Friday. A cardiology practice that runs that cadence becomes the referral relationship a penalized hospital wants more of.
| Hospital | HF excess readmission ratio | HF eligible discharges | FY2026 payment adjustment |
|---|---|---|---|
| McLaren Flint | 1.0148 | 627 | -1.01% |
| McLaren Lapeer Region | 0.9791 | 262 | -0.16% |
| Hurley Medical Center | 1.0761 | 217 | — |
| Henry Ford Genesys Hospital | 0.9183 | 421 | — |
FY2026 HRRP supplemental data file and Table 15 (discharges July 2021 to June 2024). A ratio above 1.00 means more heart-failure readmissions than expected for that hospital's patients.
Cardiology Consultants of East Michigan is a participant in McLaren High Performance Network, an Enhanced-track Medicare Shared Savings Program organization. Enhanced is the two-sided track: savings under benchmark are shared, and losses over it are shared too. A heart-failure admission that does not happen is fee-for-service margin for the service line and, for an assigned beneficiary, a dollar that stays under the ACO's benchmark. The same program writes to both ledgers.
At the model's generic 20% annual admission rate. A cohort where half the patients carry heart failure admits well above that; at 40% the figure is about 163.
At $15,000 per admission, before any shared-savings split. None of it is in the Value Analysis below, which prices the fee-for-service codes only.
The share of savings under benchmark the ACO keeps, and the share of losses it carries when admissions go the other way. The share of enrolled patients assigned to the ACO is a chart question for the first working session.
Three billing families, one clinical workflow, one care team. A patient enters wherever they are, coming out of the hospital, newly decompensated, or overdue for real between-visit management, and stays on the same pathway.
WPS, Michigan locality 99, the rates both offices resolve to.
| Code | What it covers | CY2026 rate | Cadence |
|---|---|---|---|
| 99496 | Transitional care management, high complexity, face-to-face within 7 days | $285.37 | Once per discharge |
| 99495 | Transitional care management, moderate complexity, within 14 days | $210.41 | Once per discharge |
| 99453 | Remote monitoring, patient set-up and education | $19.97 | Once per episode |
| 99445 | Device supply, 2–15 days of readings (new for CY2026) | $47.64 | Short window |
| 99454 | Device supply, 30 days of readings | $47.64 | Monthly |
| 99470 | Monitoring management, 10–19 minutes (new for CY2026) | $24.83 | Monthly |
| 99457 | Monitoring treatment management, first 20 minutes | $49.33 | Monthly |
| 99458 | Monitoring treatment management, each additional 20 minutes | $39.87 | Monthly |
| 99426 | Principal care management, clinical staff, first 30 minutes | $65.32 | Monthly |
| 99427 | Principal care management, each additional 30 minutes | $51.83 | Monthly |
CY2026 Physician Fee Schedule non-facility amounts for ZIP 48532 (WPS, Michigan locality 99), the basis the Value Analysis below is priced on.
CoachCare integrates natively with eClinicalWorks. Enrollment flags and orders leave the chart; vitals, care documentation, enrollment status and billing-ready claims come back into it. Clinicians stay in the chart they already use, and the practice's biller does not learn a new claim path.
Enrollment flags and ordering by service inside the eCW workflow; the on-site specialist works the list, and patients begin receiving services within days.
Evidence of care, vitals and care plans attach to the patient's chart monthly, which is what makes the time-based claim defensible under audit.
The CoachCare billing engine creates the claim for every enrolled patient every month, removing the manual claim step the practice's billing manager would otherwise carry.
Integration setup for eClinicalWorks runs $4,000 one time, with a $150 monthly interface fee and $1.50 per enrolled patient per month. Those figures are carried in the financial summary below and confirmed in contracting.
The Value Analysis shows the program pays. This is the part that says it is safe, and that four cardiologists see signal rather than a thousand readings a day.
Chest pain, new shortness of breath, stroke signs, syncope, sudden swelling. CoachCare's urgent and emergent policy supersedes any practice-specific preference. If the patient refuses, the clinic is notified; otherwise CoachCare activates 911.
Out-of-range but not emergent findings route to the clinician or nurse the practice designates in the charter, with the readings, the symptom check and the recommended next step attached.
