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. It is not a program TVCC opts into — it is a change in how heart failure gets paid.
Dr. Sean Rhuland (President), Dr. Therese Lango, and Dr. Zubair Khan 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. Confirm against the final CMS list (summer 2026).
~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.
Not a point solution bolted onto one diagnosis — 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. 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 unlocks 2–15-day post-episode monitoring windows |
| 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). Illustrative, modeled — verify against the current PFS and the practice's actual locality at contracting.
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 (illustrative, modeled — verify against practice data).
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 — no queue, no delay.
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. All figures are illustrative, modeled — verify against practice data.
| 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%). Figures are illustrative, modeled — verify against practice data. Full model available as a companion workbook.
Recurring, subscription-like professional-fee volume over 24 months. Illustrative, modeled — verify against practice data.
A continuous clinical picture of the heart-failure, CAD, and hypertension panels between visits. Illustrative, modeled — verify against practice data.
≈ $1.01M in avoided acute cost at $15K per admission — a system-level, indirect benefit. Illustrative, modeled — verify against practice data.
≈ 7.4 FTE-years of monitoring, outreach, and documentation handled by the service line. Illustrative, modeled — verify against practice data.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while 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. ASM participation is preliminary — confirm against the final CMS list (summer 2026).
The heart-failure patients attributed to Dr. Rhuland, Dr. Lango, and Dr. Khan 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. Illustrative and modeled — 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 — including what remains to be confirmed in discovery: