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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 Original 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.
★ 2022 Report to Congress: Center for Medicare and Medicaid Innovation, December 2022
★ Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center’s Strategy, November 2022
★ Walmart and UnitedHealth Group Collaborate To Deliver Access to High-Quality, Affordable Health Care
★ 2022 APM Incentive Payment Details Available; Learn if Action Needed
In order to be considered an Advanced APM, the APM must meet three specific criteria:
Four primary advantages to participating in the Advanced APM pathway:
Your participation in an APM determines what incentive you may receive as illustrated here by the U.S. Centers for Medicare & Medicaid Services.
Image from Advanced APMs PY 2021 (cms.gov)
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.
ASA has developed the following resources to assist you in navigating the APM value-based payment approach.
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 28, 2023.
