Implications of the CMS Ambulatory Specialty Model for Low Back Pain for Interventional Pain Management: The Good, The Bad, And The Ugly

Pain Physician. 2026 Sep;29(6):445-460.

ABSTRACT

Since the enactment of the Affordable Care Act (ACA) in 2010, the Centers for Medicare & Medicaid Services (CMS) have embraced value-based care as the organizing principle of national payment reforms. Yet, after more than a decade, the value-based movement has, at best, generated modest returns and at worst increased costs on patients and negatively impacted access. Pursuant to its authority under the ACA, CMS proposed the Ambulatory Specialty Model (ASM) in the CY 2026 Physician Fee Schedule rulemaking and subsequently finalized the model, establishing the agency's first mandatory alternative payment model focused on ambulatory specialty care. ASM targets 2 high-cost, high-prevalence chronic conditions, heart failure, and low back pain (LBP) and will require eligible physicians in selected geographic regions to accept 2-sided financial risk beginning with performance year 1 in January 2027.This article summarizes the design of ASM, details how physicians are selected into the model and how payment adjustments are calculated (including how procedure mix and site of service, office versus ambulatory surgery center or hospital outpatient, affect episode-based cost scoring), enumerates the required quality measures and patient-reported outcome measures (PROMs), describes the Collaborative Care Arrangement requirements, compares ASM against traditional Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) such as Accountable Care Organizations (ACOs), weighs whether ASM functions as a carrot-and-stick or aversion-based policy and whether it represents innovation or limitation, and addresses whether performance is compared across specialty types (e.g., neurosurgery versus pain medicine). It then examines specific implications for interventional pain management (IPM) practices, situates IPM within the broader multispecialty landscape of LBP care, and closes with a practical action list and CMS reference links for IPM groups preparing for mandatory participation.

PMID:42804297