CMS Policy · Heart Failure · Value-Based Care
ASM
Heart Failure
CMS Innovation Center
The Ambulatory Specialty Model (ASM), introduced by the Centers for Medicare & Medicaid Services (CMS) through its Center for Medicare and Medicaid Innovation, is a specialty payment model that begins on January 1, 2027. It affects selected outpatient specialists who treat Original Medicare patients with heart failure or low back pain.
For heart failure, ASM is mandatory in selected regions for physicians who commonly treat these patients in outpatient settings. Unlike traditional fee-for-service payment, ASM links specialty payment adjustments to quality performance and total cost of care across an attributed patient population.
For heart failure practices, that shift makes consistent monitoring, documentation, and care coordination central to how they are paid.
How the Model Unfolds
ASM is a mandatory CMS Innovation Center alternative payment model, authorized under Section 1115A of the Social Security Act. It covers congestive heart failure and low back pain, two areas of high Original Medicare spending. The timeline runs in three phases.
2024–2025 Selection CMS uses historical claims data to choose regions and clinicians. | 2027–2031 Performance Five performance years, measured on quality and total cost of care. | 2029–2033 Payment Adjustments applied to Part B claims, two years after each performance year. |
Two-Sided Risk
Adjustments apply to future Medicare Part B claims and can be positive, neutral, or negative. The size of the adjustment grows across the model’s performance years.
Why Only Selected Specialists Are Included
ASM is not a nationwide program. CMS selects specific geographic regions, roughly one-quarter of core-based statistical areas, and identifies participating specialists using historical Medicare claims data rather than voluntary enrollment.
For the heart failure cohort, participants are physicians who specialize in general cardiology and who have historically treated at least 20 qualifying episodes per year under CMS’s episode-based cost methodology. Cardiologists in designated regions who meet these criteria are included automatically, with no opt-out.
How Performance Is Measured Under ASM
Participants are scored across four categories, using the Merit-based Incentive Payment System (MIPS) Value Pathways (MVP) framework.
Quality Clinical outcomes, such as blood pressure control in heart failure or functional status for low back pain. | Cost Total cost of care, with attention to avoidable and unnecessary services. |
Improvement Activities Care processes, patient engagement, and screening for health-related social needs. | Promoting Interoperability Use of certified EHR technology (CEHRT) for electronic communication and data sharing. |
What the Evidence Says About Monitoring in Heart Failure
Heart failure instability often develops between scheduled visits, while a model like ASM assesses performance over time. Two studies help explain why that gap matters, and why monitoring alone is not enough.
Signal builds early ~30 days In a Circulation study, patients later hospitalized began gaining weight about 30 days before admission, with sharper gains in the final week. Greater weight increases meant higher odds of hospitalization. | Data alone is not enough ~52% vs 52% A large NEJM trial found a telephone-based telemonitoring system did not reduce readmission or death versus usual care. The rate was roughly equal in both groups. |
Key Point
The two studies point in the same direction: risk often builds between visits, but data alone does not change outcomes. Monitoring matters when it is connected to a clinical response and built into coordinated workflows that support timely decisions.
Where Remote Patient Monitoring Fits the Model
CMS does not require Remote Patient Monitoring (RPM) for ASM participation. Still, RPM for heart failure supports several priorities built into the model: consistent physiologic documentation, greater visibility into blood pressure and weight trends, earlier outpatient response, and structured escalation workflows.
CMS recognizes RPM separately in the Medicare Physician Fee Schedule under Current Procedural Terminology (CPT) codes such as 99453 for setup and patient education, 99454 for device supply, and 99457 for treatment management. These codes establish RPM as a recognized care-delivery pathway when clinically appropriate.
In a model focused on upstream chronic disease management, RPM fits operationally with the goal of monitoring patients over time. RPM is for monitoring only and does not replace in-person clinical evaluation or emergency care.
Reducing Avoidable Hospitalizations and Total Cost of Care
Hospital care is a substantial share of heart-failure-related Medicare spending, which is part of why CMS selected the condition. Under ASM, avoidable admissions influence both quality metrics and total cost of care benchmarks.
Reviewing physiologic indicators such as blood pressure, weight, oxygen saturation, and symptom changes can support a timely outpatient response when clinically indicated. The model evaluates outcomes; it does not dictate the devices a practice uses to reach them.
How DrKumo Supports Heart Failure Practices Preparing for ASM
DrKumo provides secure, HIPAA-compliant remote patient monitoring built for structured chronic disease management. Through medical devices as defined by the FDA and encrypted data transmission, the platform supports capture of blood pressure, weight, oxygen saturation, and symptom data, which supports documentation and monitoring over time across the care continuum.
For heart failure practices in regions affected by ASM, DrKumo supports defined monitoring workflows, escalation protocols tied to clinical oversight, coordination between specialists and primary care providers, and secure data management consistent with HIPAA. For teams building a comprehensive remote patient monitoring program, the platform is designed to fit existing clinical workflows rather than replace clinical judgment.
DrKumo is not a clinical entity and does not provide clinical services. Providers retain full clinical responsibility for patient care decisions.
Key Takeaways
The Ambulatory Specialty Model is a geographically targeted, mandatory specialty payment model that begins in 2027 and runs through 2031. Participation is claims-based and region-specific, and it applies two-sided risk to future Medicare Part B payments.
CMS does not require RPM. The model does emphasize upstream chronic disease management and reducing avoidable hospitalizations, and RPM supports those priorities through consistent documentation and earlier outpatient response when clinically appropriate.
Practices in designated regions should review their monitoring and documentation infrastructure well before the first performance year. DrKumo provides the technology and is not a clinical entity; licensed providers retain responsibility for all clinical decisions.
Prepare for 2027
Get your heart failure monitoring ready for the ASM.
To learn how DrKumo supports secure, HIPAA-compliant remote patient monitoring for heart failure practices preparing for the Ambulatory Specialty Model, contact us today. Our team is ready to support your journey toward better patient care.
Frequently Asked Questions
What is the CMS Ambulatory Specialty Model for heart failure specialists?
Is the Ambulatory Specialty Model mandatory for cardiologists in 2027?
How does the Ambulatory Specialty Model affect Medicare reimbursement?
How can heart failure specialists reduce avoidable hospitalizations under ASM?
Does remote patient monitoring help under the Ambulatory Specialty Model?
References
Centers for Medicare & Medicaid Services. Ambulatory Specialty Model (ASM) Fact Sheet. CMS.gov.
Centers for Medicare & Medicaid Services. CMS Innovation Center Overview. CMS.gov.
Chaudhry, S. I., et al. (2007). Patterns of Weight Change Preceding Hospitalization for Heart Failure. Circulation.
Chaudhry, S. I., et al. (2010). Telemonitoring in Patients with Heart Failure. New England Journal of Medicine.
Disclaimer: This article is intended for informational purposes only and does not constitute medical, legal, or billing advice. Model rules, timelines, and reimbursement details are set by CMS and are subject to change. Providers should consult official CMS guidance and their Medicare Administrative Contractor for current information. References to CMS and the FDA do not imply endorsement.
