How Should Practices Prepare for Reporting Under the Ambulatory Specialty Model?

The Ambulatory Specialty Model (ASM) is going to change how some specialists get paid. Starting in 2027, this program will look at how you treat Medicare patients with heart failure and low back pain, and your payments will be adjusted based on how you perform compared to others. It borrows from MIPS but has bigger swings in payment, meaning preparation is key. So, how should practices prepare for reporting under the Ambulatory Specialty Model?

Key Takeaways

Determine if your practice is included in the ASM by checking location and patient volume to assess urgency for preparation.
Ensure data collection is organized, aiming for 75% completeness in reporting tools similar to MIPS, due to significant financial implications.
Build relationships with primary care doctors to establish necessary care coordination arrangements, recognizing the time required for setup and documentation.
Test reporting systems before the performance year (2027) to identify and resolve any issues regarding data or processes.
Analyze financial impacts by modeling potential payment changes to effectively plan for variations in practice income.

Assess Your Readiness for Ambulatory Specialty Model Reporting

Ambulatory Specialty Model Reporting

Taking a clear look at where you stand today is the first step toward doing well under the Ambulatory Specialty Model (ASM). Knowing your participation status, how you’re performing now, and how you collect data matters more than most practices realize. There’s always a lot to juggle, but some focused time up front saves a lot of stress when things get real.

Understand Your Practice’s Participation Status

Before anything else, be sure whether ASM participation even applies to your locations. Not every specialist in a required area automatically faces payment adjustments.

Check Your Geography: Confirm if your clinicians practice within a mandatory CBSA (Core-Based Statistical Area). If a provider practices in several locations, CMS will assign them to a single CBSA based on the ZIP code of their most common service location; so focus on where the bulk of their work is actually performed, not your corporate billing address.
Check Your Volume: Count your qualifying episodes for 2025. You must hit the 20-episode minimum threshold in 2025 to officially lock in your 2027 participation.

There’s no point rushing into new requirements if you’re not sure you even qualify. A quick check now can help you decide how urgent a priority ASM is for your group. The Participant Readiness Roadmap can walk you through the main steps to figure this out.

Evaluate Current Performance Metrics

To evaluate current performance metrics, assess your current scores for some universal and widely used quality measures and create a table summarizing recent statistics for these measures such as performance and data completeness rates for: Blood Pressure Control (78%), Diabetes HbA1c (81%), and Heart Failure Readmissions (66%). If any measure falls below 75%, it indicates a warning sign. Identify problem areas, which may include documentation issues, technical difficulties, or missed steps, and document the causes of each dip for resolution.

Review Existing Data Collection Processes

Reliable reporting starts with clean, complete data.

Double-check whether your EHR captures all the fields needed for ASM. Even one missing data point can throw things off.
Ask who’s actually handling the reporting; if it’s always the same person, that’s a risk if they’re out or leave.
List out your documentation processes step by step. Does the process depend on lots of manual data collection, or is it mostly electronic?

Find any steps that regularly get skipped or go missing.
Look for areas where tech and manual processes mix; that’s often where mistakes sneak in.
If you’re using outside vendors, set up a check-in to make sure they’re ready for ASM rules and timelines.

Reviewing your practice’s readiness may take a weekend or two, but it pays off if you spot issues early, before the deadlines and penalties roll in. Most groups are closer to ready than they think, but waiting too long can turn a small gap into a big headache.

Strengthen Primary Care Collaboration for ASM Success

Building strong relationships with primary care providers is a key part of the Ambulatory Specialty Model (ASM). It’s not just about sending patients to them; it’s about working together to give patients the best care. If your practice has mostly operated independently, this might be a new area for you, but it’s definitely manageable.

Identify Key Primary Care Referral Partners

Start by looking at where your patients are coming from. Pulling your referral data can show you which primary care practices send you the most patients. It makes sense to focus your efforts on the top 3 to 5 of these practices, as they likely account for a large portion of the patients you share. This targeted approach helps you build meaningful connections where they matter most.

Establish Formal Collaborative Care Arrangements

This doesn’t have to be overly complicated. A formal arrangement can be as simple as a written memorandum of understanding between your practice and a primary care group. The important part is agreeing on specific elements that support coordinated care. For example, you might agree to:

Share patient information back and forth when important clinical events happen.
Define which patients are good candidates for co-management and how you’ll make decisions together.
Set up a clear process for referrals, where you send a summary of your findings and the primary care doctor acknowledges receiving it.

Documenting these agreements with signatures from both practice leaders shows a commitment to working together. Starting these conversations early is wise, as formalizing relationships can take more time than you might expect. You can find more details on how these arrangements are scored within the Ambulatory Specialty Model Explained.

Implement Closed-Loop Communication Workflows

Closed-loop communication in healthcare involves a structured process for sharing patient information between providers, ensuring mutual acknowledgment of referrals. This includes sending a summary back to the referring physician after a consultation and confirming receipt of referrals. Such practices foster coordinated care, fulfill specific program requirements, and enhance continuity of patient care.

Optimize Your Reporting Infrastructure for Accuracy

Preparing for the Ambulatory Specialty Model (ASM) starts with strengthening your reporting infrastructure. While ASM uses familiar MIPS reporting mechanisms, the performance and financial stakes are significantly higher. With a 75% data completeness requirement and potential payment adjustments reaching up to 12%, accuracy and reliability are no longer optional, they are essential.

