ASM (Ambulatory Specialty Model)

ASM (Ambulatory Specialty Model)

Notice:
ASM (Ambulatory Specialty Model) Comment Period Opens

ASM was proposed in the 2026 Physician Fee Schedule (PFS) Notice of Proposed Rulemaking on July 14, 2025. Comments are due by 5 p.m. on September 12, 2025.

The proposed Ambulatory Specialty Model (ASM) aims to improve prevention and upstream management of chronic disease, which would lead to reductions in avoidable hospitalizations and unnecessary procedures. Participation in ASM would be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in an outpatient setting across selected regions. ASM would begin on January 1, 2027 and run for five performance years through December 31, 2031.

Key Points
  • Problem: Delayed detection of chronic conditions, financial incentives that encourage unnecessary procedures, and the lack of care coordination among specialists and primary care providers all contribute to poor health outcomes for people who are at risk for or living with chronic disease. These include delayed diagnosis and poor disease management.
  • Solution: ASM would promote preventive care and more effective upstream chronic disease management by rewarding specialists for improving patient health outcomes and coordination with primary care providers.
  • Outcomes: ASM would reduce avoidable hospitalizations and unnecessary procedures, improve patient experience and outcomes, and lower costs to Original Medicare.
  • Strategy: ASM would help to Make America Healthy Again by promoting preventive care through interventions like screening, increasing transparency by making provider performance assessments more widely available, and protecting American taxpayers by holding specialists accountable for the cost of care.


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Model Summary

Stage: Announced
Number of Participants: N/A
Category: Disease-Specific & Episode-Based Models
Authority: Section 1115A of the Social Security Act

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Page Last Modified:
07/25/2025 02:14 PM