What is the Ambulatory Specialty Model (ASM)? Understanding the New CMS Model

The Ambulatory Specialty Model (ASM) is a new mandatory payment model from the Centers for Medicare & Medicaid Services (CMS) Innovation Center that will reshape how certain specialists are reimbursed under original Medicare. Beginning January 1, 2027, ASM will hold selected clinicians financially accountable for the longitudinal management of chronic conditions, starting with congestive heart failure and low back pain.

For cardiologists and specialty practices in designated regions (view a CMS spreadsheet of the mandated regions here), ASM represents a structural shift in how performance is evaluated. Rather than concentrating solely on services delivered during visits, the model measures how well chronic disease is managed across time. Quality, cost, care improvement activities, and interoperability are combined into a composite score that directly influences future Medicare Part B payment adjustments.

This article provides a foundational overview of ASM and how it works. It also takes a closer look at what the Ambulatory Specialty Model means for heart failure providers preparing for implementation and the valuable role of remote patient monitoring (RPM).

What Is the Ambulatory Specialty Model Designed to Achieve?

The Ambulatory Specialty Model was developed by the CMS Innovation Center with a goal of improving chronic disease outcomes while addressing high Medicare spending in select specialty areas. CMS identified heart failure and low back pain as two conditions with substantial opportunity for better upstream management and cost containment.

At its core, ASM seeks to:

• Encourage prevention of disease worsening or recurrence

• Improve collaboration between specialists and primary care

• Detect clinical risk earlier

• Enhance patient experience and functional outcomes

• Reduce avoidable hospitalizations and care lacking clear evidence of benefit

The model does not focus on isolated procedures or discrete episodes. Rather, it centers on sustained disease stability and measurable population-level outcomes over multiple years.

When Does the Ambulatory Specialty Model Start, and How Long Does It Last?

ASM begins on January 1, 2027, and runs for five performance years through December 31, 2031. Payment adjustments tied to performance will apply to all of the participant’s Medicare Part B claims beginning in 2029 and continue through 2033.

In the first payment year, adjustments will range from -9% to +9 percent. All participants are subject to risk, and the model is structured so that aggregate positive adjustments do not exceed aggregate negative adjustments.

Since performance is measured over a five-year period, operational decisions made before or during the earlier years of the model can heavily influence financial results for an extended duration. Infrastructure stability and documentation reliability take on greater importance in a multi-year accountability framework.

Which Specialists Are Required to Participate in ASM?

Participation in ASM is mandatory for selected clinicians practicing in designated core-based statistical areas (CBSAs). CMS selected participants in specific CBSAs, meaning participation is geographically concentrated rather than nationwide. Eligibility is determined through retrospective Medicare claims analysis rather than voluntary enrollment.

For heart failure, the specialty category is cardiology. Physicians must have historically treated at least 20 original Medicare beneficiaries with heart failure during a 12-month period to qualify.

Quality and cost performance are assessed at the individual clinician level, while care improvement activities and promoting interoperability are assessed at the group level. This dual structure means both personal clinical performance and organizational workflows influence final payment outcomes.

How Will Quality and Cost Be Measured Under the Ambulatory Specialty Model?

Participant performance is evaluated across four categories:

Quality

Measures may include control of clinical indicators such as blood pressure for patients with heart failure.

Cost

CMS evaluates reductions in unnecessary care and total Medicare spending for attributed patients.

Care Improvement Activities

Participants must implement structured improvements in clinical processes, patient engagement, lifestyle intervention support, and care coordination.

Promoting Interoperability

Specialists are expected to exchange health information electronically with patients and primary care providers.

Final scores across these domains determine whether clinicians receive positive, neutral, or negative payment adjustments in future years.

Why Is Heart Failure a Focus of the Ambulatory Specialty Model?

Heart failure represents one of the highest-cost chronic conditions within original Medicare. Hospital admissions, readmissions, and emergency department utilization account for a substantial portion of overall spending.

CMS's decision to include heart failure reflects the opportunity to improve outcomes through earlier intervention, closer monitoring, and stronger coordination between cardiology and primary care. Even modest reductions in preventable hospitalizations can meaningfully influence total cost of care calculations over time.

Since utilization outcomes are tightly linked to quality performance and cost benchmarks, heart failure management under ASM places renewed emphasis on disease stability between encounters. Note: For detailed performance measure mechanics, see our ASM FAQ for heart failure providers.

How Does the Ambulatory Specialty Model Affect Cardiology Practices Operationally?

Cardiology practices selected for ASM will need to examine their workflows through a population-health lens. Attribution is claims-driven and retrospective, which means clinicians may be accountable for patients they did not actively enroll into a value-based program.

Operational readiness under ASM includes:

• Reliable documentation of required quality measures

• Clear care coordination processes with primary care partners

• Structured monitoring of chronic disease indicators

• Data exchange capabilities that support interoperability expectations

Practices that depend primarily on visit-based documentation may find that performance measurement exposes gaps that were previously invisible under fee-for-service reimbursement.