Key steps to reinforce your reporting readiness:

Audit recent MIPS performance: Review prior submissions to identify where data completeness fell below thresholds and determine whether gaps stemmed from documentation issues, exclusions, or data extraction errors.
Eliminate single points of failure: Assess whether your reporting depends on manual processes or a single individual. ASM requires scalable, repeatable workflows with built-in redundancy to reduce risk.
Confirm Promoting Interoperability compliance: PI remains mandatory under ASM and is reported at the TIN level. Practices must verify use of certified EHR technology, completion of security risk analyses, e-prescribing performance, health information exchange, patient access, and public health reporting. Hardship exceptions are not available under ASM.

Running a test submission before the performance year begins can uncover issues early and prevent costly penalties later. Investing time now in reporting infrastructure helps ensure accuracy, compliance, and confidence as ASM reporting requirements take effect.

Integrate Patient-Reported Outcomes Collection

Medical Professional using Computer

Patient-reported outcomes (PROs) are a core component of performance evaluation under the Ambulatory Specialty Model (ASM). They provide direct insight into how patients experience their care and are increasingly central to how CMS assesses quality. Establishing a reliable PRO collection process early helps ensure consistency, data completeness, and readiness for reporting.

Key steps for integrating PROs into your workflow:

Use CMS-approved measurement tools: Heart failure cohorts must report using the KCCQ-12 or other approved tool according to the measure specification, while low back pain cohorts may use the Oswestry Disability Index (ODI) or other approved tool according to the measure specification. Consistent use of standardized tools is required.
Capture baseline and follow-up assessments: PROs must be collected at the start of an episode and again later to demonstrate functional change over time. Clear staff workflows are essential to ensure assessments occur at the right points in care.
Maintain data completeness: PRO measures are subject to the same 75% completeness threshold as other quality measures. Practices should identify where data collection may break down, such as scheduling, documentation, or EHR extraction, and address gaps early.

Successful PRO collection requires staff training, EHR integration, and coordinated processes across the care team. Practices that invest in these workflows now will be better positioned to meet ASM quality requirements and demonstrate meaningful patient-centered outcomes.

Develop a Strategic Timeline for ASM Preparation

Preparing for the Ambulatory Specialty Model (ASM) requires a deliberate, phased approach. A structured twelve-month timeline allows practices to identify gaps, strengthen reporting and care coordination capabilities, and reduce risk, without attempting a disruptive overhaul. Even for organizations that may not ultimately be selected, these preparation steps support stronger cost management, improved collaboration, and better patient outcomes.

Phase 1: Initial Assessment and Outreach

Confirm whether each practice location falls within one of the mandatory Comprehensive Care Program (CCP) areas
Estimate episode volume using 2025 data to determine likelihood of participation
Review current quality performance using existing MIPS reporting insights
Begin outreach to primary care partners to support future collaborative care arrangements

Phase 2: Infrastructure Development and Testing

Implement workflows for patient-reported outcomes collection
Enable real-time monitoring of data completeness and cost performance
Formalize collaborative care processes with referral partners
Conduct a full test submission to validate data accuracy and reporting readiness
Train staff on ASM requirements and confirm full Promoting Interoperability compliance

Phase 3: Final Readiness

Finalize reporting workflows and data validation processes
Review CMS participation notifications and model requirements
Complete a final audit to identify and resolve remaining reporting risks
Establish monthly performance monitoring and quarterly trend reviews

By January 2027, practices should have fully operational systems in place to support accurate reporting, performance tracking, and coordinated care under ASM.

Understand the Financial Implications of ASM

Woman writing patient data

Understanding the financial implications of the Ambulatory Specialty Model (ASM) is crucial for practices, as it can significantly impact revenue. The ASM utilizes a performance-based system, adjusting reimbursements based on a practice’s quality and cost relative to peers. For example, a practice with $500,000 in annual Medicare billings could face adjustments up to $45,000, or 9% of revenue. Practitioners should assess their performance by evaluating current quality scores and projected financial scenarios, and devising strategies for improvement. Additionally, a portion of physician payments will be retained by CMS, which contributes to Medicare savings while not being available for bonuses or penalties.

Plan for Performance-Based Gains and Losses

Preparing for the ASM requires a proactive approach to financial planning. You’ll need to:

Review Eligibility: Confirm if your practice falls within the selected specialties and geographic areas. Understanding your participation status is the first step.
Analyze MIPS Performance: Since ASM shares similarities with MIPS, assess your current performance in quality and cost measures. Data from MIPS reporting can offer insights into your practice’s strengths and weaknesses in MIPS reporting.
Develop Improvement Plans: Based on your analysis, create actionable plans to improve performance in areas that will be scored under the ASM.

The ASM represents a shift towards value-based care, where payment is increasingly tied to outcomes rather than the volume of services. This model encourages greater care coordination and efficiency, aiming to reduce unnecessary procedures and hospitalizations. Practices that embrace these principles are better positioned for success.

By understanding and planning for these financial implications, you can better navigate the ASM and position your practice for success in this evolving payment landscape.

Thinking about the money side of ASM? It’s important to know how it all adds up. We can help you figure out the financial picture. Want to learn more about how ASM impacts your budget? Visit our website today for clear answers!

Wrapping Up: Your Path Forward

Getting ready for the Ambulatory Specialty Model might seem like a lot right now, especially with all the moving parts. But remember, you’ve got about a year before things really get serious with performance measurement. That’s actually a decent amount of time if you start now. Focus on what you can control: understanding your data, talking to your primary care colleagues, and making sure your systems are up to snuff. Don’t wait until the last minute; that’s when things get really stressful. Taking these steps now will not only get you ready for the ASM but will also make your practice stronger overall. You can do this.