(ASM) – Heart Failure

stethoscope, EKG, blue and white colored leads

Pexels: Marta Branco

The Ambulatory Specialty Model (ASM) is a new CMS initiative that advances the transition to value-based specialty care. In our previous article, we reviewed the fundamentals of the program. In this article, we will focus on practical documentation and care management strategies that can help physicians prepare for the model’s January 1, 2027 implementation.

Likely Areas of Focus

CMS has consistently targeted:

Preventable hospitalizations
30-day readmissions
Medication optimization
Disease progression
Coordination between cardiology and primary care
Appropriate use of advanced therapies

Documentation Tips

Disease Severity

Documentation should consistently identify:

HFrEF
HFmrEF
HFpEF
Acute
Chronic
Acute on chronic
NYHA class when known

Example:

Chronic HFrEF, EF 30%, NYHA Class III, currently compensated.

This creates a much stronger picture of disease burden than simply documenting “CHF.”

Clinical Status

Providers should document:

Symptoms
Functional limitations
Volume status
Weight changes
Edema findings
Dyspnea severity

Example:

Patient reports worsening exertional dyspnea after walking one block. Weight increased 5 lbs. since prior visit. Trace bilateral edema present.

This demonstrates active management rather than passive follow-up.

Guideline-Directed Medical Therapy (GDMT)

A major ASM focus will likely be whether providers document efforts to optimize evidence-based therapy.

Examples:

ARNI (Entresto)
ACE inhibitors
ARBs
Beta blockers
SGLT2 inhibitors
Mineralocorticoid receptor antagonists

Providers should document:

Current medications
Titration efforts
Contraindications
Intolerance
Patient refusal

Example:

Unable to increase carvedilol secondary to symptomatic hypotension.

Without that explanation, CMS may interpret the lack of optimization as a quality gap.

Care Coordination

Documentation should support:

Communication with PCP
Home health involvement
Cardiac rehab referrals
Electrophysiology referrals
Advanced heart failure consultation

The model rewards evidence of coordinated care.

Financial Impact

HF Reimbursement Implications

Under ASM, cardiologists generally continue billing:

Office E/M
Hospital services
Diagnostic testing
Procedures

However, future incentive payments may depend upon:

Positive Drivers

Reduced Readmissions
Optimal GDMT utilization
Early outpatient intervention
Appropriate follow-up

Negative Drivers

Frequent avoidable admissions
Poor medication management
Lack of documented care coordination
Excessive use of low-value testing

Key Takeaways

Describe disease severity.
Demonstrate clinical decision-making, not just diagnoses.
Detail why evidence-based therapies were or were not used.
Document care coordination activities.
Always establish the pathway from conservative treatment to advanced intervention.

Final Thoughts

For Heart Failure physicians, ASM reinforces what has long been considered best practice: accurate assessment of disease severity, optimization of guideline-directed medical therapy, and proactive management to avoid preventable hospitalizations. The model provides an opportunity to demonstrate the impact of these efforts through both quality outcomes and performance-based incentives.

Resources

Ambulatory Specialty Model – Participants(external link) and FAQs(external link)

ASM (Ambulatory Specialty Model(external link))

ASM Webinar Registration Link: ASM Participant September 2026 Office Hour(external link)

CMS ASM Readiness Guide(external link)

Heart Failure (ASM) Readiness Guide (external link)