Why RPM Is Foundational to Success Under the Ambulatory Specialty Model

The Ambulatory Specialty Model (ASM) is reshaping how heart failure care is measured, reimbursed, and operationalized in outpatient settings. As a mandatory Medicare specialty payment model, ASM shifts expectations away from episodic care and toward sustained accountability for disease stability, utilization patterns, and total cost of care.

CMS released selected geographic areas and a preliminary list of participants in early 2026, with the final participant list expected in the summer of 2026. For heart failure clinicians practicing in designated regions, preparation time is narrowing. The model spans five performance years, meaning early operational gaps and shortcomings can significantly compound issues.

In this environment, remote patient monitoring (RPM) provides the structure necessary to support sustained clinical and financial performance under the new Ambulatory Specialty Model.

What the Ambulatory Specialty Model Changes for Heart Failure Practices 

The Ambulatory Specialty Model directly links specialty-specific quality performance and total cost of care to Medicare payment adjustments. For heart failure clinicians, this creates a concentrated accountability framework that differs meaningfully from past programs.

While programs such as the Merit-based Incentive Payment System (MIPS) distribute relatively modest payment adjustments across composite scoring categories, ASM centers evaluation squarely on specialty outcomes. For heart failure practices, that means performance is tied to measurable disease control and utilization trends across an attributed population.

Two categories carry particular weight:

• Quality performance, including blood pressure control and utilization-related measures such as avoidable emergency department visits and hospital admissions.

• Cost performance, measured through a risk-adjusted total cost of care benchmark for attributed heart failure patients.

This structure elevates longitudinal management. It is no longer enough to deliver appropriate care during visits. Rather, practices must demonstrate measurable disease control across time.

Why Episodic Care Creates Structural Risk Under ASM

Traditional heart failure management is largely visit-based. Blood pressure is captured in the office, weight is documented during appointments, and medication changes often occur after symptoms prompt a scheduled encounter.

Under the Ambulatory Specialty Model, this episodic structure creates measurable vulnerability. Blood pressure control measures are numerator-and-denominator based. Patients without a documented reading during the measurement period still count against performance. If documentation is inconsistent, scores decline, even when patients are clinically stable.

At the same time, heart failure deterioration often develops between visits. Fluid retention, rising blood pressure, and subtle symptom progression can precede acute events by days or weeks. Without continuous visibility, intervention is often delayed until emergency department visits or hospital admissions occur.

Under ASM, those utilization events directly affect both quality scoring and total cost of care calculations. The challenge lies less in clinical decision-making and more in the infrastructure used to capture, track, and report performance data consistently across the patient population.

How Remote Patient Monitoring Aligns With the Design of the Ambulatory Specialty Model

Remote patient monitoring addresses the two structural challenges embedded within ASM: measurement reliability and early intervention.

Strengthening Blood Pressure Control Performance

The blood pressure control measure under ASM evaluates whether attributed heart failure patients maintain readings below defined thresholds during the performance period. Performance is determined by documented readings, not clinical intent.

Remote patient monitoring strengthens performance by:

• Increasing the frequency of documented readings

• Reducing denominator leakage from missing data

• Capturing a more accurate representation of control trends

• Minimizing the impact of a single elevated office-based reading
  

Instead of relying on isolated snapshots, clinicians gain a longitudinal view of patient status. That data continuity improves both quality reporting accuracy and clinical decision-making. 

Enabling Earlier Intervention Between Visits

Heart failure rarely destabilizes overnight. Rising blood pressure trends or gradual weight increases often precede symptomatic decompensation.

With remote patient monitoring, care teams can identify patterns earlier and intervene before escalation. Earlier medication adjustments, patient outreach, or care plan modifications reduce the likelihood that worsening disease progresses to emergency utilization.

This proactive approach aligns directly with ASM's emphasis on prevention rather than reactive stabilization.

RPM's Impact on the Cost Score Under the Ambulatory Specialty Model

The cost score under the Ambulatory Specialty Model evaluates total Medicare spending for attributed heart failure patients relative to a risk-adjusted benchmark. Inpatient admissions and readmissions represent a substantial share of that spending. Even small reductions in avoidable hospitalizations can have an outsized effect on cost performance.

Remote patient monitoring supports cost control by focusing on high-impact physiologic indicators:

• Weight monitoring, which can reveal fluid retention before severe symptoms appear

• Blood pressure trend analysis, identifying sustained elevations that increase risk

• Structured escalation workflows, enabling outpatient management before admission becomes necessary

Preventing a single hospitalization may influence both sides of the performance equation, improving quality metrics while lowering total cost of care. Over five performance years, these incremental improvements compound.

Is Remote Patient Monitoring Required for ASM Success?

The Ambulatory Specialty Model does not explicitly require remote patient monitoring. However, its design makes sustained success difficult without consistent physiologic visibility between visits.

