From January 1, 2027, four of this practice's physicians carry CMS Ambulatory Specialty Model accountability for their heart-failure patients. Medicare already reimburses the work that accountability demands — under Remote Patient Monitoring and Principal Care Management — yet today that work happens on the hospital's payroll, unbilled by the practice. This page models what an owned, billable, margin-positive service line looks like.
Sarasota Memorial's Heart Failure Center describes its own program as delivering comprehensive education, symptom management and monitoring — including frequent symptom and weight tracking by phone, device monitoring to indicate fluid levels, medical-therapy optimization, and nurse specialists who follow up with recently discharged patients. Line for line, that is the clinical protocol Remote Patient Monitoring and Principal Care Management were written to reimburse. It is being performed manually, telephonically, on a hospital cost center — and no one submits a Part B claim for it.
Weights, symptoms, fluid status and post-discharge follow-up are already tracked between visits for this heart-failure population. The clinical case for remote care does not have to be made here — the workflow is running. What is missing is the reimbursed modality and the entity that bills it.
From January 1, 2027 the practice carries ASM accountability for heart-failure cost and quality, while the day-to-day management infrastructure sits on the hospital's balance sheet. The practice is judged on a measure it does not currently operate.
Standing the protocol up as a practice-billed service line converts an uncompensated dependency into practice revenue — and puts direct control of the readmission and cost levers inside the entity Medicare will hold accountable for them. Same patients, same protocol, different ownership.
This is not an adoption question. The hardest operational muscle in remote care — high-volume alert triage on a device population, every day — is already built here. The gap is a reimbursed physiologic-monitoring and care-management line sitting on top of it, and there is no incumbent vendor in the way.
Remote monitoring of implanted devices is confirmed in the practice's own patient communications — pacemakers, ICDs and implantable loop recorders are monitored in-house. The practice also claims the largest implantable loop recorder clinic in Florida. Continuous transmission triage is already routine work.
15 physicians and 9 advanced practice providers across three Sarasota sites — six interventional and three electrophysiology — with 600+ TAVR and 700+ Watchman procedures reported, full EP, cardiac PET, nuclear and vascular imaging, and in-house Holter and event monitoring.
No physiologic Remote Patient Monitoring program and no Principal Care Management program is in evidence — and no third-party remote-care vendor appears anywhere. This is a clean build on top of a proven device operation, not a rip-and-replace.
CMS CY2024 per-provider data across the practice's billing providers shows heart-failure / non-ischemic prevalence of 24–54% across physicians and 31–66% across APPs, atrial fibrillation 36–75%, chronic kidney disease 24–49%, and mean beneficiary age 77–80.
The Ambulatory Specialty Model (ASM) is a mandatory, two-sided-risk CMS program that makes cardiologists individually accountable for the cost and quality of the heart-failure patients attributed to them. Performance year one runs from January 1, 2027 through 2031, scoring cost, quality, improvement activities and interoperability, and applying a Part B payment adjustment of −9% to +9%. It is not a program a practice opts into — it is a change in how heart failure gets paid.
Four of Heart Specialists of Sarasota's physicians appear on the CMS CY2027 preliminary ASM participant list, heart-failure cohort, under the practice's billing legal name. No individual clinician is identified on this page.
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 the model's 2031 close.
ASM's heart-failure cohort excludes the interventional, electrophysiology and advanced heart-failure / transplant designations. With six interventional and three electrophysiology physicians on a 15-physician roster, the adjustment attaches to a minority of the partnership while the heart-failure population is spread across all of it. A group-wide chassis is what resolves that asymmetry.
The wedge is simple: the same service line that bills today is the heart-failure chassis for January 2027. Continuous physiologic monitoring, protocolized management between visits, and documented care coordination are what ASM will score — and what RPM and Principal Care Management already pay for under fee-for-service. Build it now, and performance year one opens with an enrolled panel instead of a blank page.
