Primary Care Associates of Hagerstown — Remote Care Program Review

The observed data

Seven periods of CoachCare billable units

These are units the CoachCare system generated for the enrolled Medicare Advantage cohort. Two lines tell the whole story: one climbs, one does not move.

Device units vs. treatment management units, P1–P7

Same axis, same scale. The distance between the lines is the entire argument.

Units generated by period — oldest to most recent
CPT	Description	P2	P3	P4	P5	P6	P7
99445	Device supply, 2–15 days	9	9	36	58	81	80
99454	Device supply, 16+ days	2	5	7	25	27	21
99453	RPM setup / education	1	0	5	0	2	1
Device units	99445 + 99454 + 99453	12	14	48	83	110	102
99457	Treatment mgmt, first 20 min	0	0	3	0	0	0
99458	Treatment mgmt, add’l 20 min	0	0	0	0	0	0
99470	Treatment mgmt, 10–19 min	1	1	7	3	4	0
Management units	99457 + 99458 + 99470	1	1	10	3	4	0
99490	CCM, first 20 min	0	0	0	0	0	0
99439	CCM, add’l 20 min	0	0	0	0	0	0

99445 and 99454 pay the same amount at this locality ($52.70), so the adherence mix between them matters clinically but carries no revenue difference — nothing in this model claims upside from shifting patients between them.

The capture gap

The equipment side is working at 78%. The clinical side is at zero.

Capture is billable units generated per enrolled patient per month, measured against the CoachCare full-service benchmark for a 200-patient enrolled census. Two rows, most recent period.

Device supply99445 + 99454 — equipment in the home, data transmitting

78%

101 units generated130 benchmark

Treatment management99457 + 99458 + 99470 — clinical time reviewing data and acting on it

0 units generated305 benchmark

99453 (setup) is held out of the device row above so the recurring comparison stays clean — it contributed 1 unit against a 1-unit benchmark in the latest period. The model applies the resulting 77.7% device capture across all three device codes, and 0% management capture across all three management codes.

Why this gap decides the economics. The device codes are the smaller half of the RPM stack — 130 benchmark units against 305 for management. You are capturing most of the smaller half and none of the larger one, while paying a flat fee that does not distinguish between them. That is why the program sits at roughly breakeven rather than returning anything: the missing revenue was never billed in the first place.

What the fee buys

Today you pay a flat fee per enrolled patient. Under full service, the monitoring fee is only incurred when a unit is actually generated.

Both columns are modeled on the same 200 enrolled patients, the same fee schedule, and the same collection assumptions. The only thing that changes is who performs and logs the treatment management work.

Current — as observed

Self-service

Device capture77.7%

Management capture0.0%

Net reimbursement$4,946

CoachCare fees−$5,000

Practice staff cost$0

Net monthly margin−$54

Annualized−$643

Effective fee / enrolled pt / mo$25.00

Net collected per fee dollar0.99×

Modeled — at benchmark capture

CoachCare full service

Device capture100.0%

Management capture100.0%

Net reimbursement$19,427

CoachCare fees−$12,403

Practice staff cost$0

Net monthly margin$7,025

Annualized$84,297

Effective fee / enrolled pt / mo$62.01

Net collected per fee dollar1.57×

The RPM swing. Your effective fee more than doubles, and what it returns per dollar goes from 0.99× to 1.57×. The higher fee pays for the clinical time that turns benchmark units into billed claims.

+$7,078

Per month

+$84,940

Per year

The line-by-line build modeled

Every row below is the workbook, unaltered. Units = 200 enrolled × the benchmark rate for that code × capture. Net collected = allowed × 92.625%.

CPT	Bench / pt	Rate	Units now	Net now	Units full svc	Net full svc	Svc fee / unit

CoachCare fee build
Fee line	Basis	Unit fee	Current / mo	Full service / mo

On the current position. At roughly breakeven, today’s program is not costing the practice meaningful money — but it is not returning any either. The honest framing is that the investment has not yet produced a return, and the reason is entirely mechanical: the codes that carry the value require documented clinical time that no one has the capacity to spend or log.

Practice staff cost is carried at $0 in both columns. That is a deliberately conservative choice, and it works against the full-service case. Enrollment, device support and monitoring effort that never becomes a billable unit is real cost the practice absorbs today; the workbook leaves that input at zero until the practice supplies a number, so the current-state margin is not overstated. Fill it in and the gap between the two columns widens.

The second layer

Care management stacks on top of RPM — and is worth more than the RPM program itself

Two routes, both billable alongside RPM. They are mutually exclusive for the same patient in the same month — you choose one, you do not run both. Modeled below on a 600-patient panel.

99490 · 99439

RPM + CCM

Chronic Care Management. Time-based: 20 documented clinical minutes per patient per calendar month. Requires 2 or more chronic conditions.

Net revenue / patient / mo$68.95

CoachCare fee / patient / mo$33.40

Practice margin / patient / mo$35.55

Care management margin / mo$21,329

Full-service RPM margin / mo$7,025

Combined margin / mo$28,354

Combined margin / yr$340,244

Net per fee dollar — CCM layer2.06×

Net per fee dollar — with RPM1.87×

G0556 · G0557 · G0558

RPM + APCM

Advanced Primary Care Management. No minute-tracking. Tiered by complexity; any consenting beneficiary can qualify.

Net revenue / patient / mo$52.11

CoachCare fee / patient / mo$28.40

Practice margin / patient / mo$23.71

Care management margin / mo$14,225

Full-service RPM margin / mo$7,025

Combined margin / mo$21,249

Combined margin / yr$254,991

Net per fee dollar — APCM layer1.83×

Net per fee dollar — with RPM1.72×

These two columns cannot be added together. CCM and APCM may not be billed for the same patient in the same calendar month. Neither can CCM be combined with PCM, TCM (99495–99496), ESRD services (90951–90970), or home health / hospice supervision (G0181, G0182) for the same patient. RPM stacks cleanly with either one.

