Prepared for Ocala Kidney Group · 2026 Strategy Review · Confidential
Nephrology Remote Care Service Line · Ocala Kidney Group × CoachCare

Every Kidney Patient, Monitored Between Visits — and Every Dollar of It Working Twice.

How Ocala Kidney Group turns continuous remote care for chronic kidney disease, resistant hypertension, and the dialysis-transition panel into new fee-for-service revenue — and a shared-savings engine for its Integrated Kidney Care of Florida risk contract.

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24-Month Net Reimbursement
$0
24-Month Practice Margin
0
Hospitalizations Avoided
0
Unique Patients in Active Remote Care (Month 24)
Independent Since 1984 · Built for This

2026 Starts From a Position of Strength

This is not a turnaround story. Ocala Kidney Group is one of Marion County's oldest independent nephrology practices, physician-owned, procedurally sophisticated, and already inside a Medicare kidney-care risk contract. The strategic question is not whether to add remote care — it is how to make one build pay twice: as new fee-for-service revenue and as the clinical engine behind shared savings.

✓ In Place

Four Decades, Physician-Owned

Serving Marion County since 1984 — independent, no private-equity backing. ~10–11 board-certified nephrologists plus 8 APRNs across three offices (Ocala main, Route 200 West, and Leesburg).

✓ In Place

Interventional & Vascular Access

A dedicated Dialysis Vascular Access Center staffed by two FASDIN interventional nephrologists — clinical depth and a procedural platform most community groups can't match.

★ Verified

Inside a Kidney Risk Contract

A confirmed CKCC participant in Integrated Kidney Care of Florida (DaVita IKC), with Dr. Rebecca Ong on the KCE governing body. The accountable-care infrastructure is already yours.

★ Verified

Retiree-Dense CKD Corridor

Marion County is 28.5% age 65+ — roughly twice the national share — with CKD + hypertension the near-universal chronic pair in older Floridians. The panel is right there.

The one thing missing is the service line itself. No RPM, PCM, telehealth, or patient-monitoring program is marketed anywhere in the practice today — a clean greenfield, with no incumbent vendor to rip out and no workflow to unlearn.

The Lead Lever · Fee-For-Service + Shared Savings

The CKCC Edge: One Program, Paid Two Ways

Most practices weigh remote care on fee capture alone. Ocala Kidney Group is different: it already carries shared-savings exposure on the total cost of care for its FFS-aligned CKD and ESRD patients. Every RPM reading and PCM touch that slows progression, controls blood pressure, or prevents a crash-start bills today and moves the number the KCE is measured on.

Verified
CKCC

Integrated Kidney Care of Florida

A confirmed participant in the DaVita-managed Kidney Contracting Entity, with Dr. Rebecca Ong on its governing body. KCE quality climbed from 87.5% (PY2022) to 90% (PY2024), and PY2022 generated $833,116 in shared savings reinvested into the program. RPM and PCM feed that machinery directly.

Tailwind
CY2026

Short-Window RPM Is Now Billable

New codes 99445 (2–15-day device supply) and 99470 (first 10 minutes of management) remove the old 16-day floor, making post-hospitalization and dialysis-transition monitoring windows cleanly billable — on top of the established 99453 / 99454 / 99457 / 99458 stack.

The Wedge
1 : 1

Clinical Value Maps to the P&L

Slower CKD progression delays dialysis — the KCE's single largest cost driver. Home BP monitoring controls resistant hypertension. Early decompensation alerts convert emergent crash-starts into planned, optimal starts. Each is a shared-savings lever, not just a CPT line.

One honest distinction, stated up front: the panel here is total Medicare — roughly 5,390 fee-for-service plus 5,390 Medicare Advantage lives. RPM and PCM bill across the whole panel: MA plans pay these federally-set codes at Medicare (FFS) rates, at no less than 100% of the fee schedule. What CKCC adds is on the FFS half only — shared savings attributes Traditional Medicare lives, so every FFS reading and touch bills and moves the KCE number, while MA lives bill but sit outside the shared-savings math. The value model below is built on the full billable panel; see Assumptions & Sources for the sizing method.
Chronic Kidney Disease
Resistant Hypertension
Dialysis Transitions
Post-Discharge CKD
The Operating Model

One Nephrology Service Line: RPM + PCM

Not a point solution bolted onto one diagnosis — a named, governed service line with its own owner and scorecard, following the CKD patient between visits on the chart you already use. Two reimbursable programs, one shared infrastructure.

