Ambulatory Specialty Model For Heart Failure

As part of its broader strategy to expand specialty participation in value-based care, the Centers for Medicare and Medicaid Services (CMS) has finalized a mandatory five-year Ambulatory Specialty Model (ASM) for heart failure (HF).

The model is designed to test whether episode-based accountability for chronic conditions like HF can improve outcomes and reduce total cost of care, aligning with MIPS Value Pathways and building on prior specialty-focused efforts.

Cardiovascular clinicians can find information regarding ACC's advocacy efforts to address ASM requirements, including details on the model's development, below. The ACC sees value-based care models as an opportunity to improve quality and access while reducing costs and will continue to advocate for proposals that achieve these goals.

Who Will Be Included in the ASM?

The model will hold cardiologists who historically treated at least 20 original Medicare beneficiaries with HF - and who practice within selected core-based statistical areas or metropolitan divisions - financially accountable for the management of chronic congestive HF.

The model limits participants to Medicare Provider Enrollment Chain and Ownership System-enrolled cardiologists while excluding cardiovascular specialties like interventional cardiology, electrophysiology, advanced HF and transplant.

CMS anticipates releasing the selected geographic areas and an initial list of preliminary participants in late 2025.

How Will Clinicians be Evaluated?

Similar to the current MIPS structure, CMS will evaluate participating clinicians in four performance categories: cost, quality, improvement activities and improving interoperability. Evaluation will occur over 12-month performance periods with payment adjustments based on risk-adjusted spending for attributed patients.

When Will This Model be Implemented?

ASM implementation is scheduled to begin on Jan. 1, 2027. The model will conclude Dec. 31, 2031. See the timeline below for more details:

  • November 2025: CMS finalized the proposed model as part of the 2026 Medicare Physician Fee Schedule final rule.
  • December 2025: CMS releases selected geographic areas and preliminary list of ASM participants.
  • July 2026: Final participant list is announced.
  • January 2027: ASM Year 1 begins.

ACC's Advocacy Efforts

The ACC submitted formal comments to CMS outlining numerous concerns with the proposed specialty model such as:

  • The individual-level focus and lack of team-based care principles.
  • Issues with the patient attribution framework.
  • Several operational and design flaws that could limit effectiveness.

Read the ACC's comment letter.

Additional Resources