What is the CMS Ambulatory Specialty Model (ASM)?

If you are a specialist managing patients with heart failure or low back pain, the time to understand your obligations is now.

The ASM is a long-term commitment to value-based care, requiring participants to navigate escalating financial stakes.

Duration:

Five years, beginning January 1, 2027, and concluding December 31, 2031.

Escalating Risk:

Participants will face a dual-sided risk profile starting at 9% and increasing to 12% over the life of the model.

The Bottom Line:

The ASM represents a move toward granular accountability. Specialists are no longer on the sidelines of value-based care—they are now a vital part of it.

The ASM is designed to improve the co-management of Traditional Medicare beneficiaries while driving down costs within defined clinical episodes. Unlike many prior payment models, this is an individual provider-level model. It places the responsibility for cost and quality directly on the MDs and DOs who manage high-cost chronic conditions.

Questions about eligibility and practice impacts from this new MANDATORY payment model? Contact YOUR Experts at the Kentucky REC for all your ASM questions. Call us at 859-323-3090 or email us kyrec@uky.edu.

CMS’s New Mandatory Ambulatory Specialty Model

The Center for Medicare & Medicaid Services (CMS) recently released the participant list for the new Ambulatory Specialty Model (ASM). This payment model gauges individual clinician-level performance around high-cost chronic conditions.

Included in this MANDATORY model is a dual-sided risk component designed to increase specialty provider accountability through the co-management of Medicare beneficiary’s care.

Important facts about this model and it’s potential impact:

1. This is a MANDATORY dual-sided risk model: ASM participants will see escalating risk from 9-12% over the life of the model impacting ALL Medicare Part B claims reimbursement.
2. Model performance begins on January 1, 2027 and runs through December 31, 2031.
3. ASM participants are assessed at the individual provider level, not the tax ID, and participation is limited to certain clinician types. Selected clinicians will participate in one of two cohorts: Low Back Pain or Heart Failure
4. Mandatory participation is based on several factors: these are related to claims billed; medical specialty type; episode thresholds; and geographic area criteria for model selection.
5. Impacted Kentucky core-based statistical areas (CBSAs): Cincinnati/Northern Kentucky, Glasgow, Louisville Metro, Lexington-Fayette, Paducah, Pikeville, and Richmond/Berea.
6. The framework of this model is based on a composite of the Quality Payment Program’s MVP and APP Tracks with components of Advanced APMs. Mandatory selection for this model may impact your individual clinical level reporting requirements for the QPP program.

Several Kentucky healthcare providers have been selected to participate in this MANDATORY model.

A list of selected providers can be found on the CMS Model website. Visit this link to determine if you are a required participant in the ASM

If you are a specialist managing patients with heart failure or low back pain, the time to understand your obligations is now.

Click this link to visit CMS’s Ambulatory Specialty Model website to learn more or contact your Kentucky REC advisor at 859-323-3090 to learn about our ASM operational and strategic support services.

Questions about eligibility and practice impacts from this new MANDATORY payment model? Contact YOUR Experts at the Kentucky REC for all your ASM questions. Call us at 859-323-3090 or email us kyrec@uky.edu.