Medicare's first mandatory specialist accountability model, the Ambulatory Specialty Model (ASM), takes effect January 1, 2027, targeting cardiologists and spine/pain specialists in roughly 25% of U.S. metro areas. Unlike voluntary value-based initiatives, ASM has no opt-out or hardship exemption. Participating clinicians face payment adjustments from -9% to +9% in Year One, based on quality, cost, care improvement activities, and interoperability metrics. The CY 2027 proposed rule represents the final opportunity to shape operational details before go-live. Affected practices must act now to confirm participant status, build care coordination infrastructure, and prepare for performance scoring that begins January 1, 2027.

Under APP Plus, a virtual cardiology visit can be clinically perfect yet vanish from your performance score. The problem isn’t the care—it’s the proof. APP Plus doesn’t ask if the visit was virtual; it asks if you can trace it, step-by-step, from the attributed patient through documented actions to a validated submission. When accountability is fragmented across platforms and partners, the evidence fails, and your score falls silently. The real risk isn't virtual care—it's assuming someone else is managing the data trail CMS requires.