Can Remote Patient Monitoring Help Heart Failure Practices Succeed Under the Ambulatory Specialty Model?

Remote patient monitoring (RPM) is not explicitly required by ASM. However, the structure of the model makes consistent physiologic visibility increasingly valuable for heart failure practices.

Blood pressure control is cited as an example quality measure for heart failure. Since performance calculations rely on documented readings within defined measurement windows, gaps in data capture can affect scores. RPM programs that collect blood pressure readings in the home environment create a more continuous record of disease control.

Weight monitoring is similarly important in heart failure management. Fluid retention often presents as gradual weight gain before symptoms escalate. Regular home-based weight data allows care teams to intervene earlier, potentially reducing emergency department visits and hospital admissions that influence both quality and cost metrics.

In addition, ASM requires implementation of collaborative care arrangements and health information exchange capabilities. Modern RPM platforms can support structured data sharing, enabling cardiology practices to communicate more effectively with primary care partners.

For many organizations, RPM serves as enabling infrastructure that strengthens measurement reliability and supports proactive clinical management across an attributed population. Note: For an even deeper analysis, see our post on how RPM supports longitudinal stability under ASM.

How Should Practices Prepare for the Ambulatory Specialty Model Now?

With performance beginning in 2027 and payment adjustments following shortly thereafter, preparation timelines are narrowing. Practices in designated regions should evaluate their exposure and operational readiness well in advance of the model start date.

Key areas for assessment include:

• Are required clinical indicators captured consistently across the attributed population?

• Do workflows allow for timely follow-up when physiologic measures trend upward?

• Is data exchange with primary care partners structured and reliable?

• Can the practice track utilization patterns and identify preventable admissions?

The five-year duration of ASM means that early variability can influence cumulative performance. Stabilizing documentation processes, monitoring systems, and care coordination protocols before payment adjustments begin reduces long-term volatility.

Preparing for ASM With Prevounce Remote Patient Monitoring

Prevounce is prepared to support those cardiology and specialty practices required to participate in the Ambulatory Specialty Model through scalable remote patient monitoring software, connected blood pressure and weight devices, and optional clinical support services.

By strengthening physiologic data capture, supporting structured workflows, and facilitating interoperability, Prevounce helps practices align their heart failure programs with the expectations embedded in ASM.

If your organization is required to participate in the Ambulatory Specialty Model, now is the time to evaluate whether your monitoring infrastructure supports sustained performance.

Contact Prevounce to learn how your practice can prepare for ASM and build a foundation for long-term clinical and financial stability under Medicare's evolving specialty payment landscape.

Frequently Asked Questions About the Ambulatory Specialty Model

How does patient attribution work under the Ambulatory Specialty Model?

Attribution under ASM is retrospective and claims-based. CMS analyzes historical Medicare billing patterns to determine which specialists most frequently treated eligible beneficiaries, and those patients become the attributed population for performance measurement. Since attribution is not prospective or voluntary, cardiology practices must evaluate performance across their broader heart failure population rather than a selectively enrolled subset.

Is the Ambulatory Specialty Model mandatory?

Yes. The Ambulatory Specialty Model is mandatory for selected specialists in designated geographic regions identified by CMS.

How are cost benchmarks determined for heart failure participants in ASM?

CMS evaluates total Medicare spending for attributed beneficiaries against a risk-adjusted benchmark. In heart failure, inpatient admissions and readmissions often drive the largest cost variation. Sustained reductions in avoidable hospital utilization can meaningfully influence performance relative to benchmark targets over the five-year model period.

What financial risk do cardiologists face under the Ambulatory Specialty Model?

In the first payment year, adjustments range from -9% to +9% on all Medicare Part B claims, not just those tied to CHF or low back pain treatment. Since performance spans five years, early underperformance can create multi-year revenue impact if documentation gaps or high utilization patterns persist. Practices should evaluate exposure based on attributed volume and Medicare mix.

How does ASM interact with accountable care organizations (ACOs)?

ASM operates as a specialty-focused model and does not replace broader ACO participation. In some cases, improved heart failure management may positively influence both specialty and ACO cost performance. However, attribution methods and benchmarks differ, requiring coordinated internal reporting to align incentives across contracts.

What operational capabilities improve performance under ASM?

Strong performers typically demonstrate consistent quality documentation, structured monitoring of heart failure indicators, defined escalation workflows, and reliable data exchange with primary care partners. Multi-year accountability favors organizations with stable infrastructure rather than reactive compliance efforts.

How should cardiology practices prepare before ASM performance begins in 2027?

Preparation should include estimating attributed patient volume, reviewing hospitalization trends, assessing documentation completeness for required quality measures, and evaluating interoperability capabilities. Since the model runs for five years, stabilizing workflows before performance periods mature reduces long-term financial volatility.

* Disclaimer: The above information is for informational purposes only and does not constitute legal or other professional advice. Billing and coding requirements — especially in the telehealth space — can change and be reinterpreted often. You should always consult an attorney and/or medical billing professional prior to submitting claims for services to ensure that all requirements are met.