CMS Ambulatory Specialty Model 2027: What provider organizations need to know
CMS has published a list of specialists who must participate in the Ambulatory Specialty Model (ASM) starting January 1, 2027. If your provider organization includes these specialists, their individual performance will affect future Medicare Part B payments.
In this blog, we help you understand the ASM requirements and where to focus your preparation efforts to succeed in ASM.
What is the CMS Ambulatory Specialty Model (ASM)?
ASM is a CMS Innovation Center model for providers selected based on their specialty, location, and the Medicare patient population, with two conditions:
Heart failure
Low back pain
ASM runs for five performance years, from 2027 to 2031, with related payment adjustments applied to future Medicare Part B payments from 2029 to 2033.
The first ASM payment adjustment from 2027 will apply in 2029 and will range from -9% to +9%.
Payment adjustment will follow the same budget-neutral approach as MIPS (penalties from low performers would pay for the incentives to high performers).
CMS will evaluate participants across all four performance categories: Quality, Cost, Improvement Activities (IA), and Promoting Interoperability (PI).
ASM will reward clinicians who:
Prevent worsening or recurrence of chronic conditions by encouraging lifestyle changes
Improve chronic disease management by encouraging collaboration between specialists and primary care providers
Detect risks and signs of chronic conditions early
Enhance patient experience by prioritizing patient-reported outcomes on function
Reduce avoidable hospitalizations and care lacking clear evidence of benefit
🔗Source: ASM Model Fact Sheet
Who must participate in ASM?
All providers selected for the 2027 ASM model must participate in the designated track. These include:
Cardiologists (treating heart failure patients)
Anesthesiologists, pain management specialists, interventional pain management specialists, neurosurgeons, orthopedic surgeons, and physical medicine and rehabilitation physicians (treating low back pain patients)
CMS determines ASM eligibility for each unique TIN-NPI combination. If CMS selects a provider (NPI) under a specific organization’s TIN, participation is mandatory for that TIN-NPI combination.
The same provider (NPI) may work for another organization (another TIN) and have different MIPS eligibility there.
Why is ASM different from traditional MIPS?
ASM uses the same four performance areas as MIPS and a 100-point maximum score. But there are 3 important differences that participating providers and organizations must make a careful note of:
1. Quality and Cost scored at an individual level
For providers belonging to organizations with 16+ NPIs (large groups), Quality data must be reported at the individual level (unique TIN-NPI combination). CMS will also calculate Cost performance at the individual level.
This means Quality and Cost performance will need to be monitored for each ASM participant. Group performance would be irrelevant.
2. Two Improvement Activities specified
ASM requires participants to complete two Improvement Activities focused on care coordination:
Connect patients to primary care and complete health-related social needs screening
Establish communication and collaboration expectations with primary care through Collaborative Care Arrangements
These activities require workflows and documentation throughout the performance year. They cannot be left unaddressed till submission.
3. No exceptions for Promoting Interoperability (PI)
As CMS hand-picked the ASM participants, they are not eligible for any PI exemption or hardship exceptions. They must complete all the PI requirements focused on collaborating with primary care and health information exchange.
To summarize, ASM participants' performance will need close monitoring and management at the individual level throughout the year, with a focus on outcomes and utilization.
What should organizations prepare for ASM?
ASM performance is measured throughout the year. Once 2027 begins, gaps in data, care coordination, and utilization can already affect performance. Preparing now gives your organization time to identify those gaps, make necessary changes, and track performance from the start.
6 steps to get ready for ASM in 2027
Confirm who is participating: Verify the TIN-NPI combinations from the CMS participant list and confirm the ASM model.
Understand the payment impact: Estimate the Medicare Part B billing for ASM participants to understand the -9% payment adjustment impact. Also consider the cost of tracking and reporting for ASM.
Check EHR readiness and workflows: Make sure your EHR can support ASM data, reporting, and interoperability requirements. Address any gaps before 2027.
Review care coordination: Make sure participating specialists can complete and document the required Improvement Activities with primary care providers.
Check Promoting Interoperability: Confirm that participating practices can meet the Promoting Interoperability and electronic data-sharing requirements.
Track performance throughout the year: Make sure you can identify performance gaps while there is still time to address them.
Get ASM-ready with MyMipsScore
Preparing for ASM means knowing which specialists are participating, tracking their performance, and addressing gaps throughout the year. MyMipsScore brings this work together in one place.
With Darena Health’s MyMipsScore, provider organizations can:
Monitor participating specialists
Track performance throughout the year
Identify performance gaps
Submit ASM data to CMS via Qualified Registry
ASM details awaiting finalization
CMS has not yet finalized the ASM measures, scoring details and weights for all performance categories, a minimum performance threshold, or payment adjustments for a given score.
We will share an update soon after these details are available.
Stay tuned!
Note: CMS may change or update the ASM specifics in the 2027 PFS Final Rule. Prepare for ASM before 2027
If your organization has providers participating in ASM, we can help you understand what you need to prepare and how MyMipsScore can support you.
