CMS Proposes Mandatory Alternative Payment Model for Heart Failure
The Center for Medicare and Medicaid Innovation (CMMI) is planning a mandatory alternative payment model, called the Ambulatory Specialty Model or ASM, applicable to specialists who care for traditional Medicare beneficiaries with either heart failure or low-back pain. Under this model, any specialist who has historically treated at least 20 heart failure or low back episodes per year and practices in the designated geographic area—to be determined—will be included. The payment proposed is "two-sided risk," meaning the clinician could earn a higher, neutral, or lower rate based on comparison to their peers. The participating cardiologists and other specialists are expected to be announced by the end of 2025, and the model would begin in calendar year 2027, running for five years. While palliative care is not explicitly included in this model, participating specialists are encouraged to form Collaborative Care Arrangements with other clinicians.