While the proposed 2026 Medicare physician payment schedule does include several updates to the ambulatory specialty model that the American Medical Association has long advocated for, it said in comments to CMS that there are still several areas in need of a redesign.
According to an Oct. 16 report, the AMA’s comments, submitted to CMS for consideration before the planned finalization of the rules Nov. 1, aim to support physicians, primarily those in private practice, and help them remain financially stable enough to continue caring for older adult patients with heart failure or low back pain.
The AMA’s recommendations to CMS include:
1. Restructure the ambulatory specialty model’s financial model. The current model guarantees that most participating physicians will see their payments cut regardless of how well they perform on the measures. Instead of reducing physician payment rates in order to save money, the AMA urges CMS to support physician payment, which will reduce avoidable Medicare spending on hospitalizations and other services.
2. Revamp the ambulatory specialty model as a voluntary model. As it stands, physicians in seven specialties across selected geographic areas would be required to participate in the model. The AMA expressed concerns that physicians treating as few as 20 patients with heart failure or low back pain annually would be required to participate in the model and have their payments reduced or increased based on the ambulatory specialty model requirements.
3. Set a performance standard in advance, rather than using a “tournament approach.” Per current proposed policy, a physician’s payment adjustment will depend on whether their performance exceeds the majority of other ambulatory specialty model participants each year.