A retake that lands in range and a clean symptom check closes the loop with a chart note and nothing else. The cardiologist's inbox is reserved for what needs a decision.
An unreachable patient is re-attempted on a schedule, the practice is notified at every decision point, and a patient who stops transmitting is worked before a billing month is lost.
Any emergency visit or hospitalization in the preceding 60 days triggers three touches inside two weeks, and when the patient was admitted it is also the TCM episode. That cadence, on this panel, is where the modeled 82 avoided hospitalizations over 24 months come from.
Reach the patient, reconcile medications against the discharge instructions, confirm the cuff and scale are transmitting.
Weight trend and symptom review, diuretic plan confirmed, follow-up appointment confirmed with the practice.
Close the episode or extend it; anything trending is escalated through the engine above.
A 24-month forecast for the RPM + PCM stack: 2,500 Medicare patients in scope for Year 1 out of an estimated panel of 3,130, sized from the practice's own CY2024 established-visit beneficiaries and the Medicare Advantage share of its two counties. 5 referring clinicians, one CoachCare-funded on-site enrollment specialist, Michigan locality 99 rates and the eClinicalWorks integration. Shared savings and transitional care are not in these numbers.
| Program | Net reimbursement | CoachCare fees | Net to practice |
|---|---|---|---|
| RPM: devices, data and management | $1,126,366 | $638,053 | $488,313 |
| PCM: principal care management | $709,919 | $368,304 | $341,615 |
| Implementation, eCW integration and outreach | — | $47,942 | −$47,942 |
| 24-month total | $1,836,285 | $1,054,299 | $781,986 |
| Enrollment outreach, care management and device logistics are CoachCare's expense: embedded in the fee, never a separate charge to the practice and never deducted from its margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 41.0%, Year 2 43.3%).
Year 1 is $238,664 net to the practice on $582,589 of net reimbursement; Year 2 is $543,322 on $1,253,696. Month 1 is −$5,218 as the one-time setup lands ahead of the ramp; monthly net is positive from month 2 onward.
Recurring professional-fee volume over 24 months, generated inside eClinicalWorks.
Blood pressure, heart rate and weight, a continuous picture of the panel between visits, triaged before a physician sees any of it.
About $1.23M in acute-care cost that never gets spent, at $15,000 per admission. In an Enhanced-track ACO that is savings the practice shares in.
About 17,256 care-team hours of monitoring, outreach and documentation carried by the service line, not by the practice's staff.
The constraint here is the eligibility definition, not outreach capacity. Remote monitoring fills its pool in month 11 and principal care management in month 23; after that the census holds and the monthly economics flatten. Widen the eligible cohort, or confirm a larger one from the chart, and the forecast moves. Add enrollment capacity and the same ceiling is reached sooner.
| Program | Enrollment ceiling | How it is defined | Month 24 |
|---|---|---|---|
| RPM | 656 | 2,500 in scope × 75% eligible × 35% acceptance | 656 |
| PCM | 638 | 2,500 in scope × 85% eligible × 30% acceptance | 638 |
| At month 24 | — | Active program enrollments = 848 unique patients | 1,294 |
Eligibility is set for a cardiology Medicare cohort. Every point of eligibility or acceptance the practice's own chart data supports beyond these raises the ceiling, and the forecast, directly. Year 1 lands at 756 unique patients.
| Enrollment staffing | 24-mo net reimbursement | Net to practice | Unique, M24 |
|---|---|---|---|
| Practice referrals only, no on-site specialist | $734,037 | $299,844 | 546 |
| One CoachCare-funded on-site specialist (this forecast) | $1,836,285 | $781,986 | 848 |
| Two specialists | $2,209,851 | $952,069 | 848 |
| Three specialists | $2,355,971 | $1,018,252 | 848 |
The month-24 census is the same at one, two and three specialists, because the ceilings bind. The revenue still moves, because the same ceiling is reached months sooner and the extra patient-months are real. Without a funded specialist the practice's own referral flow reaches less than half the forecast.
CoachCare operates as the service line's engine while the practice's cardiologists govern protocols and every clinical decision. Full-service delivery means launch needs no new hires, the eClinicalWorks integration is native, and the transitional-care path produces cash before any device ships.
