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Advanced Alternative Payment Models (APMs) are a subset of APMs that reward eligible clinicians and practices to earn greater payment incentives for taking on some risk related to their patient’s outcomes.
The Centers for Medicare and Medicaid have set a goal that 100 percent of people with Traditional Medicare will be in a care relationship with accountability for quality and total cost of care by 2030. CMS is also expanding the reach of ACOs into rural and other underserved communities. With the steady movement to value-based payment, anesthesiologists need to be informed and understand how to participate.
Your participation in an APM determines what incentive you may receive illustrated by the U.S. Centers for Medicare & Medicaid Services.
An APM Entity is composed of Eligible clinicians and their associated TINs, who are listed on a participant list, or an affiliated practitioner list associated with an APM.
To become a QP, you must receive at least 75% of your Medicare Part B Covered Professional Service payments or see at least 50% of Medicare patients through an Advanced APM entity on the determination periods (snapshots).
Not all clinicians who participate in Advanced APMs may achieve QP status. Some may be eligible to become Partial QPs. To be a Partial QP, you must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an Advanced APM Entity during the QP performance period.
The Centers for Medicare & Medicaid Services (CMS) have posted several models that are eligible Advanced APMs. Eligible clinicians and their groups should also check their participation status to see if CMS has determined your APM status.
To be considered an Advanced APM, the APM must meet three specific criteria:
Access the details of 2024 Advanced APMs at Advanced APMs Intro (cms.gov)
Four primary advantages to participating in the Advanced APM pathway:
Anesthesiologists can begin assessing the value of participation in an APM.
Starting point in calculating financial gain or loss while participating in a proposed bundled payment model for Anesthesiologists.
Take a deep dive into the role of anesthesiologists in APMs, ASA’s APM assessment framework, calculator, and more.
This document answers common questions about bundle conveners and helps you understand what role these entities play and how to engage with them.
Important articles, federal guidance, and essential reading to help you stay up-to-date on APMs.
This page is curated by the ASA Payment and Practice Management Team and was last updated March 7, 2024.
