How Tennessee Valley Cardiovascular Center turns RPM and PCM into a margin-positive remote care service line — and the operating model its heart-failure cardiologists will need when CMS's Ambulatory Specialty Model makes them accountable for heart-failure cost and quality on January 1, 2027.
CMS's Ambulatory Specialty Model (ASM) is a mandatory program that makes cardiologists individually accountable for the cost and quality of the heart-failure patients attributed to them. The first performance year applies a Part B payment adjustment of −9% to +9% and requires an electronic collaborative-care arrangement with primary care. There is no opt-in decision to make; from that date, this is how heart failure gets paid.
Three TVCC cardiologists, including the practice President, appear on the CMS CY2027 Preliminary ASM Participant List, heart-failure cohort (CMS Innovation Center dataset, updated Feb 4, 2026).
ASM reconciles attributed heart-failure spend and quality against a benchmark. Year-one adjustments swing Part B professional revenue by up to nine points in either direction, escalating through 2031.
ASM requires an electronic collaborative-care arrangement with primary care and structured longitudinal management between visits — exactly what a remote care service line operationalizes.
The wedge is simple: one service line is your ASM heart-failure chassis. The RPM and PCM programs modeled on this page are the same infrastructure ASM will demand — continuous physiologic monitoring, protocolized management, and documented care coordination. Build it now, and enter January 2027 with a running program instead of a blank page.
A multi-site cardiology group with the clinical depth ASM rewards — and open ground where the remote care service line will sit. The honest read: strong specialty capability, no remote care program in place yet.
Three cardiologists on the CMS CY2027 preliminary ASM heart-failure list — the practice already carries the accountability the service line is built to serve.
~8 cardiologists across Florence and Sheffield (NPPES-verified NPIs) with interventional, EP/device, heart-failure, vascular, and non-invasive imaging capability — and an open interventional-cardiology recruit signaling growth.
TVCC cardiologists perform interventional and surgical cardiac work at North Alabama Medical Center in Florence — the Shoals' tertiary cardiac center (4 cath labs, hybrid suite, open-heart), where the highest-acuity heart-failure discharges originate.
No public evidence of any remote monitoring, care-management, or branded patient app for TVCC today. This is a clean build on a Greenway backbone — not a rip-and-replace of an underperforming vendor.
A named service line with its own owner, P&L, and scorecard, run by TVCC's cardiologists, following the Medicare patient between visits on the Greenway backbone — rather than a point solution bolted onto one diagnosis. Three billable programs, one shared engine.
| Service | Codes | 2026 Rate (AL 10112-00) | Cardiovascular Use |
|---|---|---|---|
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | $18.79 · $45.49 · $45.49 | 99445 makes 2–15-day post-episode monitoring windows billable |
| RPM treatment management | 99457 · 99458 · 99470 (new) | $47.43 · $38.37 · $23.88 | Monthly review, titration, escalation |
| Principal Care Management | 99426 · 99427 | $62.78 · $49.79 | The principal cardiac condition — heart failure, CAD, resistant HTN — cardiology-native |
Rates auto-resolved from the CY2026 Physician Fee Schedule for MAC carrier 10112, locality 00 (Alabama; zip 35630).
Every element ASM will require of a heart-failure program is an element this service line already runs. Build once for reimbursement today; be ready for accountability in 2027.
The service line runs inside the chart TVCC already uses. CoachCare integrates natively with Greenway — enrollment, discrete vitals, care-management documentation, and claim-ready charges flow between the platform and the EHR, so clinicians and billers never leave their workflow.
Native Greenway integration setup — a single implementation fee.
No recurring EHR-interface charge in the modeled economics.
No per-beneficiary integration charge — it scales with the panel at no marginal EHR cost.
A risk-bearing heart-failure program is only as credible as the escalation logic behind it. Documented escalation and a fixed post-discharge cadence are what make TVCC's ASM heart-failure accountability real in daily practice — and they are the engine behind the roughly 67 hospitalizations the value analysis models as avoided.
Every reading — device or care-management — runs through the same clinical decision logic. No program improvises its own rules.
If an emergent symptom is active during outreach, the outreach becomes a 911 call — with the patient still on the line:
Severity decides the destination. Clinicians are reached for what needs them, and only that.
Active emergent symptoms trigger emergency services immediately, per the pathway above.
Routed to the role TVCC names — actioned inside the clinic's own workflow, not broadcast to everyone at once.
Captured in the record for continuity and trend context — visible when needed, never a page in the middle of clinic.
An ER visit or hospitalization in the last 60 days triggers a fixed three-touch cadence — the highest-yield window for preventing a return. Each touch is documented and escalates on the engine above.
