What Is the Ambulatory Specialty Model (ASM) And How Will It Affect Specialists?
What Is the Ambulatory Specialty Model (ASM) And How Will It Affect Specialists?
Starting January 1, 2027, many ambulatory specialists will transition into a new Medicare quality program called the Ambulatory Specialty Model (ASM). This model is separate from traditional MIPS and represents the next evolution of how Medicare measures and rewards quality care for specialists.
From MIPS to ASM: What’s Changing?
For years, specialists have reported under MIPS, where clinicians could pick from a menu of measures that sometimes only loosely matched their day‑to‑day work. ASM changes that. You can think of the progression this way:
Phase 1: MIPS - broad, flexible menu of measures.
Phase 2: MVPs - more specialty‑aligned “mini‑bundles” of measures.
Phase 3: ASM - a fully specialty‑focused model with fixed, clinically relevant measures.
Under ASM, clinicians are grouped into specialty cohorts. One early example is a Low Back Pain cohort for ambulatory spine, pain, rehab, and musculoskeletal specialists who see a high volume of low back pain patients.
Who Is Affected and How Selection Works
ASM participation is mandatory for clinicians and practices that CMS assigns to a given cohort:
Eligible ambulatory specialists are randomly selected based on geography, specialty, and the conditions they treat (for example, those heavily involved in low back pain care).
Once assigned, these clinicians are moved out of traditional MIPS for the model performance period. ASM replaces their usual MIPS reporting starting January 1, 2027, and runs through 2031 for that model cohort.
This means affected specialists cannot “opt out” of ASM or fall back to traditional MIPS once selected.
Important: Watch for CMS Notifications Now
Even though ASM does not begin until 2027, CMS has already started identifying participants and sending outreach:
Clinicians and practices should closely monitor letters, emails, and portal notifications from CMS regardin ASM participation.
When notified, it is critical that clinicians respond and complete their individual contact forms so CMS has accurate contact information for the practice and for each participating clinician.
Completing these forms ensures you will receive all official ASM communications, including detailed participation materials, timelines, and technical instructions.
CMS has also released a preliminary list of ASM participants, allowing practices to verify their inclusion and confirm that their contact information is up to date.
Fixed, Condition‑Focused Measures Instead of Menus
In MIPS, clinicians can choose from a menu of measures. In ASM, CMS defines a fixed measure set tailored to each specialty or condition cohort. For a Low Back Pain cohort, that would include measures like:
Patient pain improvement scores (for example, PROMIS‑type instruments).
Avoidance of unnecessary early imaging.
Improvements in physical function and daily activities.
These measures are strongly tied to real clinical outcomes rather than generic process checks.
Bigger Financial Stakes
ASM comes with a wider performance swing:
Payment adjustments range from ‑9% to +9%, based on quality and cost performance.
Results are tied to actual patient outcomes and cost, not just documentation or reporting completeness.
For affected specialists, this makes performance management more consequential than under many current MIPS configurations.
PROMs Become Central to Getting Paid
A defining feature of ASM is the central role of patient‑reported outcome measures (PROMs):
Patients in the relevant cohort (e.g., those treated for low back pain) will be asked to report their pain levels and functional status at baseline and at follow‑up visits. These PROMs feed directly into the ASM scoring methodology, meaning that documented patient improvement can materially influence Medicare payment adjustments.
Specialists in ASM cohorts will need robust workflows to consistently collect PROMs and use that information in clinical decision‑making.
Electronic‑Only Reporting (FHIR and Registries)
ASM also raises expectations for health IT:
All reporting must be electronic, using:
FHIR‑based connections from certified EHRs, or
Certified clinical data registries capable of handling ASM data.
Claims‑based reporting is not an option under ASM.
Practices affected by ASM will need:
EHR and registry partners that can support FHIR‑based data exchange for the model.
Structured documentation for assessments, treatments, outcomes, and PROMs.
Minimal manual workarounds, since data completeness and quality will be critical.
What Specialists Should Be Doing Now
For ambulatory specialists who are likely candidates for ASM cohorts (such as those focused on musculoskeletal, pain, or spine care), the priorities include:
Clinical alignment
Standardize care pathways and avoid low‑value services (for example, early imaging without red flags).
Ensure local practice patterns match evidence‑based guidelines likely embedded in ASM measures.
Patient‑reported outcomes infrastructure
Implement tools to capture PROMs via portals, tablets, or secure messaging.
Train staff to explain why these surveys matter and how they influence care and payment.
Technology readiness
Confirm that EHR and registry vendors support the necessary FHIR capabilities and ASM data requirements.
Map current documentation to the data elements that ASM will require.
