Healthcare groups ask for delay of new Medicare payment model, citing technical difficulties
A group of healthcare professional organizations and lobbies is asking the Centers for Medicare & Medicaid Services (CMS) to make significant changes to its Ambulatory Specialty Model (ASM), a value-based reimbursement model for the management of heart failure and lower back pain.
The payment model is mandatory for traditional Medicare patients, and is set to go into effect on Jan. 1.
In an open letter, the American Hospital Association (AHA) is joined by the American Medical Association (AMA), American Medical Group Association (AMGA), and others, in asking regulators to delay the implementation of the model until “significant operational and technical issues” are addressed that would facilitate compliance from providers, who will have to adhere to new care coordination methods.
The groups cite a mix of different issues that have made complying with the model difficult, including delays in their ability to access the ASM portal, such as challenges with logging in and a lack of sufficient technical support from the Center for Medicare and Medicaid Innovation, responsible for effectuating CMS payment models.
“ASM participants have experienced a number of challenges in preparing for the ASM. These delays and setbacks include, but are not limited to, delayed receipt of the final participant list; delayed access to ASM portal; challenges with logging into, accessing, or delegating authority within the portal; and receiving timely help and guidance from ASM subject matter experts,” the letter reads. “For example, the final ASM participant list was published on Sept. 15, approximately two months later than indicated in the calendar year 2026 Physician Fee Schedule final rule.”
Should CMS decide to continue with the Jan. 1 start date, the AHA, AMA, AMGA, et al., ask that participants “not be subject to downside financial risk for the initial performance period while operational infrastructure stabilizes.”
Questions unanswered
The groups thanked CMS for webinars and education resources but said they have only been helpful to a limited degree and “do not address all participant and stakeholder questions.”
“Participants and key stakeholders, such as administrative staff supporting ASM activities, are not receiving timely responses when submitting questions to the help desks,” the letter states. “Moreover, the existence of multiple help desks makes it more confusing for participants to resolve their queries.”
The undersigned emphasized that they are not opposed to the ASM, but simply feel they are not ready due to the limited timeframe and technical hiccups. They said that a delay and moratorium on penalties will “strengthen participant readiness, protect the integrity of the model’s evaluation, and help ensure that the model’s results reflect the care participants deliver to Medicare beneficiaries living with chronic conditions.”
The groups also said they are looking forward to working with the CMMI to resolve any outstanding issues so the rollout can be smooth.
CMS has not publicly responded.
For more, read the full letter by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.