Why this Newsletter
The Centers for Medicare and Medicaid (CMS) Innovation Center proposed a new alternative payment model, the Ambulatory Specialty Model for implementation starting January 2027. Physician participation in the Model is required. If you work with physicians, understanding who & how physician reimbursement will be impacted by the Model would be useful to know.
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Physicians in seven specialties, anesthesiology, cardiology, interventional pain management, pain management, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation, who treat patients with heart failure or low back pain in 240 US geographic areas would be required to participate in the Ambulatory Specialty Model for up to five years.
Payment adjustments for all the services reimbursed by Medicare, not just those for heart failure or low back pain services, would be applied two years after the performance year. Payment adjustments include reductions or increase of 9% in 2029 and 2030 for the 2027 and 2028 performance years, growing to 12% by 2033 for the 2031 performance year.
A physician’s payment adjustment depends on whether their performance exceeds the majority of other Model participants each year. Physicians treating as few as 20 patients with heart failure or low back pain a year would be required to participate in the Model, even if heart failure or low back pain patients are a small subset of all their patients.
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About Rowinski Group
2025 marks the 21st year in business for Rowinski Group LLC, a reimbursement and healthcare payer data analytics consultancy for medical devices, digital health and diagnostics companies who are developing and selling their medical technology for the U.S healthcare market.
Rowinski Group has offices in Silicon Valley – San Francisco Bay area and Chicago, Minneapolis, and Portland.
Rowinski Group has two core service offerings; securing codes and reimbursement on behalf of our company clients and using healthcare payer data analytics to help our companies solve their business issues like responding to questions from the FDA and Medicare, sales forecasting, building marketing models, Key Opinion Leader (KOL) identification.
Through these service offerings Rowinski Group hemailto:d.zimmerman@reimbursement.consultinglps U.S. and international companies build their U.S. market share. For more information visit https://reimbursement.consulting or contact Daniel Zimmerman d.zimmerman@reimbursement.consulting.