Agree the escalation routing and who receives non-critical alerts. Pull the heart-failure, atrial-fibrillation and uncontrolled-hypertension cohorts out of eClinicalWorks and confirm the enrollable list against the panel estimate in this analysis.
Turn on the eCW integration, configure the time-capture and code mapping, and run a claims test on the transitional care management path first.
The funded specialist starts in the Lapeer and Flint Township offices, working from the confirmed cohort list. Devices ship to enrolled patients. First readings arrive and the escalation engine goes live with the practice watching every route.
The census builds toward the ceilings in the analysis. Blood-pressure control, titration documentation and post-discharge touches accumulate as retrievable reports, which is what the shared savings organization's quality reporting and any future CMS model both need.
The service line on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for 500,000+ patients.
Providers running remote care programs on the CoachCare platform.
Programs implemented and operating in market.
Care plan coding and billing that has produced over 5 million claims. The billing path is not an afterthought here; it is the part most remote-care programs get wrong.
Over 100 million vitals recorded and 4 million+ care actions enabled.
CMS has proposed cutting the remote-monitoring device-supply codes for CY2027. The proposal is narrower than the headline. Here is what it does to the forecast on this page, priced at the Michigan locality amounts the forecast itself uses rather than national averages.
The proposal reaches the remote-monitoring family only. Principal care management is not in it, and on this forecast PCM carries $709,919 of the $1,836,285 in 24-month net reimbursement. Its own amounts move by well under a point through the conversion factor, so $4,662 of the $107,901 total sits outside the remote-monitoring arm.
Two contingencies are already in build. An unbundled arrangement, with the software platform, device logistics and program enablement priced separately, and an arrangement in which CoachCare manages the staffing while the practice owns the clinical program and the billing. Whichever way the final rule lands, the program does not have to be rebuilt.
CMS's ACCESS Model points at the destination: remote care paid as a risk-based per-member-per-month amount, with half of each payment withheld and reconciled against outcome attainment. A practice that already sits inside a two-sided shared savings organization has the reporting habits that shift rewards.
Three numbers, each smaller than the last, because each one sits on a larger base. Both bars are drawn on one shared dollar scale, so the red can be compared directly across them.
24-month net reimbursement, CY2026 final versus CY2027 proposed, every code repriced at WPS Michigan locality 99 amounts, non-facility, on this forecast's own billing mix. Enrollment, acceptance and mix held constant. This is the rate change alone.
National non-facility amounts from the proposed rule's Addendum B, so the movement can be read without a locality in the way. The repricing above uses Michigan locality 99 amounts; the two bases do not reconcile to the dollar, by design.
| In scope: remote monitoring | ||||
|---|---|---|---|---|
| Code | What it pays for | CY2026 | CY2027 | Change |
| 99453 | Setup and patient education | $21.71 | $20.03 | −7.7% |
| 99445 | Device supply, 2–15 days | $52.11 | $41.38 | −20.6% |
| 99454 | Device supply, 16–30 days | $52.11 | $41.38 | −20.6% |
| 99457 | Treatment management, first 20 minutes | $51.77 | $49.59 | −4.2% |
| 99458 | Treatment management, each additional 20 minutes | $41.42 | $40.39 | −2.5% |
| 99470 | Treatment management, first 10 minutes | $26.05 | $20.69 | −20.6% |
| Not in scope: principal care management | ||||
| 99426 | Principal care management, first 30 minutes (clinical staff) | $67.80 | $67.00 | −1.2% |
| 99427 | Principal care management, each additional 30 minutes | $54.11 | $54.52 | +0.8% |
| 99424 | Principal care management, first 30 minutes (physician) | $87.51 | $84.40 | −3.6% |
| 99425 | Principal care management, each additional 30 minutes (physician) | $61.46 | $59.11 | −3.8% |
The device-supply and short-treatment codes are held to a one-year maximum reduction by section 1848(c)(7) of the Act, which phases any decrease of 20 percent or more over two years. CY2027 is the capped year; the remainder of the crosswalk lands no earlier than CY2028.
The comment period on CMS-1848-P closed September 14, 2026. The final rule publishes in early November 2026 and takes effect January 1, 2027. CoachCare is leading advocacy on the remote-monitoring provisions and will rerun this forecast against the final rates the week they publish.