‘Like MIPS on Steroids’: What Practices Can Expect From Ambulatory Specialty Model

Healthcare Innovation December 9, 2025
David Raths

Consultant David Pittman, M.P.H., outlines which aspects of CMS’ mandatory two-sided risk model will be most challenging for practices

Key Highlights

• The Ambulatory Specialty Model will start in 2027, targeting specialists treating Medicare patients with heart failure and low back pain in outpatient settings.
• Participation involves a two-sided risk arrangement, with performance-based payment adjustments and reporting of patient-reported outcomes.
• The model aims to foster competition among specialists and strengthen relationships with primary care providers for better chronic disease management.

The CMS Innovation Center’s Ambulatory Specialty Model (ASM), which represents a new approach to engaging specialists in value-based care, will begin in 2027 for selected specialists who treat people with Original Medicare for heart failure or low back pain...

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