In its 2026 Physician Fee Schedule Proposed Rule, the Centers for Medicare and Medicaid Services (CMS) proposed a new mandatory payment model–titled the Ambulatory Specialty Model (ASM)–for specialists who treat congestive heart failure (CHF) and low back pain. With the reported aim of driving better outcomes, improving chronic disease management, and reducing unnecessary costs for Medicare, the ASM is expected to take effect on January 1, 2027, running for five performance years through December 31, 2031. Read the full ASM proposal in the federal register.
For affected specialists in mandated core-based statistical areas (CBSAs), including orthopedic surgeons, neurosurgeons, cardiologists, and others, the ASM would represent a major shift. It calls for specialists to take on new accountability, join in tighter coordination with primary care, and embrace transparency in cost, quality, and data sharing.
Ambulatory Specialty Model Key Goals
The ASM is focused specifically on specialists who treat CHF and low back pain among Original Medicare beneficiaries in outpatient settings. The model is designed to address systemic gaps in how chronic conditions are detected, treated, and managed, with CHF and low back pain representing common conditions with high potential for substantial cost savings for Medicare.
The model’s goals include promoting prevention and earlier detection of chronic disease to avoid costly downstream complications arising from worsening and recurring chronic conditions, improving chronic disease management through increased collaboration between specialists and primary care providers, enhancing the patient experience by prioritizing patient-reported outcomes (PROs) on function, and reducing avoidable hospitalizations and treatments that are not backed by clear evidence.
Performance Measures
The ASM measures performance on the clinician level, rather than aggregating performance across systems or practices. The model borrows from existing CMS value-models (especially MIPS Value Pathways) but adds specific conditions, risk structure, and reporting requirements, as shown below:
Risks and Opportunities
The ASM is ambitious, targeting some of the costliest chronic conditions in Medicare and asking specialists to engage in upstream work, not just procedural or consultative work.
Risks
- Financial exposure: specialists must have strong cost control (e.g. against unnecessary imaging, over-referral, avoidable hospitalizations) to avoid low scores on the cost performance measures.
- Reporting burden: specialists will need to track and report outcomes, cost, and interoperability metrics, and possibly participate in new collaborative care workflows. Added reporting burdens on clinicians can sacrifice time that can be dedicated to patient care, increase costs for clinicians, and increase burnout.
- Infrastructure gaps: many specialty clinics may not currently have CEHRT or systems for data sharing or care coordination with primary care. Finding a solution to ensure this requirement is fulfilled should be a comprehensive process to ensure suitable fit, so as to avoid downstream costs and technical complications.
- Behavior change challenge: moving from volume-driven care to value-driven care will require changes in clinical practice, referral patterns, and clinical workflows. Implementing such changes can be a time-consuming process that distracts time away from direct patient care.
Opportunities
- Improved patient outcomes through earlier intervention, better chronic disease control, and fewer complications.
- Cost savings both for providers and for Medicare, especially by reducing avoidable hospitalizations and low-value procedures.
- Competitive advantage for high performers, especially in regions where transparency and peer comparisons become more visible.
- Enhanced patient satisfaction by emphasizing care experience, function, and patient priorities.
What Specialists Should Do Now
To get ahead of ASM, health systems and specialty care providers should begin preparing immediately by following these recommendations:
- Assess current data capabilities for tracking cost, patient outcomes, and required performance metrics
- Identify and close gaps in coordination with primary care
- Review current performance on target conditions and metrics
- Pilot patient engagement, outcome tracking, and education tools
- Build reporting & analytics capacity
- Monitor updates from CMS regarding mandatory CBSAs and other details
How Force Therapeutics Can Help You Succeed
Force Therapeutics’ comprehensive digital patient engagement platform is strongly positioned to support organizations in the transition to ASM through:
- Patient-Reported Outcome Measures (PROMs): Force has been a pioneer of PROMs collection for nearly 20 years, offering configurable tools to collect PROMs efficiently, with a track record of high response rates and data capture.
- Care pathway standardization and education: Force delivers content and protocols help prepare patients pre- and post-procedure or consultation, reducing unexpected utilization and improving adherence to care plans.
- Remote monitoring and engagement: Our system supports virtual follow-ups, remote check-ins, and education to reduce unnecessary visits and inpatient use; all patient engagement is tracked thoroughly so that providers can prioritize high-value patient care while maintaining high visibility into patient progress.
- Data integration and interoperability: We integrate directly with most EHR systems and ensure that data flows can meet interoperability requirements, so specialists can share relevant information with primary care and other collaborators.
- Analytics and transparency tools: Force provides dashboards and benchmarking to help providers see how they compare to peers on cost, quality, utilization metrics, providing visibility into where improvements will be rewarded or where risk lies.
- Efficiency and automation: To reduce the burden on clinical staff, Force automates administrative work, including patient education, scheduling follow-ups, monitoring adherence, and PROMs collection, so providers can focus on clinical decisions.
Learn more about how Force can help you prepare for the ASM. Reach out for a consultation or product demonstration:
