Roughly 73% of the practice's admissions land at 2-star hospitals, and nothing reimbursed follows the patient home. Medicare pays for that missing layer — TCM at discharge, then RPM, then PCM — and it is margin-positive before any value-based dollar. This is what that service line looks like across 29 physicians and 13 locations.
A note on how patients are counted. Enrolled Patients are unique individuals — 5,779 at Month 24. Enrolled Services are total program enrollments — 7,017 at Month 24 — because roughly 70% of PCM enrollees also carry RPM, so those patients count once as a patient and twice as a service. Every chart and calculator below reports active program enrollments; the headline reports unique patients.
Tri-City's physicians hold privileges across two competing systems — deliberately, and to the practice's advantage. But the destination mix is not neutral. CMS Care Compare facility-affiliation data resolves five admitting hospitals for the group, and the three that take the large majority of admissions carry the lowest overall star ratings of the five.
| Admitting Hospital | System | Share | CMS Stars |
|---|---|---|---|
| Banner Desert Medical Center | Banner | ~34% | ★★ |
| Banner Baywood Medical Center | Banner | ~26% | ★★ |
| Banner Heart Hospital | Banner | ~13% | ★★ |
| Chandler Regional Medical Center | Dignity / CommonSpirit | — | ★★★★ |
| Mercy Gilbert Medical Center | Dignity / CommonSpirit | — | ★★★★★ |
| Three 2-star destinations | ~73% | of admissions | |
Affiliations from the CMS Care Compare Facility Affiliation file; overall star ratings from the CMS Hospital General Information file (both queried July 2026). Admission-share percentages are third-party practice-affiliation data.
A star rating is a composite, and readmissions are one of its heaviest components. When roughly three-quarters of a cardiology group's inpatient volume flows to facilities rated at the bottom of the CMS scale, the 30-day window after discharge is the practice's exposure, not the hospital's alone — the patient comes back to Tri-City's clinic, or doesn't come back at all.
Today there is no program watching that window. No post-discharge monitoring, no titration cadence, no daily weight or blood-pressure signal, no escalation path between the discharge summary and the next office visit. The heart-failure patient is told to track their own weight at home.
This is not a group that has to be convinced remote monitoring works. Tri-City has bought it twice — once as an implanted sensor, once as a virtual rehab episode. What it has never bought is the recurring, reimbursed service that sits between those two narrow slices and covers the whole cardiac panel.
Tri-City Surgical Centers was among the first ambulatory surgery centers CMS approved to implant Abbott's CardioMEMS PA-pressure sensor, live since 2024. The practice already trusts remote hemodynamic data to drive heart-failure decisions.
Pacemakers, ICDs, and loop recorders implanted and managed in-house — with two additional EPs recruited in December 2025. Remote-transmission review is already a familiar weekly workflow, which makes RPM an extension of an existing habit rather than a new concept.
The group already refers patients into an in-home virtual intensive cardiac rehab program by physician referral. Delivering cardiac care into the patient's home is already current practice at Tri-City, not a cultural leap.
Across 29 physicians, roughly 10 advanced practice providers, and 13 locations, no remote physiologic monitoring and no principal care management is billed anywhere in the group today. Every one of those dollars is currently unbilled.
Tri-City made the capital investment in heart failure — an ASC licensed for CardioMEMS, an expanding EP bench, a new Mesa campus — without the corresponding labor investment. No heart-failure clinic, no nurse navigator, no care-management team. The expensive, narrow, procedural half is built. The recurring, scalable, reimbursed half is not — and it is the half that protects the first one.
In April 2026 the category the practice already buys from — virtual cardiac rehab — publicly extended into care management. That is market direction, not a criticism of any vendor: the longitudinal layer around the cardiac patient is going to get built by someone. The only question in front of Tri-City is whether the practice owns those economics or rents them.
Tri-City recruits on physician group equity, ASC ownership, and real-estate ownership — an owner-operated practice, in a metro where several cardiology groups have already consolidated. Procedural revenue is exactly what a county running roughly 52% Medicare Advantage pressures hardest. A recurring, non-procedural service line is revenue diversification that supports independence, on the practice's own P&L.
A named, governed remote-care service line with its own owner, P&L, and scorecard, following the Medicare cardiac patient between visits — rather than a point solution bolted onto one diagnosis. CoachCare runs the engine; Tri-City's physicians govern every protocol and every clinical decision.
| Service | Codes | ~CY2026 Magnitude | Cardiovascular Use at Tri-City |
|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | ~$200–$280 per discharge | The catch at discharge from Banner or Dignity — and the on-ramp into RPM |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | 99445 makes 2–15-day post-discharge and post-procedure windows billable |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, GDMT titration, escalation before decompensation |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | The single high-risk cardiac condition (e.g., heart failure) for three months or more — the specialist's care-management code |
The rates in this table are national non-facility amounts, rounded. The Value Analysis below uses MAC carrier/locality rates auto-resolved for Mesa, Arizona (zip 85205, carrier 03102 / locality 00).
CoachCare integrates directly and bi-directionally with NextGen — Tri-City's team enrolls and monitors remote-care patients inside the NextGen Enterprise workflows they already use, with discrete vitals landing in the flowsheet and claims auto-generated every month. Nothing new for a clinician to learn, and nothing that lives outside the chart.
