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 RPM, CCM, or PCM 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.
Not a point solution bolted onto one condition — 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 unlocks 2–15-day post-procedure 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 | Multi-condition panel — HTN, diabetes, CKD under the cardiac diagnosis |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | Single high-risk condition (HF) ≥3 months |
Illustrative national non-facility magnitudes. The Value Analysis below uses MAC-locality rates auto-resolved for zip 38305 (carrier 10312, locality 35 — Tennessee). Verify against the current CY Physician Fee Schedule.
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.
"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 integration with Epic accomplishes."
One discovery item: because the practice's Epic access runs through its hospital partner's instance, the specific integration pathway (direct connection vs. configuration through the hosting build) is confirmed during technical scoping. The vendor is not in question — the practice is on Epic today.
A 24-month forecast for the practice: an estimated ~2,250-patient Medicare panel (range 2,000–2,300 — validate in discovery), 14 referring providers (6 physicians + 8 APPs) plus a dedicated on-site enrollment specialist, Tennessee MAC-locality rates for zip 38305, Epic integration. Avoided-readmission savings and procedural-throughput gains are not in these numbers; they are upside on top.
| Program | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| RPM net reimbursement | $273,851 | $434,643 | $708,494 |
| CCM net reimbursement | $281,749 | $492,116 | $773,865 |
| PCM net reimbursement | $115,161 | $350,588 | $465,749 |
| Total net reimbursement | $670,760 | $1,277,347 | $1,948,108 |
| Practice margin (after fees) | $273,199 | $547,644 | $820,843 |
| Includes an on-site enrollment specialist staffed at CoachCare's expense — embedded value already reflected in the fees above. | |||
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, AFib, and HTN panels between clinic days.
≈ $780K in avoided acute cost at $15K per admission — felt directly by your hospital partners.
19,016 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; attribution policy for CCM vs. PCM lanes; 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. Illustrative — the pilot's 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 data. The key assumptions: