New developments in APMs

What you should know right now to stay up-to-date on APMs

★ CMS Releases CJR-X Model Overview
CMS has released new CJR-X Model Overview Slides to help hospitals and clinicians prepare for implementation. The resource covers episode design, quality measures, pricing and payment methodology, and other model requirements relevant to care teams participating in lower-extremity joint replacement episodes. For anesthesiologists, the resource provides useful context for understanding the payment and quality framework surrounding the surgical episodes in which they provide care. View the CJR-X Model Overview Slides (PDF) and consult the CJR-X webpage for more details.

★ 2026 APM Incentive Payments Now Disbursed - Action May Be Required
The Centers for Medicare & Medicaid Services has disbursed 2026 Advanced Alternative Payment Model (APM) Incentive Payments to eligible clinicians based on Qualifying APM Participant Performance Period 2024. 
To view your payment details, log in to the QPP website using your HARP credentials. Payment information is available at both the 10-digit NPI and organization levels.
Do You Need to Act? Only if you have not received your payment, verify by October 13.

1. Check the 2026 QP Notice for APM Incentive Payment to see if your name is listed.
2. If listed, you must complete and submit your Medicare billing information by October 13, 2026.
3. Failure to verify by this deadline will result in no payment being issued.

★ CMS Expands Nationwide the Comprehensive Care for Joint Replacement Payment Model Beginning in 2028
As part of the Fiscal Year 2027 Inpatient Prospective Payment System (IPPS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, a nationwide mandatory episode-based payment model for most hospitals beginning January 1, 2028. Under CJR-X, hospitals will be accountable for Medicare spending associated with hip, knee, and ankle replacement episodes, including the hospitalization and 90 days of post-discharge care. CMS states the model builds on the success of the original Comprehensive Care for Joint Replacement (CJR) Model, which operated from 2016 through 2024 and reportedly generated more than $100 million in Medicare savings while maintaining quality of care. Additional information is available on the CJR-X web page here. Lastly, as part of the IPPS rule, any changes to the Transforming Episode Accountability Model (TEAM) are also included. The updates are available on the TEAM web page here.

★ On June 8th, the ASA submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) in response to the FY 2027 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, urging refinements to episode-based payment models to better reflect clinical realities, multidisciplinary care, and responsible stewardship of Medicare resources. Read all the details at ASA Urges CMS to Refine CJR-X and ASC Episode Models in FY 2027 IPPS Proposal | American Society of Anesthesiologists (ASA) 

★ As part of ASA efforts to ensure members are aware and prepared to participate in Alternative Payment Models, two recent publications were published in the ASA Monitor and on the ASA webpage. Process Makes Perfect: The Role of Anesthesiologists in the CMS TEAM and Calendar Year (CY) 2026 Medicare Conversion Factors Higher for Physicians in Alternative Payment Models | American Society of Anesthesiologists (ASA).

★ The mandatory, episode-based alternative payment model called Transforming Episode Accountability Model (TEAM) begins on January 1, 2026. The ASA is developing resources for members that are in a selected hospital to be informed and prepared. See if your hospital is required to participate and learn more about TEAM at Medicare's Transforming Episode Accountability Model (TEAM) | ASA.

★ On April 11, 2025, CMS confirmed the list of acute care hospitals located in one of the Core Based Statistical Areas (CBSAs) selected for mandatory participation in the Transforming Episode Accountability Model (TEAM) announced on September 5, 2024. See if your hospital is one of the mandatory participants at list of acute care hospitals. To learn more about the model, see Transforming Episode Accountability Model (TEAM) | CMS.

★ 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.

★ In a recent response to the proposed 2025 Inpatient Prospective Payment System (IPPS), 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). ASA opposes making alternative payment models mandatory and, if TEAM is finalized, our letter called for a voluntary, thoughtful roll out of the TEAM model over several years.

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