The New CMS ASM Model Is Bringing Physician-Level Outcomes Accountability to Spine and Cardiology

Here’s what spine and cardiology providers need to know about PROMs, Quality ID 377 and future Medicare reimbursement changes beginning in 2027.

Beginning in 2027, the CMS Ambulatory Specialty Model (ASM) will require certain specialists to participate in a CMS value-based reimbursement model tied to physician-level performance across quality, cost, interoperability and patient-reported outcomes. The model increases accountability for longitudinal care management, functional outcomes tracking and PROM collection.

The ASM is a CMS Innovation Center payment model that was finalized in the CY2026 Physician Fee Schedule Final Rule. It applies to certain specialists treating Medicare fee-for-service patients with heart failure and low back pain. Unlike many value-based programs, physicians are scored individually rather than at the practice level.

How ASM Impacts Participating Specialists

Participation in ASM is expected to be mandatory for qualifying clinicians practicing within CMS-selected CBSAs, representing approximately 25% of CBSAs nationally. CMS has not provided an opt-out or hardship exemption pathway for eligible participants. To qualify, clinicians must have historically treated at least 20 Original Medicare episodes related to the applicable condition during the CMS lookback period.

Specialties, listed on CMS, impacted under the model include:

Heart Failure

• Cardiology

Low Back Pain

• Orthopedic surgery
• Neurosurgery
• Pain management
• Interventional pain management
• Anesthesiology
• PM&R (Physical Medicine & Rehabilitation)

Physicians are scored primarily at the individual clinician (TIN/NPI) level. CMS does allow certain small practices to report quality data at the group (TIN) level, but cost performance and payment adjustments remain tied to the individual physician.

Payment adjustments under ASM range from −9% to +9% during the first two payment years and −12% to +12% during years three through five. Physician performance is evaluated relative to peers across quality, cost, interoperability and improvement activities using a framework built on the MIPS MVP structure. Performance beginning in 2027 will drive the first Medicare payment adjustments applied in 2029.

ASM Timeline Snapshot:

Milestone	Date
Performance Year 1 begins	January 1, 2027
Performance Year 5 ends	December 31, 2031
Payment Year 1 (first $ adjustment applied)	January 1, 2029
Payment Year 5 ends	December 31, 2033
Final CY27 participant list + selected geographies published	July 2026

In addition to increased accountability for functional outcomes and longitudinal patient follow-up, CMS also expects participating organizations to support collaborative care arrangements that include provider data sharing, coordinated transitions of care, referral communication and integrated approaches to outcomes tracking and care management. For spine and cardiology providers, this likely means greater operational focus on PROM collection, patient engagement and longitudinal tracking.

Importantly, ASM payment adjustments are not limited to heart failure or low back pain visits. Physician performance can affect Medicare Part B reimbursement across a clinician’s broader covered professional services.

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What Does the Workflow Look Like?

For low back pain providers participating in ASM-related quality reporting, functional status collection is not simply a one-time patient survey. It requires coordinated workflows across scheduling, intake, clinical staff, follow-up and discharge management throughout the episode of care.

In most practices, organizations will need workflows to:

• Distribute baseline assessments prior to or during the initial visit
• Ensure patients complete intake assessments before the clinical encounter
• Track progress throughout the episode of care
• Capture discharge assessments at the appropriate time
• Re-engage patients who miss visits or leave care early
• Document exceptions and maintain reporting-ready records for MIPS submission

ASM also includes a depression screening and follow-up measure for low back pain providers. Patients must be screened within 14 days of the visit using an approved screening tool, and positive screenings require a documented follow-up action plan.

Operational Workflows Required to Support PROM Collection

Organizations typically rely on a combination of pre-visit outreach, in-clinic collection and hybrid follow-up workflows to support PROM completion across the episode of care.

Operationally, this often requires patient outreach, front-desk coordination, clinician engagement, follow-up management and ongoing monitoring to ensure assessments are completed within required reporting windows. Practices must also maintain accurate documentation tied to each episode of care, including assessment dates, functional status scores and predicted improvement benchmarks used to calculate performance under the measure.

While the quality measure itself may appear straightforward on paper, sustaining consistent collection and follow-up across real-world patient populations can quickly become resource-intensive without dedicated workflows and operational support.

Preparing for Physician-Level Outcomes Measurement

For spine providers especially, ASM could significantly increase focus on functional outcomes collection and physician-level performance measurement. For both spine and cardiology organizations, now is likely the time to evaluate PROM workflows, follow-up processes, documentation practices and operational readiness as CMS continues expanding specialty-specific reimbursement tied to patient-reported outcomes.

As CMS expands physician-level reimbursement accountability tied to PROMs and longitudinal outcomes tracking, spine and cardiology organizations may need more scalable operational approaches to patient follow-up and quality measurement.