Setting your practice up for long-term clinical and operational success starts with getting comfortable with the ASM.
Understanding the ASM mandate
What is the ASM?
On January 1, 2027, the Centers for Medicare & Medicaid Services (CMS) will launch the Ambulatory Specialty Model (ASM). This mandatory, five-year payment model evaluates how specialty care coordination and upstream chronic disease management can improve patient outcomes while lowering overall care costs.
In its initial phase, the ASM focuses on two high-expenditure clinical areas and their corresponding specialties:
- Heart failure (HF) – Cardiology
- Low back pain – Anesthesiology, Pain Medicine, Interventional Pain Management, Orthopedic Surgery, Neurosurgery, and Physical Medicine & Rehabilitation (PM&R)
Who is impacted by the ASM?
While ASM represents a broader shift toward specialty value-based care, participation in the initial rollout is targeted. Mandatory participation is limited to eligible specialists in chosen Core-Based Statistical Areas (CBSAs)—covering roughly 25 percent of regions nationwide—who manage 20 or more qualifying annual patient episodes within these target tracks.
Even if none of your organization's specialists are mandated during this first wave, studying the model offers essential insight into how CMS plans to restructure specialty care reimbursement across Medicare Part B.
How does the ASM work?
Under the ASM, participating specialists will receive positive, neutral, or negative payment adjustments on future Medicare Part B claims based on their performance relative to their peers.
The model simplifies reporting by focusing on four tailored performance categories specific to specialty care:
- Quality – Tracking targeted clinical measures, specifically blood pressure control and guideline-directed medical therapy (GDMT) titration for HF patients
- Cost – Measuring episode-based costs, with an emphasis on reducing unnecessary utilization and avoidable hospitalizations
- Improvement activities – Encouraging active screening for health-related social needs (HRSN) and formal care coordination between specialists and primary care providers
- Improving interoperability – Leveraging EHR system integration to facilitate seamless, secure data sharing across the care continuum
By understanding these categories early, clinics gain a clear, multi-year runway to refine clinical workflows, align care teams, and establish reproducible care pathways.
From episodic care to continuous management
"The ASM model is really taking episodic care and making it more of longitudinal care. So, we need to figure out a method… where we can be involved even during the interim when we are not physically seeing [patients]."
Sunthosh V. Parvathaneni, MD, FACC, FHRS
Regional Section Lead, Clinical Cardiac Electrophysiology, Mercy Central Communities & Asst. Professor, Univ. of Missouri/Mercy Hospital Springfield
Chronic cardiovascular conditions—particularly HF—represent some of the most complex and resource-intensive areas in healthcare, with HF care alone accounting for an estimated $10 to $13 billion in annual Medicare spending.
Historically, fee-for-service reimbursement incentivized discrete, in-office encounters, leaving a dangerous blind spot in the critical space between visits. Subtle warning signs—such as changes in blood pressure or sudden weight gain—frequently signal deterioration long before an acute crisis occurs.
This is where remote patient monitoring (RPM) and strong data infrastructure become essential. RPM shifts cardiology from reactive, visit-based care to continuous monitoring, capturing physiological trends in real time. But collecting data is only half the battle—the core challenge for modern clinical teams is transforming those daily metrics into timely, actionable insights before an acute event happens.
The ASM signals a new operating reality built specifically to address this gap. Rather than rewarding visit volume, the ASM aligns financial incentives with proactive, continuous care. By coupling continuous RPM with structured primary care-specialist collaboration, health systems can bridge the space between office visits, stabilizing cardiovascular patients in the outpatient setting, preventing acute crises, and thriving under modern value-based payment structures.
What the ASM means for cardiology practices
Modernization can’t wait
The shift under the ASM is not just a regulatory adjustment; it fundamentally redefines operational success for cardiology clinics. For years, many practices have managed remote data reactively through informal workflows—such as reviewing manufacturer portals ad hoc or manually uploading PDFs. Under the mandatory 2027 ASM framework, informal monitoring becomes a direct clinical and financial liability.
Protecting practice margins against performance adjustments
Because future Medicare Part B reimbursements are tied directly to quality and cost metrics relative to peers, unorganized data workflows directly erode practice revenue. Standardizing remote monitoring infrastructure helps clinical teams document patient progress, protect margins against negative adjustments, and capture value-based upside.
Eliminating clinician data fatigue
Managing incoming transmissions across disparate vendor portals creates a massive signal-to-noise problem. Modernizing infrastructure replaces raw data dumps with exception-based triage—filtering out routine checks and surfacing only high-risk trends that require immediate intervention.
Getting cardiology ready for the ASM
"The winning move for us as cardiologists is not new. I really believe that we should take the playbook from our pacemaker clinics and really introduce that into our heart failure clinics. The ability to monitor thoracic impedance, blood pressure, weights—all the RPM values should really come in through that clinic."
Kenneth Civello, MD, MPH, FACC
Electrophysiologist, Louisiana Cardiology, FMOL Health
Succeeding under the ASM requires cardiology practices to proactively manage high-risk patients long before acute crises occur. To help clinics navigate these mandatory CMS changes, clinical and operational leaders joined a panel discussion webinar co-hosted by Murj® and Becker’s Healthcare to share practical strategies for building scalable, ASM-ready RPM workflows.
Here are four key insights shared during the session:
- Repurposing proven blueprints for HF care – Rather than building HF remote monitoring from scratch, cardiology practices can adapt the nurse-led, protocol-driven workflows of established pacemaker clinics to manage HF metrics like blood pressure, weight, and other physiologic data.
- Overcoming "alarm fatigue" through smart filtering – High daily alert volumes quickly cause clinician burnout. Integrating AI-enabled filters and exception-based triage protocols ensure care teams review only high-risk, actionable trends rather than getting bogged down by raw device alerts.
- Empowering care teams to work at the top of their license – Expanding patient capacity requires leveraging multidisciplinary teams—including nurse practitioners, clinic nurses, and PharmDs—to handle routine medication titrations under standardized protocols.
- Establishing outpatient safety nets – Setting up rapid-access transition clinics and virtual fluid management clinics provides intermediate care between routine visits, keeping vulnerable post-discharge patients stabilized and preventing emergency readmissions.
Watch the full Murj & Becker's webinar to gain detailed operational blueprints for preparing your cardiology practice for ASM.
Moving beyond informal monitoring
“Where we were looking at episodic care, now we're looking at the entire continuum. Before, we were making sure that transitions of care from hospital to home were taken care of. Now, we're pulling that time period in between [routine clinic visits]. So, that requires close navigation.”
Vicki Miller, DNP, RN, CPHQ
Director, System Advanced Heart Failure, Lee Health
Under mandatory ASM regulations, RPM is no longer just a standalone billing activity—it serves as an essential clinical engine for ASM performance. Relying on manual portal checks or informal workflows threatens performance revenue and long-term practice stability.
To thrive under shifting CMS guidelines, practices require purpose-built tools designed for modern cardiac data demands. Specialized platforms like Murj provide the vendor-neutral consolidation, exception-based triage, and bidirectional EHR integration necessary to convert fragmented device transmissions into actionable clinical insights and better patient care.
