The new CMS model keeping cardiologists up at night

The Center for Medicare & Medicaid Innovation has finalized a mandatory Ambulatory Specialty Model that, beginning January 1, 2027, ties a portion of cardiologists' Medicare payments to their performance on quality, cost, and care-coordination metrics — with heart failure management among the first conditions in scope.

Dr. Ilan Kedan, cardiologist and Professor of Cardiology at the Smidt Heart Institute at Cedars-Sinai, sees the model as part of a familiar pattern in how CMS approaches chronic-disease management.

“This approach is a repeated theme from CMS to shifting risk and responsibility to physicians and specialists for the global care of chronic disease management.”

— Dr. Ilan Kedan

A core concern, he notes, is that the model assumes patients already have reliable access to both specialists and primary care — an assumption that doesn't match what he sees in practice, where wait times for cardiology are approaching a month or more and many Medicare patients lack a consistent primary care relationship.

“Again, the real-world experience for specialists caring for Medicare patients is that very often patients do not have reliable and consistent care and access to a primary care physician, let alone a primary care team. This inevitably results in the shifting of non-specialty care and primary care to specialists.”

— Dr. Ilan Kedan

Layering additional care-coordination and administrative work onto specialists, Dr. Kedan argues, raises the time, resources, and infrastructure cost of caring for these patients — costs that are likely to come at the expense of specialists' income and could ultimately backfire on the access the model is meant to protect.

“Sadly, this may also serve to push specialists out of Medicare participation and further limit access to care for Medicare patients.”

— Dr. Ilan Kedan

He also cautions that heart failure patients are often complex, with multiple comorbidities and long medication lists, and that adverse outcomes driven by those co-occurring conditions may be unfairly attributed to deficient care of the specific diagnosis the model is measuring.

To read the full perspectives shared by cardiology leaders on the new model, see the complete article on Becker's ASC Review.