Tri-City has publicly committed to consolidating onto fewer, deeper technology partners rather than stacking point solutions across the practice. A remote-care service line that writes back into NextGen is that same architectural decision applied to the clinical side.
CoachCare is the only care-management platform that provides automated claims creation via its own billing engine — the reason capture holds when the panel reaches four figures across 13 locations.
Every billed minute is time-stamped against a named protocol, with device-data provenance and a documented care plan in the chart. PHI moves under a signed Business Associate Agreement with HIPAA-compliant handling end to end.
"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 EHR integration accomplishes."
The readmission exposure at the top of this page has a direct answer: a documented, escalation-governed clinical operating model, not a dashboard. Every RPM and PCM reading runs through one decision engine, with a hard emergency guarantee, defined routing, and a fixed post-discharge cadence. This is the protocol layer behind the modeled 433 avoided hospitalizations.
Every escalation is time-logged against a named protocol on six fixed fields — an auditable record of each event, by construction:
An active emergent symptom during any outreach call triggers 911 with the patient still on the line:
If the patient refuses, the clinic is looped in; if the clinic is unavailable, CoachCare activates 911 itself. CoachCare's urgent and emergent policy supersedes any local escalation preference — patient safety is never deferred to configuration.
An active emergent presentation bypasses every queue and goes straight to emergency services, with the clinic notified.
An out-of-range value or qualifying trend that needs clinical eyes routes to a named practice team member — not a general inbox.
A reading that self-resolves or returns to range is logged as a documented note — full visibility, without a page.
An emergency-department visit or hospitalization in the prior 60 days automatically triggers a fixed three-touch cadence across the first two weeks after discharge — the exact window in which a low-rated admitting hospital's readmission risk is decided.
A 24-month forecast for the cardiology remote-care service line, built on a discovery-stage panel estimate of ~30,400 Medicare patients — roughly 14,700 in traditional fee-for-service plus a comparable Medicare Advantage population at Maricopa County's ~52% MA penetration; 41 referring providers; one CoachCare-funded on-site enrollment specialist; MAC-locality rates for Mesa (zip 85205); NextGen integration. RPM and PCM bill cleanly on the fee-for-service half of that panel; the Medicare Advantage half requires plan-by-plan confirmation in discovery. Avoided-hospitalization savings are shown as clinical value, not revenue.
| Program | Net Reimbursement | CoachCare Fees | Practice Margin |
|---|---|---|---|
| RPM — remote physiologic monitoring | $6,209,226 | $3,465,190 | $2,744,037 |
| PCM — principal care management | $1,949,882 | $1,017,686 | $932,196 |
| Implementation, integration & ancillary | — | $196,490 | −$196,490 |
| 24-month total | $8,159,108 | $4,679,365 | $3,479,743 |
| By Year | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Net reimbursement | $2,005,076 | $6,154,032 | $8,159,108 |
| CoachCare fees | $1,156,575 | $3,522,790 | $4,679,365 |
| Net to practice (after fees) | $848,501 | $2,631,242 | $3,479,743 |
| Enrollment, device logistics, 24/7 monitoring, and billing capture are delivered by CoachCare — no new practice headcount required. The on-site enrollment specialist is CoachCare's expense and is never subtracted from practice margin. | |||
24-month practice margin: 42.6% of net reimbursement (Year 1 42.3%, Year 2 42.8%).
Full model available as a companion workbook.
At the modeled scenario the explorer reproduces the workbook run: Month-24 active census of 5,249 RPM · 1,768 PCM = 7,017 enrollments (5,779 unique patients), and 24-month net reimbursement of $8,159,108.
Reimbursement is the reason the service line is self-funding. It is not the reason to build it. Over 24 months the modeled program generates a continuous clinical record of the cardiac panel between visits — and absorbs the care-management labor a 29-physician group would otherwise have to hire.
Recurring, subscription-like professional-fee volume across the RPM and PCM stack over 24 months.
A continuous picture of the heart-failure, coronary, hypertension, and post-discharge panels between office visits.
≈ $6.49M in avoided acute cost at $15K per admission — clinical value, excluded from every revenue figure here.
Monitoring, outreach, and documentation performed by CoachCare — roughly 33.3 FTE-equivalents of work Tri-City does not have to hire.
CoachCare runs the service line's engine: enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation. Tri-City's physicians govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount; practice staffing formalizes only as census grows.
Named service-line owner, P&L, and scorecard; NextGen integration and billing configuration; protocol sign-off for heart failure, coronary disease, hypertension, post-discharge, and device-population pathways.
Start where the exposure is: patients discharging from Banner and Dignity, plus the arrhythmia-center and CardioMEMS populations already generating remote data. TCM-to-RPM handoff live; first billable claims by day 45.
Referral engine extended across all 41 referring providers and the East Valley clinic network; PCM layered onto the principal-condition panel alongside RPM; monthly scorecard to practice leadership.
Roughly 3,550 active program enrollments — about 2,924 unique patients — by month 12, scaling toward 7,017 enrollments and 5,779 unique patients by month 24, with recurring professional-fee revenue and a continuous clinical picture of the cardiac panel between visits.
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 $1,949,882 of the modeled $8,159,108 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 $553,025, RPM accounts for $546,936 and the care-management arm for $6,089.
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.