Tri-City already implants the sensors, owns the surgical center, and runs a five-electrophysiologist device bench. What it does not have is the reimbursed, longitudinal layer that carries a cardiac patient from discharge back to stability — TCM, then RPM, then CCM and PCM. This is what that service line looks like across 29 physicians and 13 locations, and it is margin-positive before any value-based dollar.
A note on how patients are counted. Enrolled Patients are unique individuals — 4,470 at Month 24. Enrolled Services are total program enrollments — 7,016 at Month 24 — because roughly 70% of enrolled patients carry two programs at once (RPM plus one longitudinal chronic-care wrapper). Every chart and calculator below reports active program enrollments; the headline reports unique patients. Illustrative, modeled — verify against practice data.
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 and should be validated against the group's own discharge reporting. Stated as published public data, not as a judgment of any hospital.
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 not a cultural leap at Tri-City — it is current practice.
Across 29 physicians, roughly 10 advanced practice providers, and 13 locations, no remote physiologic monitoring, chronic care management, or 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.
Not a point solution bolted onto one diagnosis — a named, governed remote-care service line with its own owner, P&L, and scorecard, following the Medicare cardiac patient between visits. 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 unlocks 2–15-day post-discharge and post-procedure windows |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly review, GDMT titration, escalation before decompensation |
| Chronic Care Management | 99490 · 99439 | ~$60 + ~$47 add'l | Two or more chronic conditions under the cardiac diagnosis |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | Single high-risk condition (e.g., heart failure) for three months or more |
Illustrative national non-facility magnitudes shown for orientation only. The Value Analysis below uses MAC carrier/locality rates auto-resolved for Mesa, Arizona (zip 85206, carrier 03102 / locality 00). Verify against the current CY Physician Fee Schedule.
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, and it is not a dashboard — it is a documented, escalation-governed clinical operating model. Every RPM, CCM, 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 279 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 85206); NextGen integration. RPM, CCM, 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 | 24-Month Net Reimbursement | Share |
|---|---|---|
| RPM — remote physiologic monitoring | $3,998,738 | 46.4% |
| CCM — chronic care management | $3,367,639 | 39.1% |
| PCM — principal care management | $1,245,108 | 14.5% |
| Total net reimbursement | $8,611,485 | 100% |
| By Year | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Net reimbursement | $2,105,281 | $6,506,204 | $8,611,485 |
| Net to practice (after fees) | $883,839 | $2,780,728 | $3,664,567 |
| Enrollment, device logistics, 24/7 monitoring, and billing capture are delivered by CoachCare — no new practice headcount required. | |||
Figures are illustrative and modeled — verify against practice data. Full model available as a companion workbook.
At the modeled scenario the explorer reproduces the workbook run exactly: Month-24 active census of 3,379 RPM · 2,508 CCM · 1,129 PCM = 7,016 enrollments (4,470 unique patients), and 24-month net reimbursement of $8,611,485.
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 three-program stack over 24 months.
A continuous picture of the heart-failure, coronary, hypertension, and post-discharge panels between office visits.
≈ $4.18M in avoided acute cost at $15K per admission — clinical value, excluded from every revenue figure here.
Monitoring, outreach, and documentation performed by CoachCare — roughly 36.9 FTE-equivalents of work Tri-City does not have to hire.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while 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; CCM and PCM layered onto the multi-condition panel; monthly scorecard to practice leadership.
Roughly 3,550 active program enrollments — about 2,260 unique patients — by month 12, scaling toward 7,016 enrollments and 4,470 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 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 to cited public data. The key assumptions — and the items to confirm in discovery: