CMS Names Physicians Required to Participate in New Heart Failure Payment Model

The Centers for Medicare & Medicaid Services (CMS) has released a searchable database of physicians who will be required to participate in a new payment model for heart failure care starting Jan. 1, 2027. The model will run for 5 years.

Participants will have their Medicare Part B payments adjusted in the range of –9% to +9% in the first 2 payment years (2028 and 2029). The range of payment adjustments will increase in later years. The payment adjustment is at the individual level and applies to all of a physician’s Part B claims.

CMS’s Ambulatory Specialty Models (ASMs) are based on the Merit-based Incentive Payment System (MIPS) Value Pathways and measure provider performance in the areas of quality, care improvement, cost, and interoperability. MIPS is one of the quality reporting programs under the Medicare physician payment system.

Physicians assigned to the Heart Failure ASM have met the following criteria:

• Billing under the Medicare physician fee schedule;
• Practicing in one of CMS’s targeted geographic areas;
• Specialty designation is general cardiology; and
• Historically treated at least 20 heart failure episodes per year as identified by the episode-based cost measure methodology.

CMS will use data from the calendar year 2 years prior to a given ASM performance year to evaluate these criteria. For example, CMS will use data from 2025 to determine final eligibility for the 2027 performance year. Additional resources, including an FAQ, can be found here.

You can help us understand the impact of the new payment model on ASNC members! If you have been selected to participate in the new heart failure payment model, please contact ASNC Director of Regulatory Affairs Georgia Lawrence, JD, at glawrence@ASNC.org.