How the Heart & Vascular Center of West Tennessee converts a five-site rural cardiology franchise into continuous care for heart failure, coronary artery disease, atrial fibrillation, and hypertension — as a recurring, margin-positive service line that stands on its own P&L.
This is not a turnaround story. The Heart & Vascular Center of West Tennessee is the region's independent, physician-owned cardiovascular practice — six cardiologists and eight advanced-practice providers covering five communities that larger systems reach only from a distance. The strategic question is how to monetize the care that already happens between visits, before any payment model requires it.
Interventional cardiology, electrophysiology, WATCHMAN left-atrial-appendage closure, vascular lab, external counterpulsation, and active clinical trials — in an independent practice.
Cardiac PET/CT and nuclear imaging accredited by the American College of Radiology — diagnostic depth most independent groups outsource.
Jackson hub plus Lexington, Dyersburg, McKenzie, and Ripley — a hub-and-spoke network that puts a cardiologist within reach of deeply rural West Tennessee.
The practice already outsources remote device monitoring for pacemakers and ICDs to a specialist partner — proof that buy-over-build works here when the economics are right.
One more structural advantage: since October 2025 the practice runs on Epic, with MyChart live for patients, through its hospital partner's instance — one chart, one in-basket, one billing layer. That is precisely the substrate a remote care service line needs. What's missing is the service line itself: no remote monitoring or care-management program is marketed anywhere in the practice today.
Three things converge in 2026: a billing change that finally fits cardiology's clinical windows, readmission economics that your hospital partners feel every year, and a timing position most cardiology groups would envy.
New CY2026 codes 99445 (2–15-day device supply) and 99470 (first 10 minutes of management) make post-procedure and transitional monitoring windows cleanly billable — removing the 16-day floor that previously blocked episodic remote care after WATCHMAN, interventional, and EP procedures.
Heart-failure readmission penalties bite the hospitals your patients discharge from — Jackson-Madison County General and Dyersburg among them. A practice that demonstrably keeps discharged cardiac patients out of the hospital becomes the referral partner every case manager calls first.
No mandatory model exposure — pure-upside timing, and prepared if selection maps change. Every dollar in this analysis is fee-for-service revenue the practice earns directly, starting now, with no downside risk attached.
A named, governed service line with its own owner, P&L, and scorecard, following the Medicare patient from hospital discharge through long-term management across all five sites.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use |
|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200 / ~$280 | Every HF and post-procedure discharge |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 makes 2–15-day post-procedure windows billable |
| 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 for orientation. The Value Analysis below uses MAC-locality rates auto-resolved for zip 38305 (carrier 10312, locality 35 — Tennessee).
McKenzie sees a cardiologist on Mondays. Ripley sees one a single day each month. Between those visits, a decompensating heart-failure patient in Carroll or Lauderdale County has two options today: drive to Jackson, or wait — and waiting is how emergency admissions happen.
Remote physiologic monitoring inverts that geography. Cellular devices report weight, blood pressure, and pulse ox daily from the patient's home — no portal setup, no Wi-Fi required — and a 24/7 monitoring team escalates by protocol to your clinicians. The practice's clinical reach becomes every day, in every county, while the visit schedule stays exactly as it is.
| Location | Cardiology On-Site | With RPM |
|---|---|---|
| Jackson (hub) | Monday–Friday | Daily |
| Lexington | Monday–Friday | Daily |
| Dyersburg | Monday–Friday | Daily |
| McKenzie | Mondays only | Daily |
| Ripley | One day per month | Daily |
Site schedules from the practice's published locations (July 2026). RPM coverage is continuous wherever cellular service reaches the patient's home.
Since October 2025 the practice has run on Epic through its hospital partner's instance, with MyChart live for patients. CoachCare integrates directly and bi-directionally with Epic — practices enroll and monitor remote-care patients inside built-in Epic workflows, without learning a new system. The whole program lives in the Epic environment.
from enrollment flag to a patient receiving billable RPM and care-management services.
CoachCare is the only care-management platform integrated with Epic that provides automated claims creation via its billing engine.
A program stays efficient and sustainable when the patient and the provider both work in tools they already know. That is what the Epic integration delivers.
