For a decade, cardiology’s exposure to value-based payment has run largely through the Merit-based Incentive Payment System, or MIPS — a program that scores group practices and moves payments modestly. The next model raises the stakes. On Jan. 1, 2027, CMS will launch the Ambulatory Specialty Model (ASM), a mandatory payment model that ties a general cardiologist’s Medicare payments to how well heart failure is managed, including in the long stretches between office visits.
During a webinar hosted by Becker’s Healthcare and sponsored by Murj®, a panel of cardiovascular leaders laid out a practical roadmap for navigating the transition. The discussion was moderated by Kenneth Civello, MD, MPH, FACC, an electrophysiologist with Louisiana Cardiology at FMOL Health (Baton Rouge, La.). The panelists were:
- Vicki Miller, DNP, RN, CPHQ, Director, System Advanced Heart Failure, Lee Health (Fort Myers, Fla.)
- Sunthosh V. Parvathaneni, MD, FACC, FHRS, Regional Section Lead, Clinical Cardiac Electrophysiology, Mercy Central Communities & Asst. Professor, Univ. of Missouri/Mercy Hospital Springfield (Springfield, Mo.)
- Roy Davis, Group Director, Operations, Medical Cardiovascular, Mercy Health (Cincinnati)
Below are four takeaways from their conversation.
Note: Quotes have been edited lightly for length and clarity.
1. The ASM is mandatory — and personal
General cardiology practices in selected regions will be enrolled automatically in the ASM, based on historical volume — generally those managing more than 20 Medicare heart failure episodes a year — with roughly 8,600 physicians expected to fall under the model. Where MIPS evaluates the group, the ASM names the individual physician and puts far more on the line: as much as 9% (plus or minus) in incentives in the early years, rising to 12% in the final year and applied to a physician’s entire Medicare Part B payment.
“As a physician, it’s personal, because you are personally named as the provider, and up to 12% of your Medicare payment really rides on it. It’s going to take community as a whole to rally behind these physicians to come up with programs that help them stay ahead,” Dr. Civello said.
2. Success now depends on the time between visits
The panel’s central theme was the shift from episodic encounters to continuous, longitudinal management. Ms. Miller described pulling the focus into the vulnerable window after discharge, building longitudinal GDMT titration clinics close to patients’ homes rather than relying on a single post-discharge touchpoint.
Dr. Parvathaneni’s group runs a nurse-practitioner-led fluid management clinic that can deliver IV diuretics, order labs and titrate medications over consecutive days to avoid admissions. When the clinic is closed on weekends, patients are seen at an acute care center or ER and scheduled back into the clinic within 24 to 48 hours.
“The ASM is really taking episodic care and making it more of longitudinal care,” Dr. Parvathaneni said, noting that the interim period is often when heart failure patients decompensate.
3. The pacemaker clinic is the playbook
Dr. Civello returned repeatedly to a model cardiology has run for two decades: the device clinic, with its scheduled transmissions, nurse-led triage and escalation protocols. When a pacemaker lead fails, he noted, no one waits for the next office visit — and the same discipline can be applied to heart failure, swapping the measurement of device voltage for the measurement of fluid volume.
Mr. Davis said Mercy Health is working to mirror that collaborative device-clinic model across heart failure care, and credited its device-data partner, Murj, with producing reliable data that lets electrophysiologists make decisions in real time.
4. Team-based care and AI make it scalable
With hospital closures in some markets driving up patient volume, the panelists agreed that physician-only models can’t meet demand. Their answer is staffing at the top of license — nurse-led diuretic protocols and PharmD-run GDMT titration, which Dr. Parvathaneni’s practice offers virtually and at no charge to patients — paired with AI that surfaces meaningful trends rather than a flood of individual alerts.
Both Ms. Miller and Dr. Parvathaneni pointed to AI-enabled data integration as the way to keep pace with whatever CMS introduces next, from implanted devices to consumer wearables.
“If we’re not doing anything with that data, it’s not helping — that’s a huge gap,” Ms. Miller said, emphasizing that operational protocols, not the monitoring hardware, are what link the continuum together.
Where cardiology leaders go from here
The panel’s consensus was that the ASM is not a reporting exercise but a mandatory model that names physicians individually — and the systems that succeed will be the ones that stop treating heart failure as a series of office visits. As Dr. Civello framed it, the winning move isn’t new: cardiology has already solved between-visit monitoring in its pacemaker clinics and simply needs to extend that model to heart failure.
With the model going live Jan. 1, leaders can start by taking inventory of the CMS programs already available — principal care management, chronic care management and remote monitoring among them — and building the care-coordination staffing, EHR integration and AI-enabled data infrastructure that will outlast whatever model comes next.
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