CMS released the final participant list in September for its Ambulatory Specialty Model, a mandatory payment model that will tie physicians’ Medicare Part B pay to their performance on heart failure and low back pain care, starting Jan. 1, 2027.
The final list includes 5,533 clinicians across 46 states, down from more than 6,600 on the preliminary list released in February. The low back pain cohort includes 3,319 orthopedic surgeons, neurosurgeons, pain management physicians, interventional pain physicians, anesthesiologists and physical medicine and rehabilitation physicians. The heart failure cohort includes 2,214 cardiologists.
CMS did not add any new participants beyond those on the preliminary list, according to the American College of Cardiology.
Under the model, physicians are scored individually on quality, cost, improvement activities and interoperability. The resulting bonus or penalty applies to all of a physician’s Medicare Part B payments, not only those tied to heart failure or low back pain care.
Here are the 14 physician groups with the most clinicians on the final list across both cohorts, according to the CMS dataset:
(Editors note: Five groups tied at 22 clinicians)
- Inova Health Care Services (Arlington-Alexandria-Reston, Va.): 37 (33 heart failure, 4 low back pain)
- HealthTexas Provider Network (Dallas): 35 (26 heart failure, 9 low back pain)
- OrthoLoneStar (Houston, Tyler, Austin and Dallas, Texas): 31 (31 low back pain)
- Lehigh Valley Physician Group (Allentown, Pa.): 31 (14 heart failure, 17 low back pain)
- St. Luke’s Physician Group (Allentown-Bethlehem, Pottsville and East Stroudsburg, Pa.): 30 (19 heart failure, 11 low back pain)
- Baptist Health Medical Group (Louisville, Lexington and Paducah, Ky.): 29 (16 heart failure, 13 low back pain)
- TMH Physician Associates (Houston): 27 (7 heart failure, 20 low back pain)
- St. David’s Heart & Vascular (Austin, Texas): 26 (26 heart failure)
- Providence Medical Foundation (Anaheim-Santa Ana-Irvine and Santa Rosa, Calif.): 25 (19 heart failure, 6 low back pain)
- OrthoNJ (Lakewood-New Brunswick, N.J.): 22 (22 low back pain)
- Sutter Valley Medical Foundation (Sacramento, Calif.): 22 (18 heart failure, 4 low back pain)
- The Emory Clinic (Atlanta): 22 (3 heart failure, 19 low back pain)
- Sutter Bay Medical Foundation (San Francisco and Santa Rosa, Calif.): 22 (16 heart failure, 6 low back pain)
- Health First Medical Group (Palm Bay-Melbourne-Titusville, Fla.): 22 (11 heart failure, 11 low back pain)
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