If you've been looking for an on-ramp to value-based care, the new CMS ambulatory specialty model (ASM) is your starting point. Finalized in the CY 2026 CMS Physician Fee Schedule Final Rule, this mandatory payment model officially begins January 1, 2027.
The ASM layers performance-based adjustments on top of fee-for-service reimbursement, Depending on how your performance compares to your peers, you will see a positive, neutral, or negative adjustment in 4 key areas:
- Quality
- Cost
- Improvement activities
- Improving interoperability
These adjustments start at +/- 9% in 2027 and will scale to +/- 12% by 2031. To protect your revenue, you need to understand how the model works and how to prepare your workflows now.
An overview of the CMS ambulatory specialty model
Before you adjust your clinical workflows, here are the essential facts about the ASM rollout:
- Timeline: The CMS ambulatory specialty model will run for 5 performance years (2027 to 2031). ASM’s payment years run from January 1, 2029, through December 31, 2033.
- Clinical focus: The CMS ambulatory specialty model will focus on low back pain and congestive heart failure. CMS identified these as high-spend areas in Medicare with significant potential for cost savings.
- Goals: The CMS ambulatory specialty model aims to help you detect chronic disease early, reduce unnecessary procedures and surgeries, and improve the patient experience. To succeed, you must implement collaborative care with primary care providers, perform preventative care and social needs screenings, provide patient support for lifestyle changes, and exchange health information.
- Mandatory participation: Participation in this model will be mandatory for certain specialists in certain geographic areas:
- For heart failure, this includes physicians who specialize in general and interventional cardiology.
- For low back pain, it includes physicians who specialize in anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, or physical medicine and rehabilitation.
- The model will only include physicians who have historically treated at least 20 heart failure or lower back pain episodes per year as identified by the episode-based cost measure methodology.
“This is something that all physicians, regardless of specialty, need to pay attention to,” says Jesse P. Houghton, MD, FACG, medical director of gastroenterology at Southern Ohio Medical Center. “When starting these types of value-based initiatives, CMS always begins with certain fields or specialties, but eventually incorporates all providers. Consequently, it is best to get on board early, especially if you are in a multi-specialty group."
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7 steps to prepare for the CMS ambulatory specialty model
You have time to transition to the CMS ambulatory specialty model, but you shouldn't wait until 2027 to get started. Here are 7 steps to take throughout 2026 to prepare.
- Confirm your participation status. Do your specialty and geographic location align with ASM focus areas? Do you meet the volume thresholds? CMS plans to release an initial list of ASM participants in early 2026, with a final list coming later that year.
- Audit your current metrics. Identify ASM-relevant quality measures for your specialty. Begin auditing relevant clinical documentation now to see where you might fall short of standardizing care pathways.
- Track condition-specific outcomes. Establish a baseline for complications and outcomes for your heart failure or back pain patients. Practices that track now can proactively shape positive performance under the CMS ambulatory specialty model.
- Analyze downstream costs. Review your data for imaging, procedures, and ED visits. Reducing duplicative testing through better coordination and record access is a quick win for cost-performance scores.
- Strengthen care coordination with PCPs. Create a standardized workflow for sending timely consult notes and care plans. If your communication with primary care is currently hit-or-miss, this will hurt your performance scores.
- Screen for social determinants of health. Embed health-related social needs screening questions into your intake or annual visit workflows. You should also establish referral pathways for patients who identify needs for transportation, housing, or food security.
- Evaluate your EHR's ASM readiness. Your EHR for your specialty must do more than just document a visit. To thrive under the CMS ambulatory specialty model, your technology must enable real-time coordination with PCPs, make cost and utilization visible, and produce the defensible data you need to prove your performance to CMS. Use this resource to help jump start your assessment.
Setting your 2026 strategy for success
In 2026, your focus should be on building the infrastructure necessary for value-based care. This is the year to address gaps in your data, validate your EHR is the best tool for the job, and formalize your referral relationships.
The goal is not to focus on incentives just yet, but rather to ensure that when your performance is evaluated, you can clearly show that you are effectively managing patient care over time. Specialists who adapt early by making their costs visible and their coordination seamless will be the ones who see positive adjustments. Those who ignore the shift may find themselves blindsided by decreased payments and lower performance scores in the years to come.
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