How Houston Cardiovascular Associates can convert its heart failure, coronary artery disease, atrial fibrillation, and hypertension populations into continuous care, durable recurring revenue, and 2027 payment-model readiness.
A note on how patients are counted. Enrolled Patients are unique individuals — 3,321 at Month 24. Enrolled Services are total program enrollments — 3,957 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 below reports active program enrollments; the headline reports unique patients.
Three forces are converging on independent cardiology: Medicare is moving cardiologists to two-sided accountability for heart failure, CY2026 billing expanded remote-care reimbursement, and the Houston market is already competing on continuous care.
CMS's Ambulatory Specialty Model makes cardiologists directly accountable for heart failure cost and quality, with Part B adjustments of −9% to +9% in the first payment year. Practices with a functioning remote care chassis enter with the data, workflows, and results already in place.
Medicare's 2026 fee schedule added 99445 (2–15-day device supply) and 99470 (first-10-minute management) — purpose-built for short post-procedure and transitional monitoring windows that were previously unbillable. The billing stack now fits how cardiology actually works.
With roughly 61% MA penetration (~250K enrollees, 70 plans), payers reward practices that can demonstrate managed populations and avoided admissions. Houston-area competitors already market remote monitoring programs — continuous care is becoming table stakes.
This isn't a program transplant. HCVA already runs the clinical assets a remote care service line plugs into — what's missing is the billing-grade monitoring layer that turns them into a managed, reimbursed population.
A rare-for-independents advanced HF program — amyloidosis, cardio-oncology, transplant pathway — anchored by dedicated HF cardiology.
HCVA already trusts home hemodynamic monitoring for HF. The clinical buy-in for remote data is proven; RPM extends it to the broader population.
In-house cath lab/ASC, EP, structural heart, and peripheral vascular — every procedural line benefits from monitored transitions and faster, safer discharge.
US Heart & Vascular publicly commits to chronic care management, remote monitoring, and MA risk arrangements. A program at HCVA is the platform's Houston flagship.
The gap: no practice-branded RPM or PCM program is visible to patients or payers today — while the local benchmark hospital's own data shows heart failure patients accumulating +7.6 excess days in care per 100 discharges after they leave. Post-discharge is exactly where a monitored population outperforms.
A managed remote care service line runs as its own P&L: enrollment, connected devices, 24/7 alert triage, nurse care management, billing capture, and analytics — delivered as one shared engine underneath every program.
| Service | Codes | ~CY2026 Magnitude | Cadence |
|---|---|---|---|
| RPM setup & device supply | 99453 · 99454 · 99445 (new) | ~$20 setup · ~$52/mo | Monthly per enrolled patient |
| RPM treatment management | 99457 · 99458 · 99470 (new) | ~$52 + ~$41 add'l | Monthly per managed patient |
| Principal Care Management | 99426 · 99427 | ~$60 + ~$50 add'l | Monthly, the single high-risk cardiac condition |
| Transitional Care Management | 99495 · 99496 | ~$200–$280 | Per qualifying discharge |
National non-facility magnitudes for orientation. Actual payment is locality-adjusted; the Value Analysis below uses MAC-resolved rates for zip 77004 (Novitas JH, TX carrier 04412 / locality 18 in the model).
A 24-month forecast built in the CoachCare Value Analysis Model, using HCVA's actual footprint — 55 referring providers, MAC-locality rates for zip 77004, eClinicalWorks integration — and conservative enrollment mechanics.
| Program (24-Month) | Net Reimbursement | CoachCare Fees | Practice Margin |
|---|---|---|---|
| RPM — remote physiologic monitoring | $3,717,010 | $2,062,097 | $1,654,914 |
| PCM — principal care management | $1,035,896 | $535,962 | $499,934 |
| Implementation, integration & ancillary | — | $118,045 | −$118,045 |
| 24-month total | $4,752,906 | $2,716,104 | $2,036,802 |
| By Year | Year 1 | Year 2 | 24-Month |
|---|---|---|---|
| Net reimbursement | $1,168,778 | $3,584,128 | $4,752,906 |
| CoachCare fees | $674,902 | $2,041,202 | $2,716,104 |
| Practice margin (after fees) | $493,876 | $1,542,926 | $2,036,802 |
24-month practice margin: 42.9% of net reimbursement (Year 1 42.3%, Year 2 43.0%).
Enrollment, device logistics, 24/7 monitoring, and billing capture are delivered by CoachCare — no new practice headcount required.
Over 24 months — recurring, subscription-like professional-fee volume across the RPM and PCM stack.
A continuous clinical picture of the HF, CAD, AFib, and HTN panels between visits.
≈ $3.77M in avoided acute cost at $15K per admission — clinical value, excluded from every revenue figure here.
38,674 care-team hours of monitoring, outreach, and documentation handled by the service line.
CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while HCVA's physicians govern protocols and keep every clinical decision. Full service delivery means no new headcount is required to launch.
eClinicalWorks integration, MAC/billing configuration, protocol sign-off for HF, CAD, AFib, and HTN pathways, care-team workflow design.
Physician-referral enrollment opens across all three locations; telephonic enrollment layers on; first devices shipped and first billable months captured.
TCM + short-window RPM (99445) wraps every discharge; enrollment reaches steady referral cadence; margin is positive and compounding.
Roughly 2,000 active program enrollments — about 1,680 unique patients — under management by month 12; quality and utilization dashboards in place, the evidence base for ASM 2027 and MA payer conversations.
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 $1,035,896 of the modeled $4,752,906 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 $322,143, RPM accounts for $317,419 and the care-management arm for $4,724.
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 Houston Cardiovascular Associates specifically, not remote care in general.
CoachCare integrates bi-directionally with eClinicalWorks: eligibility flags and orders leave the chart, and discrete vitals, care documentation and claim-ready charges come back into it. One record for the clinicians, one workflow for the billing team, and no second system to learn to start.
Enrollment outreach, the care team, device logistics, 24/7 alert triage and billing preparation are CoachCare's payroll. The practice inherits a running program the month it turns on, at a 42.9% margin, with no hiring cycle. On-site enrollment is our expense, because 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 and NPIs. CoachCare supplies the staff, devices, platform and billing preparation under that governance, the operating model an independent group keeps control of.
Houston-area competitors already market remote-monitoring programs, but there is no vendor line to migrate off inside this practice. The program builds directly on the heart failure, coronary artery disease, atrial fibrillation and hypertension populations the group already carries, without a contract to exit first.
Every structural-heart case opens a post-procedure monitoring window, and the same documented monthly management is the work the Ambulatory Specialty Model reads. One remote care service line covers both, bills under the current fee schedule now, and produces the evidence later.
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.