With the mandatory Ambulatory Specialty Model (ASM) for Heart Failure (HF) slated to begin Jan. 1, 2027, the ACC is prioritizing member awareness and education, while pressing the Centers for Medicare and Medicaid Services (CMS) to address key issues with the model's design and requirements.

ACC's primary concerns regarding the current model include:

• Focusing on the cardiologist as an individual, contrary to the ACC-endorsed standard of the team-based approach to HF treatment.
• Adding administrative and reporting burden.
• Failing to account for specialist and workforce distribution.
• Lacking timely and actionable data for clinicians to improve patient care and outcomes.
• Creating a win-lose-draw structure for all participants.
• Requiring an HF episode cost measure new to MIPS reporting and lacking data transparency for the intended ASM usage.

In response, the College has made the following recommendations to CMS in meetings with agency staff and through formal written comments:

• Limit ASM downside and upside risk at +/–2% using a phased-in approach tied to the model's stability and participant readiness.
• Require at least one dedicated educational and testing year before financial accountability begins.
• Provide participants with actionable, near-real-time cost and quality data to support timely clinical decision-making.
• Replace individual-clinician attribution with a team-based methodology that reflects the multidisciplinary nature of HF care.
• Establish a built-in goal score based on guideline-directed clinical care that protects participants achieving meaningful improvement from financial penalties.
• Incorporate risk-adjustment for clinical complexity, comorbidities and social determinants of health.

Looking for more information on how to prepare for the ASM for HF? Access ACC resources developed by ACC’s Payer and Care Delivery Policy Team.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Centers for Medicare and Medicaid Services, U.S., ACC Advocacy, Heart Failure, Cardiologists, Costs and Cost Analysis, Decision Making, Workforce, Patient Care, Policy