You already monitor more than 1,500 device patients and 500 on physiologic RPM. What you have never billed is the care management those same patients need between visits — and starting January 2027, that is the half CMS counts.
Year 1 margin 41.9% · Year 2 42.5%. Enrollment begins in month 1 and the practice clears positive in month 2. Patient counts are deduplicated — a patient enrolled in both programs is counted once.
This is not a greenfield pitch. Your CY2024 Medicare claims show a real remote-monitoring operation across 47 clinicians — and they show exactly where it stalled.
Cardiac device remote monitoring (93294–93298) $863,546 across 1,513 patients · extended external ECG $505,840 · physiologic RPM $330,100. Loop-recorder and pacemaker insertions are procedures and are excluded from that figure.
Nearly twice the national average risk. Heart failure 40.5% · ischemic heart disease 67.0% · CKD 49.9% · atrial fibrillation 45.0%. Hypertension and hyperlipidemia both report at 75%, the ceiling CMS publishes to.
22 physicians and 25 advanced practice providers across Citrus, Sumter, Lake and Marion counties. TAVR, MitraClip, ablation, PET/CT, an anticoagulation clinic running 4,700 services a year.
Your active census held near 520. New enrollment did not.
Enrollment is the part of remote care that needs a person doing it every week. It is also the first thing a busy clinic drops. Everything downstream of it — census, revenue, and the clinical signal you get back — follows that one line.
Roughly 0.07 add-on units for every primary unit billed. Across CoachCare's book the same ratio runs near 1.45. The second and third twenty-minute increments are where a monitored patient-year earns most of what it is worth, and almost none of it is being captured.
No 99490, no 99424–99427, and 31 patients on 99496 from a single clinician against a panel where two in five carry heart failure. This is the gap that costs money twice — once in fees never billed, and once in how CMS scores you from 2027.
Citrus Cardiology already carries downside on two CMS contracts. A third starts on 1 January 2027. All three are settled by total cost of care, and all three turn on the thirty days after a discharge.
Seven clinicians billing under Citrus Cardiology Consultants, PLLC are named on the CMS preliminary participant list for the Ambulatory Specialty Model, heart-failure cohort. Performance year 1 is CY2027; it is paid out in payment year 2029. None of the seven carries the small-practice designation.
You joined a physician-led Enhanced-Track Shared Savings ACO on 1 January 2024 — the highest-risk track CMS offers. You are the only specialty practice among its twelve participants, which makes cardiovascular cost performance for the whole attributed population yours to move.
A second risk-bearing organisation, in the Global track, carries full savings and losses on its aligned population and counts you among its providers. Two separate entities already have a financial stake in whether your cardiac patients stay out of the hospital.
Under the model's heart-failure cost measure, the codes that trigger an episode are the care-management families — PCM, CCM, TCM. The physiologic RPM family is not among them. Two things follow, and both cut against the way Citrus bills today.
First, RPM billed into your heart-failure population does not enlarge the attributed denominator. Second, it does not help a clinician clear the 30% attribution threshold — so a cardiologist whose heart-failure contact is mostly remote monitoring can fall below it and not be attributed the episode at all. Meanwhile monitoring spend carried on a heart-failure diagnosis still counts against the cost measure.
You have spent four years building the half that does not count, and none of the half that does. Adding PCM to the population you already monitor fixes both sides at once.
Per enrolled patient-year, on a heart-failure population
| Line | Per patient-year |
|---|---|
| RPM added | $1,461.81 |
| PCM added | $1,065.70 |
| Program cost added | $2,527.51 |
| 20-point drop in hospitalization rate, at $15,000 | −$3,000 |
| Net position | +$472 |
The hospital that takes 47% of your admissions holds a 2-star CMS overall rating, the lowest of your three named partners. The detail matters more than the headline, because it points at a different problem than most readmission pitches assume.
| CMS measure, largest admitting partner | Score | Versus national |
|---|---|---|
| Hybrid hospital-wide readmission | 16.8 | Worse than the national rate |
| Hybrid hospital-wide mortality | 5.3 | Worse than the national rate |
| 30-day heart-failure readmission | 20.2 | No different than national |
| 30-day heart-attack readmission | 13.7 | No different than national |
| Excess readmission ratio, heart failure | 1.0244 | Above 1.0 |
| Excess readmission ratio, heart attack | 1.0128 | Above 1.0 |
The device clinic and the anticoagulation clinic stay exactly as they are. What gets added is the longitudinal layer underneath them — the part that bills, triggers episodes, and produces the data your risk contracts are scored on.
