Advocating for You: Assisting physician anesthesiologists navigate the APM quality journey and receive value-based payment
Why This Matters
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.
In order to be considered an Advanced APM, the APM must meet three specific criteria:
Require participants to use certified electronic health record technology (CEHRT)
Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS.
Either be a Medical Home Model expanded under CMS Innovation Center authority; or require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.
Four primary advantages to participating in the Advanced APM pathway:
Participants are excluded from MIPS reporting.
Participants and APMs receive a 5% lump sum bonus through 2024.
For performance year 2023, participants received a 3.5% APM incentive payment.
Beginning in 2026 and beyond, eligible clinicians will receive a 0.75% payment update if they are Qualified Participants (QP) and 0.25% if they are partial Qualified Participants (partial QP).
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.
What You Can Do Now
ASA has developed the following resources to assist you in navigating the APM value-based payment approach.