A 24-month forecast for the practice: a ~2,250-patient Medicare panel, 14 referring providers (6 physicians + 8 APPs) plus a dedicated on-site enrollment specialist, Tennessee MAC-locality rates for zip 38305, Epic integration. The service line is RPM + PCM — physiologic monitoring plus Principal Care Management on the principal cardiac condition. Avoided-readmission savings and procedural-throughput gains are not in these numbers; they are upside on top.
| 24-month, by program | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| RPM | $1,051,940 | $590,672 | $461,268 |
| PCM | $728,697 | $377,008 | $351,689 |
| Implementation & ancillary | — | $45,900 | −$45,900 |
| Total, 24 months | $1,780,637 | $1,013,580 | $767,057 |
| By period | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| Year 1 | $604,887 | $354,397 | $250,490 |
| Year 2 | $1,175,750 | $659,183 | $516,567 |
| 24 months | $1,780,637 | $1,013,580 | $767,057 |
| Includes an on-site enrollment specialist staffed at CoachCare's expense — embedded value, never subtracted from practice margin. | |||
24-month practice margin: 43.1% of net reimbursement (Year 1 41.4%, Year 2 43.9%). Full model available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months.
A continuous clinical picture of the HF, CAD, AFib, and HTN panels between clinic days.
≈ $1.16M in avoided acute cost at $15K per admission — felt directly by your hospital partners.
~17,246 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 the practice's physicians govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount: your clinicians review escalations and sign orders; the service line does the rest.
Named owner, P&L, scorecard; Epic integration scoping and billing configuration; PCM principal-condition documentation policy; protocol sign-off for HF, CAD, AFib, and HTN pathways.
Two anchor cohorts: HF discharges from Jackson-Madison County General with TCM contact within 2 business days, and the hub's hypertension panel on daily BP monitoring.
Full-week satellite sites join enrollment; post-procedure short-window RPM live for WATCHMAN, interventional, and EP recovery; monthly scorecard reporting to practice leadership.
McKenzie and Ripley panels enrolled — daily monitoring where the cardiologist visits weekly or monthly; hypertension panel matured toward the renal-denervation opportunity; year-one economics reviewed against this analysis.
Centre Plaza Drive is the natural pilot site — the practice's headquarters, its highest patient volume, its imaging and procedural coordination, and the shortest loop to Jackson-Madison County General discharges. The highest-acuity patients and the clinicians who follow them already sit in one building, on one Epic chart.
A Jackson-first launch concentrates enrollment where volume already flows, lets one site's physicians and staff shake out the workflow, and produces the internal evidence — census, capture rate, revenue per patient-month, readmission signal — that makes the five-site rollout a data decision, not a leap.
| Milestone | Target |
|---|---|
| Epic integration + protocol sign-off | Day 30 |
| First billable enrollments | Day 30–45 |
| 48-hour TCM outreach rate | ≥ 90% |
| 7-day post-discharge follow-up rate | ≥ 70% |
| Active program enrollments by Day 90* | ~195 |
| Go / scale decision with full unit economics | Day 90 |
*The modeled months 1–3 practice-wide enrollment ramp (40 → 105 → 195 active program enrollments), concentrated at the hub during the Jackson-first phase.
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 $728,697 of the modeled $1,780,637 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 $94,943, RPM accounts for $92,997 and the care-management arm for $1,946.
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 partnership fits the practice specifically, not remote care in general.
CoachCare integrates bi-directionally with Epic: eligibility flags and orders leave the EHR, and discrete vitals, care documentation and claim-ready charges come back into it. One chart for clinicians across the five sites, one workflow for billing, and no second system to learn to start.
Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. The practice inherits a running program the month it turns on, at a 43.1% practice margin, with no hiring cycle. On-site enrollment is our expense — telephonic outreach converts about 8%, so we staff the clinic instead.
Your cardiologists set the protocols, sign the care plans and make every clinical decision, and claims go out under the practice's own entity and NPIs. CoachCare supplies the staff, devices, platform and billing preparation under that governance — the operating model an independent, physician-owned group keeps control of.
Every WATCHMAN, electrophysiology and device case opens a post-procedure monitoring window, and the post-discharge heart-failure panel needs the same continuous watch. Transitional care management at discharge, remote physiologic monitoring and principal care management run as one service line across a ~2,250-patient Medicare panel.
Verified against the current CMS selection files, this market carries no mandatory-model exposure, so nothing here is compliance-driven. On the fee schedule the ACCESS Model would pay remote care as its own line if the practice ever opts in — the timing is the practice's to choose.
Fees are per active patient per month; there is no capital outlay and no payroll ramp. Because the forecast is set by enrollment pace, throughput is the lever. If the census does not build, CoachCare does not get paid, and the forecast, Disclosures and workbook behind this page are yours to keep either way.