Ambulatory Specialty Model (ASM) for Cardiologists: What Heart Failure Specialists Need to Know
A practical summary of the Ambulatory Specialty Model (ASM) for cardiologists: participation, scoring, quality measures, and the data available now to prepare.
On January 1, 2027, cardiologists in 235 selected metro areas enter the Ambulatory Specialty Model's heart failure cohort, a mandatory five-year test of financial accountability for specialist-managed heart failure care. This summary covers what is specific to cardiology: who is in the cohort, the five measures, and what drives heart failure episode cost.
ASM in three lines
- Score: quality 50% and cost 50%, with deductions of up to 20 points for Improvement Activities and 10 for Promoting Interoperability, benchmarked against the rest of the national heart failure cohort.
- Money: ±9% of all Part B payments for the 2027 and 2028 performance years, rising to ±12% by 2031, paid two years later.
- MIPS: waived for any year you meet ASM eligibility.
Full mechanics: The Ambulatory Specialty Model Explained. Spine and pain: ASM for Low Back Pain Specialists.
Who Is in the Heart Failure Cohort
The cohort is cardiology only. CMS assigns specialty from the code on the plurality of your Part B claims, and eligibility requires at least 20 attributed heart failure episodes under the MIPS episode-based cost measure, counted in the calendar year two years before the performance year (2025 claims for 2027). A heart failure episode opens with two Part B claims from the same clinician within 180 days, and it is attributed to you only if you bill at least 30% of its Part B services.
CMS's February 2026 preliminary list named 2,610 cardiologists. The final 2027 list, rechecked against 2025 claims, was posted to data.cms.gov in September 2026 and names 2,215; the recheck could only remove clinicians, not add them. Search the final list by name, NPI, or organization or browse by state.
The Five Heart Failure Quality Measures
The measure set is fixed; every cardiologist in the cohort reports all of it.
| Measure ID | Measure | What It Assesses |
|---|---|---|
| Q492 | Risk-Standardized Acute Unplanned CV Admission Rates | Are HF patients being hospitalized for preventable CV events? |
| Q008 | HF: Beta-blocker Therapy for LV Systolic Dysfunction | Are HFrEF patients receiving guideline-directed beta-blocker therapy? |
| Q005 | HF: ACE Inhibitor/ARB/ARNI Therapy for LV Systolic Dysfunction | Are patients receiving guideline-directed medical therapy? |
| Q236 | Controlling High Blood Pressure | Is blood pressure controlled in your HF population? |
| Q377 | Functional Status Assessments for Heart Failure | Are you collecting patient-reported functional status? |
Q492 is where quality and cost meet. CMS calculates it from claims, with the specification modified for ASM so that an admission is attributed only to participants who saw the patient at least once. The same unplanned admission also lands in your heart failure episode cost, so one avoidable hospitalization lowers both the quality half and the cost half of the score.
Q008, Q005, and Q236 can be submitted as eCQMs or MIPS CQMs, and most cardiology practices already report them. Q377 is eCQM-only and asks whether functional status was assessed (the KCCQ-12 is the common instrument), so it depends on the EHR capturing a structured patient-reported score. Your MIPS rates on these measures are a fair preview of your clinical performance. They won't predict your ASM decile, because ASM benchmarks are rebuilt from the cohort's own results rather than taken from MIPS.
What Drives Heart Failure Episode Cost
Your cost score reflects total Medicare spending in the heart failure episodes attributed to you, not just what you bill:
- Hospitalizations and emergency department visits
- Post-acute care and skilled nursing facilities
- Imaging and diagnostic testing
- Services from other specialists and providers
Costs are risk-adjusted for patient health status, and you are compared with other cardiologists across the whole cohort, not your local market. CMS calculates the same Heart Failure episode-based cost measure for MIPS today, so your MIPS cost feedback shows which patients and service categories drive your spending. It is a view of cost drivers, not a forecast of your ASM cost score, which depends on where the 2027 cohort median lands. Review the cost methodology →
Cardiology usually starts closer to ASM's primary care requirements than spine practice does, because heart failure patients are followed over time. The written collaborative care arrangement and the post-visit PCP updates are still new for most practices; the ASM Preparation Guide covers both.
Next Steps
SOURCES