A 24-month forecast for the cardiology service line — an estimated ~1,911-patient total-Medicare panel (modeled as 863 fee-for-service Part B grossed up for 54.84% MA penetration: 863 ÷ (1 − 0.5484) = 2.21× ≈ ~863 FFS + ~1,048 Medicare Advantage, with MA reimbursed at Medicare rates) across TVCC's Florence and Sheffield sites, 7 referring providers, 1 CoachCare-funded on-site enrollment specialist, telephonic enrollment, MAC-locality rates for AL 10112-00 (zip 35630), native Greenway integration. The service line is RPM + PCM — physiologic monitoring plus Principal Care Management on the principal cardiac condition. ASM episode performance and avoided-admission savings are not in these numbers; they are upside on top.
| 24-month, by program | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| RPM | $888,952 | $518,634 | $370,318 |
| PCM | $654,082 | $348,655 | $305,427 |
| Implementation & ancillary | — | $17,420 | −$17,420 |
| Total, 24 months | $1,543,034 | $884,709 | $658,325 |
| By period | Net reimb. | CoachCare fees | Practice margin |
|---|---|---|---|
| Year 1 | $542,912 | $319,161 | $223,751 |
| Year 2 | $1,000,122 | $565,548 | $434,574 |
| 24 months | $1,543,034 | $884,709 | $658,325 |
| Delivered full-service — telephonic enrollment, devices, 24/7 monitoring, and billing handled by CoachCare, including an on-site enrollment specialist at CoachCare's expense — embedded value, never subtracted from practice margin. | |||
24-month practice margin: 42.7% of net reimbursement (Year 1 41.2%, Year 2 43.5%). Full model available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months.
A continuous clinical picture of the heart-failure, CAD, and hypertension panels between visits.
≈ $1.01M in avoided acute cost at $15K per admission — a system-level, indirect benefit.
≈ 7.4 FTE-years of monitoring, outreach, and documentation handled by the service line.
CoachCare runs the service line's engine: enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation. TVCC cardiologists govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount; the staffing model formalizes as census grows.
Named owner, P&L, scorecard; Greenway integration and billing configuration; attribution policy for shared patients; protocol sign-off for the heart-failure, CAD, and hypertension pathways.
The decompensation-risk heart-failure panel first — RPM plus PCM, protocolized GDMT titration, telephonic enrollment, and TCM at discharge for the highest-acuity patients.
Extend RPM to CAD and hypertension; extend the PCM wrapper across the principal-condition panel; monthly scorecard reporting to service-line governance.
Formalize electronic collaborative-care arrangements, harden the titration production process, and enter January 2027 with a running program.
The heart-failure patients attributed to the three listed cardiologists are exactly the population ASM will hold the practice accountable for. Starting there concentrates enrollment where the clinical and financial stakes converge, and produces the internal evidence — census, capture rate, revenue per patient-month, decompensation signal — that makes the panel-wide rollout a data decision, not a leap.
| Milestone | Target |
|---|---|
| Greenway integration + protocol sign-off | Day 30 |
| First billable enrollments | Day 30–45 |
| RPM device-connectivity rate | ≥ 85% |
| Documented GDMT titration touch, per patient/mo | ≥ 1 |
| Active enrollments by Day 90* | ~188 patients |
| Go / scale decision with full unit economics | Day 90 |
*The modeled months 1–3 total active census (38 → 101 → 188 patients) for the whole service line, concentrated in the heart-failure cohort during the pilot 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 day to day.
Remote care programs launched on this infrastructure.
Care-plan coding and billing behind more than 5 million claims.
Over 100 million vitals recorded and 4 million+ care actions delivered.
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 $654,082 of the modeled $1,543,034 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 $79,526, RPM accounts for $77,486 and the care-management arm for $2,040.
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 Tennessee Valley Cardiovascular Center specifically, not remote care in general.
CoachCare integrates natively with Greenway: enrollment, discrete vitals, care-management documentation and claim-ready charges move through the chart the practice already uses. One workflow for clinicians across the Florence and Sheffield sites, and no second system for the billing team to learn.
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 42.7% practice margin with no hiring cycle. A CoachCare-funded on-site enrollment specialist works the clinic, because telephonic outreach converts about 8%.
The heart-failure cardiologists set the protocols, sign the care plans and make every clinical decision, and claims go out under the group's own entity. CoachCare supplies the staff, devices and platform under that governance.
TVCC is on the CMS CY2027 Preliminary ASM Participant List for the heart-failure cohort, which makes the practice accountable for the cost and quality of those patients. The care-management codes that open and hold heart-failure episodes are the ones this service line documents every month. One spine carries the daily program and the model performance.
The panel runs 54.84% Medicare Advantage. The fee-for-service quarter bills per claim month after month, and the MA majority is protected by the statutory floor that pays a non-contracted plan no less than original Medicare. That mix is worked deliberately, not left to chance.
This is a clean build on the Greenway backbone, not a rip-and-replace of an underperforming vendor. Fees are per active patient per month, with no capital outlay, and throughput is the lever. If the census does not build, CoachCare does not get paid, and the forecast and workbook are yours to keep either way.