How to choose

CCM pays more — and asks for the one thing that has not happened yet

At equal panel size CCM models roughly $85,252 per year above APCM. That number is real and it is in the workbook. But CCM is time-based: 20 documented minutes of clinical staff time, per patient, every calendar month, defensible on audit.

That is precisely the discipline the observed data shows has not been sustainable in-house — management units sat at zero across seven periods.
Under full service CoachCare carries the logging, but the audit exposure stays with the billing practitioner.
CCM time and RPM treatment management time may not be double-counted. The 20 minutes supporting 99490 must be distinct from the 20 supporting 99457.
Eligibility is narrower — 2 or more chronic conditions — so the CCM-eligible panel will be smaller than the APCM-eligible panel, which narrows the advantage above.

APCM pays less — and removes the stopwatch entirely

APCM is a flat monthly service by complexity tier with no minute threshold to document. Its operating requirements are structural rather than clerical, which is exactly what a full-service partner is built to carry.

No time-based documentation, so the failure mode that produced zero management units does not repeat.
Any consenting beneficiary can qualify — a wider eligible panel than CCM.
Thirteen service elements must be continuously available, including 24/7 access to a care team member with real-time record access. That is a staffing requirement, not a documentation requirement.
Practices billing APCM must report the Value in Primary Care MIPS Value Pathway.

The recommendation, and why it is not the bigger number. Selling a documentation-dependent code stack to a practice whose demonstrated constraint is documentation is selling the same problem at a higher price. Both paths are shown here at equal weight and the CCM figure is presented honestly — the case for APCM rests on operating risk, not on revenue. If the practice’s eligible CCM panel comes back close to the APCM panel and there is confidence in sustained time segregation, CCM is the better economics. Absent both, APCM is the more durable choice.

The risk that decides everything

Every rate in this model is a Medicare fee-for-service amount. This cohort is Medicare Advantage.

MA plans contract their own rates. Some pay at or near fee-for-service parity. Some pay materially less. Some do not separately pay RPM or APCM at all. A weak enough rate does not shrink the conclusion, it reverses it.

Modeled outcome by MA rate factor — at the current panel and capture settings
MA pays this % of Medicare FFS	Full-service RPM / mo	RPM + APCM / yr	RPM + CCM / yr

Break-even — RPM alone

63.8%

Below this, full-service RPM on its own does not cover its fees.

Break-even — RPM + APCM

58.1%

The care management layer widens the margin of safety.

Break-even — RPM + CCM

53.4%

The most tolerant of a weak MA rate — and the most exposed on documentation.

What this means practically. At 60% of fee-for-service the full-service RPM program alone is underwater. Every figure elsewhere on this page is shown at 100% parity unless you move the MA slider in the next section.

Explore the model

Move the levers. Every figure on this page moves with them.

This runs the same arithmetic as the workbook. Changing the MA rate factor updates the stat tiles at the top, the ledger, both care management paths, and the tables below — nothing on this page is a static number pretending to be a live one.

Care management panel size 600

Patients enrolled in CCM or APCM — never both.

MA rate factor 100%

What your MA plans pay as a percentage of the Medicare fee schedule.

Full-service management capture 100%

Stress test: how much of the treatment management benchmark the CoachCare care team actually converts into billable units. Device capture is held at 100%.

$7,025

$84,297 / yr

Full-service RPM
margin / mo

$28,354

$340,244 / yr

RPM + CCM
combined / mo

$21,249

$254,991 / yr

RPM + APCM
combined / mo

Care management margin by panel size — at the current MA rate factor
Patients	CCM / mo	CCM / yr	APCM / mo	APCM / yr

Care management margin only — the full-service RPM margin above is additional. The two care management columns are alternatives, never a sum.

Why CoachCare for Primary Care Associates of Hagerstown

Built for the Way This Practice Runs

Six reasons this partnership fits Primary Care Associates of Hagerstown specifically, not remote care in general.

Full service — the model that runs without hiring. Thirteen service elements must be continuously available, including 24/7 access to a care team member with real-time record access. That is a staffing requirement, not a documentation requirement, and it sits on CoachCare's payroll. The practice keeps $35.55 of margin per CCM patient per month and $23.71 per APCM patient, with no one added to the schedule.

Governance — the practice stays in charge. The physicians set the protocols, sign the care plans and make every clinical decision, and every claim goes out under the practice's own entity and NPIs. CoachCare supplies the care team, the devices and the platform under that governance.

Payer mix — worked with eyes open. Every rate in this model is a Medicare fee-for-service amount, and that rate is the floor a Medicare Advantage plan must meet, with terms set contract by contract. The traditional Medicare share is where these codes bill per claim, and the enrolled MA cohort is worked knowing which line moves and which does not.

One spine, several levers. Chronic care management, Advanced Primary Care Management and remote monitoring run on one enrolled census. APCM is tiered by complexity with no minute-tracking, so any consenting beneficiary can qualify. One service line, several billing levers, one care team behind them.

The gap this closes. The equipment side already transmits at 78% of benchmark; the clinical management side bills close to nothing. The full-service model closes that gap by converting the eligible panel into documented, billable units, with device capture held at 100%.

Aligned — paid as you enroll. Fees are per active patient per month; there is no capital outlay and no payroll ramp. If the census does not build, CoachCare does not get paid, so throughput is the shared lever. The forecast and the workbook behind this page are yours to keep either way.

The ask: a working session with the practice to validate the eligible chronic-care panel against your own chart counts, confirm the Medicare Advantage split, and set the first enrollment cohort.