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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.
★ On September 5, 2024, CMS published a list of acute care hospitals (XLSX) located in one of the Core Based Statistical Areas (CBSAs) selected for mandatory participation in the Transforming Episode Accountability Model (TEAM). TEAM is a mandatory, episode-based, alternative payment model, in which selected acute care hospitals will coordinate care for people with Traditional Medicare undergoing one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. CMS used Core-Based Statistical Areas (CBSAs) to identify selected geographic regions for the model test. See if your hospital is one of the mandatory participants at list of acute care hospitals (XLSX). To learn more about the model, see Transforming Episode Accountability Model (TEAM) | CMS.
★ Provide Your Billing Information to Receive Your Alternative Payment Model (APM) Incentive by September 1, 2024. The Centers for Medicare and Medicaid Services issued a payment advisory notice asking APM participants to provide current Medicare billing information by September 1, 2024. The Centers need information including Taxpayer Identification Numbers to issue the APM Incentive Payment for the 2024 payment year. Check if you are on the list and access the notice for directions on how to submit your information at 2024-15644.pdf (federalregister.gov).
★ In a recent response to the proposed 2025 Inpatient Prospective Payment System (IPPS) (PDF), ASA urged the Centers for Medicare & Medicaid Services (CMS) to expand opportunities for anesthesiologists to participate in alternative payment models (APMs). As leaders in perioperative care and care coordination, anesthesiologists would be essential to the successful implementation of CMS’s proposed Transforming Episode Accountability Model (TEAM). Read more ›
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 October 17, 2024.