Remote Physiologic Monitoring (RPM)
  • What Cellular-connected blood-pressure cuffs and scales — the continuous early-warning and titration layer for CKD progression, resistant hypertension, and fluid status.
  • Who CKD stages 3–5, resistant/uncontrolled hypertension, and the post-hospitalization and dialysis-transition panels.
  • Codes 99453 · 99454 · 99445 (new) for setup & device; 99457 · 99458 · 99470 (new) for monthly management.
Principal Care Management (PCM)
  • What Nephrology-native chronic management of the single, high-risk dominant condition — CKD — between the acute episode and stability.
  • Who Patients whose CKD alone warrants ongoing care coordination for three months or more.
  • Codes 99426 first 30 minutes · 99427 each additional — billable alongside RPM for the same patient in the same month.
The one coordination rule: RPM stacks with PCM for the same patient in the same month, so a CKD patient can be both monitored and principally managed. This build intentionally excludes CCM and APCM — PCM is the right fit for a single dominant condition, and it keeps the model clean, focused, and easy to govern.

The CY2026 Billing Stack

ServiceCodes~CY2026 MagnitudeNephrology Use
RPM setup & device supply99453 · 99454 · 99445 (new)~$20 setup · ~$50/moBP & weight monitoring; 99445 unlocks 2–15-day windows
RPM treatment management99457 · 99458 · 99470 (new)~$50 + ~$40 add'lMonthly review, titration, escalation
Principal Care Management99426 · 99427~$80 + ~$60 add'lSingle high-risk condition (CKD) ≥ 3 months

Illustrative national non-facility magnitudes. The value analysis below uses MAC-locality rates auto-resolved for zip 34471 (First Coast Service Options, Florida). Verify against the current CY Physician Fee Schedule.

Connective Tissue

One Operating System, Every CKCC Lever

The same infrastructure — enrollment, cellular devices, 24/7 alert triage, nurse outreach, billing capture, analytics — powers each lever that moves both the practice's revenue and the KCE's shared-savings math. Build once, reuse everywhere.

Slow CKD Progression
Continuous BP and adherence monitoring plus PCM titration flatten the eGFR-decline curve and delay dialysis — the single largest cost driver in the CKCC risk pool. Every month of delayed progression is a shared-savings win.
Control Resistant Hypertension
Home blood-pressure RPM turns titration into a production process for a retiree-dense panel where hypertension is the dominant driver of CKD advancement. It is also the most billable, highest-adherence RPM use case in nephrology.
Avoid Crash-Starts
Early decompensation alerts convert emergent, hospital-based dialysis crash-starts into planned, optimal starts — often on a home modality. This is the highest-value single event the KCE can influence, and remote monitoring is how it gets caught in time.
Cut Hospitalizations & Readmissions
Between-visit surveillance catches fluid overload and electrolyte drift before the ED does. The model projects roughly 154 admissions avoided over 24 months — a direct KCE quality-and-cost metric and ~$2.31M in avoided acute cost at $15K per admission.
Capture Recurring FFS Revenue
Independent of shared savings, RPM and PCM generate recurring, subscription-like professional-fee revenue that funds the program on its own economics — so the CKCC upside is genuinely additive, not a break-even bet.
Native · In the Chart You Already Use

Greenway Integration, Not a Second System

Ocala Kidney Group runs on Greenway — confirmed via the myhealthrecord.com patient portal. CoachCare integrates natively so that enrollment, discrete vitals, care documentation, and auto-generated claims live inside the Greenway workflow. Your team never learns a new platform; the program lives in the record they already touch every day.

Greenway OKG's practice EHR Chart & encounters Orders & flags Flowsheets / vitals Patient portal Billing workqueues CoachCare Remote care platform Cellular devices 24/7 monitoring Nurse outreach Enrollment team Billing engine FROM GREENWAY Enrollment flags & trigger orders Patient health history BACK INTO GREENWAY Discrete vitals — in the flowsheet, not PDFs Care summary & compliance documentation Real-time enrollment status Claims — auto-generated, every patient, every month Clinicians never leave Greenway — the program lives in the chart they already use
$2,500
Integration Setup · One-Time
$0
Monthly Interface Fee
$0
Per-Patient Interface Fee

Catalog integration pricing shown for reference. Ocala Kidney Group's exact Greenway product — Intergy versus Prime Suite — and version should be confirmed in contracting, as it determines the precise interface path (Intergy carries modern FHIR/USCDI APIs; Prime Suite is more constrained).

