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To get a detailed understanding of APMs and how you may participate, as well as federal guidance:
Clinically Integrated Networks and How They Can Benefit Anesthesiologists
Committee on Economics. December 2023
Rescanning the Alternative Payment Model Horizon for Physician Anesthesiologists
David P. Martin, MD, PhD, FASA; Vanessa Salcedo, MPH; Sharon K. Merrick, MS, CCS-P. ASA Monitor June 2021, Vol. 85, 38–39.
APMs: Time to Scan the Horizon | ASA Monitor | American Society of Anesthesiologists (asahq.org)
Sharon K. Merrick, M.S., CCS-P. ASA Monitor August 2019, Vol. 83, 54–55.
Deciphering the Alphabet Soup of MACRA, MIPS and APMs: Essentials for Anesthesiologists | ASA Monitor | American Society of Anesthesiologists (asahq.org)
Karen B. Domino, M.D., M.P.H.; James M. Moore, M.D. ASA Monitor October 2017, Vol. 81, 8–11.
• Summary: This case study spotlights Duke’s Integrated Pain and Wellness (IPW) program that integrates early identification and stratification of patients at risk for poor pain outcomes. The program focuses on early intervention, customized treatments, and patient feedback to improve pain management and the patient’s psychological and functional well-being. The program has improved patient-reported outcome measures related to both pain scores and average Pain Catastrophizing Scale scores, levels of anxiety, fatigue, pain interference, pain intensity, and the ability to participate in social roles. The program also reduced negative thought patterns related to pain, ED visits, and hospital admissions. Early results reflect the effectiveness of the program’s interventions — coordinated by a care team triad featuring a pain specialist physician, an advanced practice provider, and a licensed clinical social worker — in managing chronic pain and reducing acute care usage. Gular P, Christie N, Pope A, Zambrano D, Vorenkamp K, Nelli A. NEJM Catal Innov Care Deliv. 2024;5(4). Published March 20, 2024. DOI: 10.1056/CAT.23.0308
• Summary: This review provides an overview of the involvement of anesthesiologists in alternative payment models (APMs) as found in published literature. It specifically aims to categorize and understand the breadth and depth of their participation, revolving around 3 main axes or “Aims”: (1) shaping APMs through design and implementation, (2) gauging the value and quality of care provided by anesthesiologists within these models, and (3) enhancing nonclinical abilities of anesthesiologists for promoting more value in care.
Sanghvi J, Qian D, Olumuyide E, Mokuolu DC, Keswani A, Morewood GH, Burnett G, Park CH, Gal JS. Scoping Review: Anesthesiologist Involvement in Alternative Payment Models, Value Measurement, and Nonclinical Capabilities for Success in the United States of America. Anesthesia & Analgesia ():10.1213/ANE.0000000000006763, February 07, 2024. DOI: 10.1213/ANE.0000000000006763
• Summary: Anesthesiologists engage in preoperative optimization, personalized care delivery, and evidence-based practices, bolstering their influence in the perioperative environment. Their collaboration with perioperative stakeholders propels the shift toward a value-driven healthcare landscape. This review analyzes the implementation of value-based care in anesthesiology, assesses the significance of technology in enhancing its delivery, and outlines potential strategies for improving its application. Ahmed F, Chithrala B, Barve K, Biladeau S, Clifford SP. Value-Based Care and Anesthesiology in the USA. Cureus. 2023 Aug 30;15(8):e44410. doi: 10.7759/cureus.44410. PMID: 37791193; PMCID: PMC10543093.
• Summary: A systematic review of the effects of commercial insurance models that focuses on value-based payment models.
Milad MA, Murray RC, Navathe AS, Ryan AM. Value-Based Payment Models in the Commercial Insurance Sector: A Systematic Review. Health Affairs. 2022;(4):540-548. Accessed June 13, 2022. https://doi.org/10.1377/hlthaff.2021.01020
• Summary: MedPac Report chapter that is a quick read and contains private payer APM information.
MedPac. Streamlining CMS’s Portfolio of Alternative Payment Models. Report to the Congress: Medicare and the Health Care Delivery System. Published online June 2021. Accessed June 13, 2022. https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/default-document-library/jun21_ch2_medpac_report_to_congress_sec.pdf
• Summary: An essential read for every anesthesiologist. This article outlines the different ways anesthesiologists are paid.
Gal JS, Vaidyanathan M, Morewood G. Anesthesiology payment methods: US perspective. International Anesthesiology Clinics. 2021;(4):37-46. doi:10.1097/AIA.0000000000000334
• Summary: An easy-to-read CMS webpage outlining value-based programs and the different kinds.
CMS’ Value-Based Programs. Centers for Medicare & Medicaid Services. Accessed June 13, 2022. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
• Summary: A review of current literature regarding the status of physician compensation models.
Slater BJ, Collings AT, Corvin C, Kandel JJ. Value-based surgery physician compensation model-review of the literature . Journal of Pediatric Surgery. Published online January 2022. doi:10.1016/j.jpedsurg.2022.01.009
• Summary: A study outlining anesthesia clinician performance during the first two years of MIPS program.
Gal JS, Morewood GH, Mueller JT, Popovich MT, Caridi JM, Neifert SN. Anesthesia provider performance in the first two years of merit-based incentive payment system: Shifts in reporting and predictors of receiving bonus payments. Journal of Clinical Anesthesia. Published online February 2022:110582. doi:10.1016/j.jclinane.2021.110582
• Summary: A primer on population health management and its perioperative applications is presented.
Boudreaux AM, Vetter TR. A Primer on Population Health Management and Its Perioperative Application. Anesth Analg. 2016 Jul;123(1):63-70. doi: 10.1213/ANE.0000000000001357. PMID: 27152835.
Curated by: the ASA Department of Payment and Practice Management
Date of last update: July 1, 2024