The Center for Medicare and Medicaid Innovation (CMMI) announced on on July 14 a new 5-year Ambulatory Specialty model in the proposed 2026 physician fee schedule rule.

The model is targeted at specialty physicians who frequently treat Medicare fee-for-service (FFS) beneficiaries with low back pain or heart failure and practice in selected core-based statistical areas or metropolitan divisions. Under the model,  these specialists will be financially accountable for “upstream management of chronic conditions,” by providing timely preventive care and interventions to avoid unnecessary hospitalizations and surgeries. The model will focus on low back pain and congestive heart failure.

The model will begin January 1, 2027, and impact payment years from January 1, 2029, through December 31. 2033. Specialists’ Part B payments will be adjusted +/- 9% and the model will be budget neutral. While aging service providers are not mandatory participants in the model, they should expect care delivery expectations to change as participating specialists try to avoid hospitalizations for older adults in Medicare FFS and seek to deploy more preventative treatment strategies.

More details on the model can be found here.