Healthcare Groups Urge Delay of Medicare Specialty Model Launch

By Jessica Parker 29/10/2026 2 min read 21 views

Several healthcare groups are urging the Center for Medicare & Medicaid Innovation (CMMI) to delay the rollout of its Ambulatory Specialty Model (ASM), a new value-based care initiative set to launch in 2027. The model, which targets specialists treating Original Medicare patients with heart failure or low back pain in outpatient settings, faces operational and technical challenges, according to an open letter from stakeholders. Notably, the ASM represents a significant shift in CMS’s strategy, as it moves beyond hospital-based payments to focus on ambulatory settings, marking the first concerted effort to involve specialists in alternative payment models outside of oncology and kidney care.

Stakeholders Voice Concerns Over ASM Rollout

Organizations including the American Hospital Association, American Medical Association, AMGA, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, and Premier Inc. have raised concerns about the ASM’s readiness. They cite issues such as delayed access to the ASM portal, difficulties in logging in or delegating authority, and a lack of timely support from experts. These challenges, they argue, could divert resources and undermine the model’s early performance. The letter highlights that participants have also faced delays in receiving the final participant list, further complicating their preparation efforts.

The letter emphasizes the financial risk participants face under the ASM, which uses a two-sided risk arrangement. Stakeholders request that if the January 1, 2027, start date is maintained, participants should be shielded from downside financial risk during the initial period. They also seek advance notice of performance thresholds and alignment of quality measure reporting with other CMS programs. Additionally, they advocate for practice-level reporting of quality measures to minimize participant burden and ensure consistency across CMS models.

Potential Impact on Medicare Beneficiaries

Miller, CEO of the Center for Healthcare Quality and Payment Reform (CHQPR), stated that over 5,500 specialists may be forced to participate. The model’s design, he noted, could lead to payment cuts of up to 9% for providers, even if they deliver high-quality care. This could incentivize specialists to limit services to affected patients, potentially leaving tens of thousands without needed care. Miller further explained that CMS’s design intentionally penalizes the majority of physicians, creating a disincentive to treat Medicare beneficiaries with these conditions.

In December 2025, Healthcare Innovation interviewed David Pittman, M.P.H., a former NAACOS executive and founder of Pittman Policy Strategies, about the significance of this new model. Pittman noted that the ASM’s two-sided risk arrangement could create competition among specialists in the same field, describing it as “MIPS on steroids.” He emphasized that while CMS has previously attempted to engage specialists through hospital-based payments, the ASM marks a novel approach by targeting ambulatory settings. However, the model’s complexity and potential risks have sparked debate over its readiness and impact on both providers and patients.