As part of the proposed Physician Fee Schedule (PFS), the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) has proposed a new mandatory payment model for physicians who treat low back pain and heart failure. The proposed model has a 5-year period of performance running from January 1, 2027, to December 31, 2031. Participation will be mandatory for all physicians treating low back pain or heart failure located in selected metropolitan divisions or Core Based Statistical Areas (CBSAs), which can include areas designated by the Federal Office of Rural Health Policy as rural.
The proposed ASM model cohort for heart failure, would be physicians who specialize in general cardiology. For low back pain, participants would be physicians who specialize in anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, or physical medicine and rehabilitation. The model would only include physicians who have historically treated at least 20 heart failure or low back episodes per year as identified by CMMI. All participants will be subject to both upside and downside risk.
Comments are due by September 12.
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