How Northwest Indiana's independent cardiology group converts the Medicare panel it already manages — heart failure, coronary artery disease, atrial fibrillation, and hypertension — into a continuously monitored remote care service line with recurring reimbursement, margin-positive before any value-based dollar. Powered by CoachCare.
Cardiovascular Consultants already runs nearly every piece of a modern cardiovascular practice. Seven cardiologists and three advanced practice providers cover interventional, structural-heart evaluation, diagnostics, and chronic cardiac clinics across three offices and seven satellite communities. What the public footprint shows no trace of is the one layer Medicare now pays for month after month: a chronic remote care program.
Interventional coronary, peripheral, and carotid work; left atrial appendage (LAA) closure procedures; evaluation for TAVR and mitral clip — the procedural franchise is already built.
Holter and mobile cardiac telemetry, echo, vascular and nuclear imaging, pacemaker/defibrillator checks — the practice already consumes device data every day. The chronic monitoring layer is the natural extension.
A coumadin management clinic and a lipid clinic — standing longitudinal programs whose patients are exactly the RPM and PCM enrollment funnel.
The FollowMyHealth patient portal — a Veradigm product — is already in patients' hands, corroborating the practice's Veradigm EMR environment. Patients are already digital; monitoring is the next step.
Three offices — Munster, Hammond, Crown Point — plus satellite reach into DeMotte, Dyer, East Chicago, Lake Station, Portage, Whiting, and Winfield. And in that entire footprint, no remote patient monitoring, chronic care management, or principal care management program is marketed anywhere today. That whitespace is the opportunity on this page.
Three forces converge this year: Medicare's remote-care billing framework just got broader, readmissions still carry real financial consequences for the hospitals that depend on this practice, and — unusually — there is no downside clock running. The timing is pure upside.
New CY2026 codes 99445 (2–15-day device supply) and 99470 (first 10 minutes of management) remove the 16-day floor that previously blocked episodic monitoring — making post-procedure recovery windows after LAA-closure and other interventions cleanly billable for the first time.
Medicare's readmission penalty program still bites the area hospitals this practice works with every day. The cardiology group whose heart failure patients don't bounce back inside 30 days becomes the group every discharge planner wants on the chart — a referral-relationship asset no competitor in the market currently holds.
The practice carries no mandatory model exposure — pure-upside timing, and prepared if selection maps change. Every dollar in the forecast below is fee-for-service reimbursement for care the practice controls, with nothing owed back to CMS under any scenario.
A named service line with its own P&L, rather than a point solution bolted onto one condition, following the cardiac patient from discharge to long-term stability. The practice already runs connected-monitoring workflows for Holter and device checks; this is the partner model that adds the chronic layer without adding headcount.
| Service | Codes | CY2026 Rate (IN Locality) | Cardiovascular Use |
|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200 / ~$280* | Every HF and post-procedure discharge |
| RPM device supply | 99454 · 99445 (new) | $48.15/mo | 99445 unlocks 2–15-day post-procedure windows* |
| RPM treatment management | 99457 · 99458 · 99470 (new) | $48.89 + $39.29 add'l | Monthly review, GDMT titration, escalation |
| Principal Care Management | 99426 · 99427 | $64.26 + $51.15 add'l | The principal cardiac condition — HF, CAD, resistant HTN — ≥3 months |
Dollar rates are CY2026 Medicare values for the Indiana statewide locality (zip 46321 — Munster is priced at Indiana rates, not Chicago's). *Asterisked figures are national magnitudes for codes outside the modeled economics; TCM and the new 2026 codes are not in the forecast below — they are upside on top of it.
The forecast below stands on its own P&L — everything after the first layer is additional return on infrastructure the service line has already paid for.
The practice's Veradigm EMR — already corroborated by the FollowMyHealth patient portal your patients use today — is a supported CoachCare integration. Enrollment, vitals, documentation, and billing-ready output flow between the two systems so the program lives where your clinicians already work. The integration's setup and maintenance costs are already inside the fee lines of the forecast below.
Veradigm integration setup and monthly maintenance are inside the month-1 economics and the fee lines of the forecast — no hidden IT project.
The integration is scoped to the practice's exact Veradigm product during contracting — a configuration step, not a discovery risk.