"Key to achieving a program that is efficient, effective and sustainable is creating a seamless, intuitive experience for the patient and provider — and that is what native EHR integration accomplishes."

CoachCare Value Analysis · Modeled for Ocala Kidney Group

The Value Analysis

A 24-month forecast for the RPM + PCM nephrology service line — a ~10,780-life total-Medicare panel, roughly 19 referring providers, MAC-locality rates for zip 34471, Greenway integration. CKCC shared-savings upside and avoided-hospitalization dollars are not in these revenue numbers; they are upside on top of the reimbursement run below.

Active Program Enrollments Under Remote Care

Monthly active census by program (active program enrollments/services); headline stat = unique patients, deduped for ~70% cross-program dual-enrollment — physician referrals (8/provider/mo, 80% acceptance), one CoachCare-funded on-site enrollment specialist, plus telephonic enrollment, net of attrition

Monthly Economics — Revenue, Fees, Margin

Net reimbursement (after denials, coinsurance bad debt) vs. CoachCare fees; margin turns positive in month 2

24-Month Net Reimbursement Mix

$2.98M total across the two-program nephrology stack — RPM + PCM only, no CCM

The Financial Summary

ProgramYear 1Year 224-Month
RPM net reimbursement$546,300$1,669,910$2,216,210
PCM net reimbursement$184,008$576,229$760,237
Total net reimbursement$730,308$2,246,139$2,976,447
Practice margin (after fees)$304,241$955,842$1,260,083
Fees include implementation, Greenway integration, devices, 24/7 monitoring, and enrollment — embedded value already reflected in the margin above.

Figures are illustrative and modeled — verify against practice data. Full model available as a companion workbook.

Scenario Explorer — Build Your Own Forecast

Adjust the assumptions and watch the 24-month forecast recompute live. Directional, calibrated to the CoachCare Value Analysis engine — the companion workbook remains the source of truth.
24-mo net reimbursement
$2.98M
24-mo practice margin
$1.26M
Active enrollments · M24
2,545
Hospitalizations avoided
~154
56,351

Billed Claims / Units

Recurring, subscription-like professional-fee volume over 24 months.

242,195

Physiologic Readings

A continuous clinical picture of the CKD and hypertension panels between visits.

~154

Hospitalizations Avoided

≈ $2.31M in avoided acute cost at $15K per admission — and direct CKCC shared-savings relief.

25,251

Care-Team Hours

≈ 12.1 FTE-years of monitoring, outreach, and documentation absorbed by the service line.

Implementation

Chartered in 30 Days.
Piloting by Day 90.

CoachCare operates as the service line's engine — enrollment outreach, device logistics, 24/7 monitoring, and billing-ready documentation — while Ocala Kidney Group's nephrologists govern protocols and every clinical decision. Full-service delivery means launch requires no new headcount; the pilot cohort proves the unit economics before any scale commitment.

A natural proving ground: the CKD stage 4–5 and resistant-hypertension panel at the main Ocala campus, co-located with the Dialysis Vascular Access Center, where the highest-acuity patients already concentrate. Modeled census reaches roughly 200 active enrollments by Day 90 (months 1–3: 41 → 108 → 201), footnoted honestly — the real funnel is set in protocol design.

Schedule the Working Session
0–30 Days

Charter the Service Line

Named owner and scorecard; Greenway integration and billing configuration; confirm the exact EHR product and version; segment the FFS/CKCC vs Medicare Advantage panel; protocol sign-off for CKD and hypertension pathways.

31–90 Days

Pilot: The CKD + HTN Cohort

Stage 4–5 CKD and resistant-hypertension patients at the Ocala main campus — referral plus telephonic enrollment, cellular BP and weight devices, protocolized titration under nephrology direction.

91–180 Days

Scale Across All Three Offices

Ocala main, Route 200 West, and Leesburg all enrolling; the Leesburg clinic extends into the retiree corridor; balanced scorecard reporting monthly to service-line governance.

181–365 Days

Close the CKCC Loop

Full-panel enrollment; a formal reporting loop that feeds RPM/PCM clinical outcomes into the Integrated Kidney Care of Florida shared-savings model — turning the fee-for-service program into a documented KCE performance engine.

