Hundreds of cardiologists incorrectly added to new mandatory payment model
After receiving several inquiries from members about being included on the new mandatory Medicare Ambulatory Specialty Model (ASM) for heart failure, the American College of Cardiology (ACC) found that approximately 500 cardiologists were incorrectly included on the list.
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released a list of 2,600 general cardiologists who will now be required to participate in the new ASM payment model for heart failure starting Jan. 1, 2027. However, the ACC said it found the list contained a sizable number of specialists who were should not have been added, including electrophysiologists, interventional cardiologists and advanced heart failure and transplant specialists.
"Because the model is intended to include only general cardiology, these discrepancies could result in some clinicians being inappropriately included in the mandatory payment program," the ACC explained in a statement.
The ACC said it raised these concerns directly with CMS. The group is now working to better understand the source of the discrepancies and advocate for appropriate corrections.
The ACC is also urging CMS to establish a formal, transparent process for submitting and resolving specialty classification errors. In the absence of this process, cardiologists who believe they have been incorrectly included in the model are urged to take immediate action by contacting CMS at [email protected].
The final ASM participant list is expected to be released in late summer.
“What we have found out in looking at the list, there are some cardiologists that are interventional cardiologists that are on the list, that according to CMS should not be,” Samuel Jones, MD, a member of the ACC Board of Trustees, said in a recent interview with Cardiovascular Business. He said some cardiologists on the CMS list also may not be aware they are on it, which could have a serious financial impact starting in 2027.
“The payment adjustment is real. The payment adjustment could be positive, up to 9%, or graded down to negative 9% of all of your Part B claims. That’s some serious money we’re talking about here,” he explained.
Under this new ASM, physicians will be evaluated using both quality and cost measures. Jones said CMS is still finalizing the details, but several metrics have already been outlined. These include rates of unplanned hospitalizations for heart failure and whether patients with reduced ejection fraction are receiving guideline-directed therapies such as beta blockers, ACE inhibitors and related medications. The model also includes patient-reported outcome measures, something many cardiologists may not yet be prepared to track.
“Providers that are on that list need to make sure they have access to those, because you have to go get a license ahead of time," Jones said.
CMS said the new program aims to improve prevention and upstream management of high-cost chronic diseases with an initial push in heart failure and lower back pain. The new payment model is an attempt to reduce avoidable hospitalizations and unnecessary procedures. Heart failure is a major driver of Medicare expenses and currently costs the U.S. health system about $179.5 billion annually.
Participation in the ASM will be mandatory for certain specialists who commonly treat these conditions in Medicare patients in an outpatient setting. The ASM will begin on Jan. 1, 2027, and run for five performance years through Dec. 31, 2031.
View the complete list of cardiologists included on the ASM Heart Failure mandatory payment model.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]