This week, MD Revolution and CoachCare hosted a live webinar featuring Paul Huffman, VP of Client Services, and Dr. Teresa Sieck, Chief Medical Officer, who walked through one of the most compelling heart failure monitoring outcomes we’ve ever seen:
Zero readmissions in a 450-patient advanced heart failure cohort at MercyOne Iowa Heart Center.
The session combined real-world results, workflow strategy, clinical interpretation, and policy context around the upcoming 2026 CMS changes — all leading to a unified takeaway: Continuous, structured monitoring isn’t just effective. It’s essential.
Below is a recap of the key moments and the most important questions answered during the live event.
The MercyOne Story: Why This Program Worked
A Unique Challenge: Advanced Heart Failure Patients
MercyOne manages more than 9,000 heart failure patients — including a large advanced HF population that historically experienced preventable, high-frequency readmissions.
Dr. Sieck described these patients as “clinically fragile, highly variable, and capable of destabilizing within hours.”
Small shifts in weight, blood pressure, or oxygen saturation are often early signals of decompensation — signals that traditional visit-based care simply can’t catch in time.
A Deliberate Strategy: Start with the Sickest
Rather than easing in with low-acuity patients, MercyOne enrolled 450 high-risk, advanced HF patients from the start. Their baseline? An 18% 30-day readmission rate.
The program paired:
- Continuous daily review from CoachCare’s clinical monitoring team
- Clear, rapid escalation to MercyOne’s HF specialists
- Trend-based interpretation instead of alert chasing
- Medication titration and same-day visits when necessary
The result: Zero heart failure readmissions during the observation period.
And this wasn’t luck — it was the product of consistent daily oversight and fast specialty intervention.
Reinforcing Evidence: The 26,000-Patient Cardiac Solutions Study
To show the model wasn’t an anomaly, Paul and Teresa compared MercyOne’s results to a much broader dataset: 26,000+ patients at Cardiac Solutions, analyzed over 12 months.
Patients enrolled in RPM + CCM experienced ~50% fewer HF readmissions than those who were not — even without selective enrollment or special protocol design.
The common thread across sites?
- Daily monitoring
- Trend-based risk detection
- Reliable escalation
- Clear specialist response
This is a scalable model — not a one-off success story.
Operational & Financial Impact
Beyond clinical outcomes, MercyOne saw a transformative shift in clinic operations:
- Fewer emergency escalations
- More predictable workflows
- Reduced clinician burnout
- Improved medication adherence
- 81 readmissions avoided
Preventing avoidable hospitalizations produces immediate ROI and stabilizes care teams — a critical advantage as CMS pushes cardiology toward coordinated, out-of-hospital care.
Why These Results Matter for 2026
The second half of the session focused on one of the most important policy shifts coming to cardiology:
The Ambulatory Specialty Model (ASM)
Beginning in 2026, CMS will move large segments of cardiology into a mandatory, two-sided risk model focused heavily on:
- Readmissions
- Cost containment
- Quality performance
- Care coordination
- Interoperability
Practices will see –9% to +9% payment adjustments tied directly to outcomes.
Meanwhile, the 2026 Physician Fee Schedule introduces:
- 7% cuts for facility-based cardiology
- 5% increases for non-facility settings
- A 2.5% “efficiency adjustment” pushing toward higher-value chronic care models
In short:
The clinical model MercyOne implemented aligns exactly with the model CMS is now incentivizing nationwide.
As Dr. Sieck put it:
“The future CMS wants is the future MercyOne is already living in.”
Key Takeaways from the Discussion
1. Start with high-risk patients
Advanced heart failure patients benefit most from daily oversight because small physiological changes can predict rapid destabilization.
2. Workflow drives outcomes more than technology
MercyOne’s zero readmissions were achieved through consistent daily monitoring, trend-based interpretation, and rapid escalation to HF specialists — not by adding more devices or data.
3. Early signals are the strongest predictors
Weight trajectories, blood pressure variability, oxygen saturation changes, missed readings, and patient-reported symptoms provided the earliest indicators of decompensation.
4. The model is repeatable across organizations
A 26,000-patient analysis at Cardiac Solutions showed nearly a 50% reduction in HF readmissions for patients enrolled in RPM + CCM, reinforcing that the approach scales across different settings.
5. The results align directly with CMS’s 2026 direction
Both the Ambulatory Specialty Model and the 2026 Physician Fee Schedule prioritize continuous, proactive, coordinated heart failure management — the same structure that produced MercyOne’s outcomes.
What’s Next?
As part of this week’s event:
- Check out the full case study here
- Additional HF benchmarks are available upon request
- Dr. Sieck will host Open Office Hours in January 2026
- Our team is available to walk through ASM, HF care strategy, or program design
If your organization is evaluating heart failure strategy ahead of 2026, or if you’d like to explore how these workflows could apply in your environment, we’d love to connect.