About CoachCare

The Experience to Get It Right

The service line described on this page runs on infrastructure already proven at national scale.

500,000+

Patient Management Expertise

Over 400 managed conditions for 500,000+ patients.

10,000+

Clinician Success

Providers committed to remote care excellence.

1,000+

In-Market Success

Successful program implementations.

5M+

Operational Excellence

Care plan coding and billing generating over 5 million claims.

100M+

Unprecedented Scale

Over 100 million vitals recorded and 4 million+ care actions enabled.

Transparency

Assumptions & Sources

Every number on this page traces to the CoachCare Value Analysis workbook or cited public data. The key assumptions:

Population sizing (nephrology RPM + PCM)
  • The panel is total Medicare = ~10,780 lives, modeled as 2× fee-for-service Part B (~5,390 FFS + ~5,390 Medicare Advantage). This is a modeling estimate, not a chart count — validate the FFS base and the FFS/MA split in discovery.
  • MA lives are counted as billable because RPM and PCM are federally-set codes that MA plans reimburse at Medicare (FFS) rates, at no less than 100% of the fee schedule. Eligibility applied at 60% for both RPM and PCM (~6,468 in scope each); enrollment conversion 30% (RPM) and 25% (PCM), yielding active-patient ceilings of ~1,940 (RPM) and ~1,617 (PCM).
  • Enrollment pathways: one CoachCare-funded on-site enrollment specialist (~80/month at steady state), physician referral (8 referrals/provider/month across ~19 clinical providers at 80% acceptance ≈ 122/month), plus a telephonic enrollment stream (~9/month).
  • Census reaches ~2,545 active enrollments — ~2,069 unique patients — by month 24 (RPM ~1,865 + PCM ~679; CCM and APCM are out of scope and modeled at zero). Month-1 / month-12 / month-24 checkpoints: ~41 / ~1,287 / ~2,545.
Fee-for-service vs. Medicare Advantage & CKCC
  • This is an MA-heavy market — The Villages sits at ~60% Medicare Advantage penetration (60.29%, Jul 2025), well above the ~51% national share — so roughly half the ~10,780-life panel is MA.
  • Both halves bill: RPM and PCM are federally-set codes, and MA plans reimburse them at Medicare (FFS) rates (≥100% of the fee schedule). The reimbursement model therefore runs on the full billable panel, not the FFS half alone.
  • What CKCC adds sits on the FFS half only: shared savings attributes Traditional Medicare lives, so FFS patients generate RPM/PCM billing and shared-savings impact, while MA patients bill but do not flow to the KCE. The FFS-vs-MA split is a top discovery confirmation.
Rates & revenue mechanics
  • CY2026 PFS rates auto-resolved by MAC carrier/locality for zip 34471 (First Coast Service Options, Florida); 2.5% denial rate; 20% coinsurance with 25% coinsurance bad debt; 1.5% monthly attrition; 2.5% annual growth.
  • Code-level capture assumptions (e.g., the share of managed months billing 99457 and adding a 99458 unit) are itemized in the companion Value Analysis workbook.
Verified facts (July 2026)
  • CKCC: confirmed participant in Integrated Kidney Care of Florida, LLC (a DaVita Integrated Kidney Care-managed KCE); Dr. Rebecca Ong (OKG) on the KCE governing body. KCE quality PY2022 87.5% → PY2024 90%; PY2022 shared savings $833,116 reinvested. Source: DaVita CKCC portal. Risk track (Professional vs. Global) not public — confirm in discovery.
  • Practice: independent nephrology group, est. 1984; ~10–11 nephrologists + 8 APRNs; three offices (Ocala main at 2980 SE 3rd Ct., Route 200 West, and Leesburg). No clinic in The Villages — that tie is via dialysis-unit medical directorships. Distinct from North Florida Kidney Care.
  • EHR: Greenway confirmed (myhealthrecord.com patient portal). Intergy vs. Prime Suite is unverified (lean Intergy) — confirm exact product and version in contracting.
  • Whitespace: no RPM, CCM, PCM, telehealth, or patient app marketed anywhere on the practice site — a clean greenfield.
  • Market: Marion County 28.5% age 65+ (~2× national); CKD + hypertension the near-universal chronic pair in older Floridians.