A named service line with its own owner, P&L and scorecard, run by the practice's cardiologists and advanced practice providers, following the Medicare patient between visits on the Greenway backbone. The sequence starts at the hospital door.
| Service | Codes | 2026 Rate (FL 09102-99) | Cardiovascular Use |
|---|---|---|---|
| Transitional Care Management | 99495 · 99496 | Not modeled — upside | The discharge handoff from Sarasota Memorial; excluded from every figure on this page |
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | $21.12 · $50.00 · $50.00 | 99445 makes 2–15-day post-discharge monitoring windows billable |
| RPM treatment management | 99457 · 99458 · 99470 (new) | $51.12 · $41.22 · $25.73 | Monthly review, diuretic and guideline-directed therapy titration, escalation |
| Principal Care Management | 99426 · 99427 | $67.57 · $53.69 | The single high-risk condition — heart failure, cardiology-native; the specialist's care-management code |
Rates auto-resolved from the CY2026 Physician Fee Schedule for MAC carrier 09102, locality 99 (Florida; zip 34239).
The service line runs inside the chart the practice 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 and nobody logs into a second system to do the work.
Weights, blood pressures and oximetry land in the flowsheet as structured data the practice can trend, filter and report on — the substrate ASM's quality and interoperability domains will be scored against.
Care summaries, time logs and compliance documentation post back into the chart and the billing workqueue, so the codes are supported by the record without a parallel paper trail.
Clinicians and staff stay in Greenway. Enrollment status is visible in the chart in real time — a meaningful detail for a practice whose patient-facing digital tools are currently spread across several unconnected systems.
The weight-and-symptom monitoring Sarasota Memorial's nurses already perform by phone is the right clinical instinct. This is that same work made billable, documented and escalation-safe — a service line the practice owns and controls, run to the standard a two-sided-risk program demands. It is the operating model behind the roughly 293 hospitalizations the Value Analysis models as avoided, and the documentation trail that a risk-bearing program is scored on.
Remote Patient Monitoring (RPM) and Principal Care Management (PCM) readings all route through one decision path — one standard, not per-nurse judgment. Noise is filtered at the source; genuine risk moves immediately.
If an active, emergent symptom surfaces during any outreach, the care team calls 911 with the patient still on the line — it does not wait for a callback or a routing decision.
If the patient refuses, the care team loops in the clinic; if the clinic is unavailable, CoachCare activates 911 itself. This urgent/emergent policy supersedes any local escalation preference — there is no configuration in which an active emergency waits. A symptom that was present recently but is not active at the time of contact (within 72 hours) follows the practice's stated preference instead.
Physicians are not paged for what does not need them. Each event is sorted by severity and sent to exactly one destination.
Active emergent findings bypass routing entirely — the emergency pathway runs, with the patient on the line and the practice notified.
Out-of-range readings and confirmed trends route to a defined practice team member under the practice's protocols — not a general in-box, a specific owner.
Readings that self-resolve or return to range are recorded for the chart and trend history without interrupting anyone.
An emergency-room visit or hospitalization in the last 60 days triggers a structured cadence over the first two weeks — the window where heart-failure readmissions are made or prevented, and the population the practice carries the ASM accountability for. Every touch is documented and escalates on the same logic.
A 24-month forecast for the cardiology remote care service line. The panel: roughly 22,600 Medicare patients — about 11,300 in traditional fee-for-service, plus a comparable Medicare Advantage population at Sarasota County's ~43% Medicare Advantage penetration — across the practice's three Sarasota sites, with 24 referring providers (15 physicians and 9 APPs), one CoachCare-funded on-site enrollment specialist, telephonic enrollment, MAC-locality rates for FL 09102-99 (zip 34239) and native Greenway integration. ASM performance and avoided-admission savings are not in these numbers — they are upside on top.
| Program (24-Month) | Net Reimbursement | CoachCare Fees | Practice Margin |
|---|---|---|---|
| RPM — remote physiologic monitoring | $4,225,940 | $2,404,876 | $1,821,064 |
| PCM — principal care management | $1,413,723 | $744,556 | $669,167 |
| Implementation, integration & ancillary | — | $61,381 | −$61,381 |
| 24-month total | $5,639,663 | $3,210,813 | $2,428,850 |
| By Year | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Net reimbursement | $1,386,180 | $4,253,483 | $5,639,663 |
| CoachCare fees | $795,216 | $2,415,597 | $3,210,813 |
| Net to practice (after fees) | $590,965 | $1,837,886 | $2,428,850 |
| Practice margin (% of net reimbursement) | 42.6% | 43.2% | 43.1% |
| Delivered full-service — telephonic enrollment, devices, 24/7 monitoring and billing handled by CoachCare. The on-site enrollment specialist is staffed at CoachCare's expense: embedded value, never a deduction from the practice's net. | |||
The full model is available as a companion Value Analysis workbook.