Practices attempting to manage an attributed heart failure population using visit-only workflows face recurring friction, including the likes of:

• Gaps in documented blood pressure readings

• Delayed identification of clinical deterioration

• Higher exposure to avoidable emergency department visits

• Limited ability to demonstrate longitudinal disease stability

Over a five-year mandatory model, those gaps accumulate. Financial exposure is not limited to a single reporting year. When patterns repeat, performance trends persist.

Remote patient monitoring does not replace in-person care, but it reduces structural vulnerability under ASM. For many heart failure practices, RPM becomes integral to operational stability.

The Five-Year Compounding Effect of the Ambulatory Specialty Model

The Ambulatory Specialty Model is scheduled to span five performance years, meaning early weaknesses can and likely will echo forward. Practices that begin with inconsistent monitoring workflows may spend multiple years correcting performance patterns that could have been addressed proactively. Conversely, those that implement reliable longitudinal monitoring early can create a stable baseline that supports sustainable improvement.

With CMS having already released preliminary participant lists and final selections expected in July 2026, the window for preparation is limited. Claims-driven attribution means some clinicians may not yet recognize their exposure. Waiting until formal confirmation risks compressing implementation timelines and increasing early-year financial volatility.

What High-Performing Heart Failure Practices Will Prioritize

Heart failure practices preparing for ASM success are likely to focus on infrastructure rather than isolated initiatives. They will prioritize:

• Consistent blood pressure documentation across the attributed population

• Routine weight monitoring to identify early fluid retention

• Defined escalation protocols triggered by physiologic trends

• Documentation processes aligned with ASM quality specifications

• Longitudinal data visibility beyond the walls of the clinic

These priorities reflect the shift from episodic encounters to continuous population oversight. Remote patient monitoring supports each of these objectives by extending care visibility into the home setting and creating structured, repeatable data capture. Over time, that visibility strengthens both clinical confidence and financial predictability.

Positioning for Sustained Success Under the Ambulatory Specialty Model

For heart failure clinicians practicing in designated regions, the Ambulatory Specialty Model represents a mandatory evolution in specialty reimbursement. It concentrates accountability, amplifies utilization exposure, and extends performance measurement across five years.

Remote patient monitoring aligns directly with the model's core themes: early intervention, consistent measurement, and hospitalization prevention. While not formally mandated, RPM increasingly functions as enabling infrastructure for practices looking for strong, sustained performance under ASM.

Prevounce supports cardiology practices and specialty practices navigating the Ambulatory Specialty Model through integrated remote patient monitoring software, connected blood pressure and weight devices, and optional outsourced care management services. By combining technology, devices, and operational support, practices that select Prevounce as their RPM partner can improve measurement reliability, intervene earlier, and reduce avoidable utilization across their attributed population.

As ASM implementation approaches, practices that invest now in longitudinal monitoring infrastructure will be better positioned to manage cost, stabilize quality performance, and succeed in a mandatory value-based specialty environment.

Frequently Asked Questions About Remote Patient Monitoring and the Ambulatory Specialty Model

When should heart failure practices implement RPM for ASM?

Heart failure practices in designated ASM geographic regions should evaluate and implement RPM infrastructure before the final participant list is published in July 2026. Because the model runs for five years and performance compounds, delaying implementation compresses onboarding timelines and increases first-year exposure. Early adoption allows time to stabilize workflows and documentation processes before payment adjustments begin.

How does RPM affect attribution management under the Ambulatory Specialty Model?

While attribution under the Ambulatory Specialty Model is claims-driven and retrospective, RPM improves a practice's ability to manage its attributed population proactively. By increasing visibility into physiologic trends across the full panel of heart failure patients, clinicians can intervene earlier and reduce utilization events that influence both cost benchmarks and quality performance.

What operational changes are required to support RPM under ASM?

Successful RPM implementation under ASM requires more than device deployment. Practices should establish structured review workflows, escalation protocols for abnormal readings, documentation processes aligned with quality measure specifications, and clear clinical oversight responsibilities. Technology must be integrated into daily operations rather than functioning as a parallel system.

What happens if a heart failure practice underperforms in the early years of ASM?

Since the Ambulatory Specialty Model spans five performance years, early underperformance can create financial volatility and require corrective operational adjustments. Practices that lack consistent monitoring systems may need to rapidly implement new workflows mid-model, which can be more disruptive than proactive preparation. Establishing reliable physiologic monitoring before performance periods mature reduces this risk.

Can outsourced RPM services help reduce administrative burden under ASM?

Yes. For many heart failure practices, outsourced RPM support — including device logistics, patient onboarding, and clinical monitoring services — can accelerate implementation while limiting internal staffing strain. This allows physicians and advanced practice clinicians to focus on clinical decision-making while maintaining consistent physiologic oversight across the attributed population.

* 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.