| Code | Service | Rate |
|---|---|---|
| 99453 | RPM setup and patient education, one time | $21.12 |
| 99454 | Device supply with daily recordings, per 30 days | $50.00 |
| 99445 | Device supply, 2–15 days of readings | $50.00 |
| 99457 | Treatment management, first 20 minutes | $51.12 |
| 99458 | Treatment management, each additional 20 minutes | $41.22 |
| 99470 | Short-window monitoring, 2–15 days | $25.73 |
| 99426 | Principal care management, first 30 minutes | $67.57 |
| 99427 | Principal care management, each additional 30 minutes | $53.69 |
Readings, care-plan notes, time logs and billing codes land in the patient's eCW chart. Nobody signs into a second system to find out what happened overnight.
Patient demographics, problem list and encounter data flow to the monitoring platform; readings, escalations and documented time flow back as discrete chart data rather than a scanned attachment.
Time thresholds are tracked against each patient-month, so 99457 and its add-on increments post when the work has actually been done. The add-on capture gap closes here rather than in a monthly audit.
Escalations route into the eCW task queue your team already works. A cardiologist reviewing a heart-failure patient sees the same trend the care manager saw at 6am.
The economics prove the service line pays. This is the part that proves it is safe — one escalation engine, written down, that every reading routes through before it reaches your team.
Any of these and the care manager calls 911 with the patient still on the line. If the patient refuses, they are directed to the clinic; if they refuse that, CoachCare activates 911 regardless.
CoachCare's urgent and emergent policy supersedes any practice-specific escalation preference. That is not configurable, and it is the reason the practice can delegate the overnight watch without inheriting the risk.
The three-touch cadence triggers on any emergency-room visit or hospitalization in the previous 60 days. It is the operational mechanism behind the 452 hospitalizations avoided in the forecast, and it is aimed squarely at the all-cause hospital-wide readmission gap at your largest admitting partner.
Modeled on 39,000 Medicare patients across the four counties, 31,200 of them in scope for remote care, and 47 referring clinicians — at the CY2026 fee schedule for Florida locality 09102-99.
Neither program reaches its ceiling inside 24 months — throughput is the constraint, not eligibility
Net reimbursement, CoachCare fees, and what the practice keeps
Where the revenue comes from
| Financial summary | Year 1 | Year 2 | 24 months |
|---|---|---|---|
| Net reimbursement | $2,048,715 | $6,527,044 | $8,575,759 |
| CoachCare fees | $1,189,615 | $3,753,574 | $4,943,190 |
| Net to the practice | $859,100 | $2,773,470 | $3,632,569 |
| Practice margin | 41.9% | 42.5% | 42.4% |
| By program, 24 months | Net reimbursement | Net to practice |
|---|---|---|
| Remote patient monitoring | $6,518,006 | $2,854,909 |
| Principal care management | $2,057,754 | $987,067 |
| Total | $8,575,759 | $3,632,569 |
Over 24 months — 107 in year 1, 346 in year 2. The measure your risk contracts are settled on.
Physiologic data on the population your specialty model episodes are scored against.
34.7 full-time equivalents of clinical work, delivered without a hire.
Deduplicated at month 24, from 2,966 at month 12. Roughly 20% of the in-scope cohort.
The sliders start at the modeled run. Because this account is throughput-limited rather than eligibility-limited, enrollment capacity moves the answer more than cohort size does.
Capped near 1.4× the modeled cohort — the eligibility rates behind this model describe a condition-defined population, not an entire panel.
22 physicians and 25 advanced practice providers today.
CoachCare-funded. More capacity cannot raise the ceiling, but it reaches it sooner — and those patient-months are real revenue.
Performance year 1 of the specialty model begins 1 January 2027. A program started this quarter has a full year of documented care management behind it before the first episode is scored.
Chart count to replace the modeled 39,000-patient panel, your heart-failure hospitalization baseline, and the terms on which your Medicare Advantage contracts pay the care-management families. Three answers, and the forecast stops being a model.
Integration configured once against your cloud instance. Escalation thresholds, routing rules and the named clinical contact per site agreed and written down.
Starting where the evidence is strongest — the heart-failure cohort and post-discharge patients. This is the function whose absence shows up in your 99453 line.
2,966 patients under management by month 12, and a full year of care-management documentation on the population your specialty-model episodes are built from.
Remote care programs fail on operations, not on technology. These are the numbers behind the operations.
Across more than 400 managed conditions.
Providers running remote care programs day to day.
Programs stood up and running in market.
Care-plan coding and billing behind more than five million claims.
Over 100 million vitals recorded, and more than 4 million care actions enabled.