The census line plots active program enrollments. Unique patients are derived from that census — RPM census plus 30% of the PCM census — and are always the smaller number. At the modeled scenario the explorer reproduces the workbook run: Month-24 census of 3,554 RPM · 1,262 PCM = 4,816 enrollments (3,933 unique patients) and $5,639,663 of 24-month net reimbursement.
Reimbursement is the reason the service line sustains itself. These are the reasons it matters to the heart-failure population — and to the physicians whose Part B is on the line in 2027.
Recurring, subscription-like professional-fee volume across 24 months — revenue that does not depend on procedure schedules or referral surges.
A continuous picture of weight, blood pressure and oximetry trends between visits — the earliest available signal of heart-failure decompensation.
≈ $4.40M in avoided acute cost at $15K per admission — a system-level benefit, and the same denominator ASM reconciles the practice against.
≈ 22.9 FTE-equivalent of monitoring, outreach and documentation performed by CoachCare — work the practice does not hire for, in a market where it has struggled to.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring and billing-ready documentation — while the practice's cardiologists and advanced practice providers govern protocols and every clinical decision. Full-service delivery means launch requires no new practice headcount; the staffing model formalizes as census grows.
Named owner, P&L and scorecard. Confirm the Greenway product and interface scope, configure the integration and billing, set the PCM attribution policy against the named principal cardiac condition for each patient, and sign off the heart-failure, post-discharge and arrhythmia pathways.
Start where the ASM exposure and the clinical stakes converge: patients discharged from Sarasota Memorial with heart failure. TCM at discharge, then RPM plus Principal Care Management, with protocolized diuretic and guideline-directed therapy titration and telephonic enrollment.
Extend RPM to the arrhythmia, device-follow-up, CKD and hypertension populations; extend Principal Care Management across the broader cardiac panel; hand the advanced-practice bench a structured workflow for the panels it already carries. Monthly scorecard to service-line governance.
Formalize the electronic collaborative-care arrangements with referring primary care, harden the titration and documentation production process, and open January 2027 with an enrolled panel and a coordination record instead of a plan.
The service line described on this page runs on infrastructure already proven at national scale.
Over 400 managed conditions for more than 500,000 patients.
Providers running remote care programs day to day.
Successful program implementations.
Care-plan coding and billing behind more than 5 million claims.
Over 100 million vitals recorded and more than 4 million care actions enabled.
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 $1,413,723 of the modeled $5,639,663 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 $360,985, RPM accounts for $353,492 and the care-management arm for $7,492.
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 partnership fits Heart Specialists of Sarasota specifically, not remote care in general.
CoachCare integrates bi-directionally with Greenway: eligibility flags and orders leave the EHR, and discrete vitals, care documentation and claim-ready charges come back into it. One chart for clinicians across the three Sarasota sites, one workflow for the billing team, no second system 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 43.1% margin, with no hiring cycle. On-site enrollment is our expense — telephonic outreach converts about 8%, so we staff the clinic instead.
Your 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, platform and billing preparation under that governance — the operating model an independent group keeps control of.
Pacemakers, ICDs and implantable loop recorders are already monitored in-house — the largest loop recorder clinic in Florida — so daily, high-volume alert triage is routine work here. There is no third-party remote-care vendor in the way. The gap is a reimbursed physiologic-monitoring and principal-care-management line on top of the operation you already run.
Every structural-heart case — 600-plus TAVR and 700-plus WATCHMAN — and every electrophysiology case opens a post-procedure monitoring window, and the same care-management enrollment feeds performance under the Ambulatory Specialty Model. One remote care service line covers the procedural cohorts and the model math at once.
Fees are per active patient per month; there is no capital outlay and no payroll ramp. Because the forecast is set by enrollment pace, throughput is the lever. If the census does not build, CoachCare does not get paid, and the forecast, Disclosures and workbook behind this page are yours to keep either way.