A 24-month forecast built on this practice's own parameters: an estimated ~4,000-patient Medicare panel, 10 referring providers, one on-site enrollment specialist, Veradigm integration, and CY2026 Medicare rates auto-resolved for zip 46321 (Indiana statewide locality). The service line is RPM + PCM — physiologic monitoring plus Principal Care Management on the principal cardiac condition. Avoided-readmission savings, TCM, and the new 2026 short-window codes are not in these numbers — they are upside on top.
| 24-month, by program | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| RPM | $1,557,755 | $873,485 | $684,270 |
| PCM | $720,575 | $374,783 | $345,792 |
| Implementation & ancillary | — | $58,578 | −$58,578 |
| Total, 24 months | $2,278,330 | $1,306,846 | $971,484 |
| By period | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| Year 1 | $616,896 | $360,654 | $256,242 |
| Year 2 | $1,661,434 | $946,192 | $715,242 |
| 24 months | $2,278,330 | $1,306,846 | $971,484 |
| Includes an on-site enrollment specialist staffed at CoachCare's expense — embedded value, never subtracted from practice margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 41.5%, Year 2 43.0%). Full model available as a companion workbook. "Active enrollments" counts program enrollments, not unique patients — dual-enrolled patients appear in each program they join; the headline patient figure of 1,253 is deduped.
Recurring, subscription-like professional-fee volume over 24 months.
A continuous clinical picture of the HF, CAD, AFib, and hypertension panels between visits.
≈ $1.70M in avoided acute-care cost at $15K per admission — and 30-day readmission relief for hospital partners.
~20,894 care-team hours of monitoring, outreach, and documentation handled by CoachCare's clinical staff.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while Cardiovascular Consultants' physicians govern protocols and every clinical decision. Full-service delivery means launch requires no new practice headcount: the on-site enrollment specialist is CoachCare's hire, and the monitoring load lands on CoachCare's clinical staff, not the practice's medical assistants.
Named physician champion and P&L; Veradigm integration and billing configuration; PCM principal-condition documentation policy set in protocol; pathway sign-off for HF, CAD, AFib, and hypertension.
Heart failure post-discharge patients and the coumadin/device-clinic panels — the populations already known, already engaged, already generating data.
Munster, Hammond, and Crown Point all enrolling; post-procedure recovery monitoring live for the interventional and LAA-closure caseload; monthly service-line scorecard in place.
Resistant-hypertension RPM panel building the renal-denervation-readiness funnel; enrollment outreach extended through the seven satellite communities — remote care follows the patients the satellites already serve.
The Munster headquarters is the natural pilot site — the practice's highest-volume office, on the campus of its primary hospital partner, steps from where the highest-acuity discharges happen. The coumadin clinic, the device-check clinic, and the physicians who round on those inpatients all work from the same building.
A Munster-first launch concentrates enrollment where discharge volume already flows, lets one office'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 practice-wide rollout a data decision, not a leap.
| Milestone | Target |
|---|---|
| Veradigm integration + protocol sign-off | Day 30 |
| First billable enrollments | Day 30–45 |
| 48-hour post-discharge outreach rate | ≥ 90% |
| 7-day post-discharge follow-up rate | ≥ 70% |
| Active remote-care enrollments by Day 90* | ~177 |
| Go / scale decision with full unit economics | Day 90 |
*The modeled months 1–3 practice-wide enrollment ramp (36 → 95 → 177 active program enrollments), concentrated at the pilot office during the Munster-first phase.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 conditions managed for 500,000+ patients.
Providers running remote care programs on CoachCare today.
Remote care programs implemented for provider organizations.
Care-plan coding and billing that has produced over 5 million claims.
Over 100 million vitals recorded and 4 million+ care actions.
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 $720,575 of the modeled $2,278,330 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 $140,716, RPM accounts for $139,039 and the care-management arm for $1,677.
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 Cardiovascular Consultants specifically, not remote care in general.
The Veradigm platform your patients use today is a supported CoachCare integration. Enrollment, vitals, documentation and billing-ready output move between the two systems, so clinicians keep one chart and the billing team keeps one workflow.
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%.
Seven cardiologists and three advanced practice providers govern the protocols and every clinical decision, and claims go out under the group's own entity. CoachCare supplies the staff, devices and platform under that governance.
The service line runs structured 30-day transitional care after discharge, longitudinal monitoring, and principal care management on one spine. A resistant-hypertension RPM panel is the substrate for renal denervation readiness, documenting the refractory patients the structural and interventional programs already see.
Across the full footprint, from Munster to Winfield, no remote patient monitoring, chronic care management or principal care management is billed today. Nothing has to be unwound, so every enrolled patient is net-new recurring revenue.
Fees are per active patient per month, with no capital outlay and no payroll ramp. Throughput is the lever: if the census does not build, CoachCare does not get paid. The forecast, Disclosures and workbook behind this page are yours to keep either way.