Ongoing Reform by the Centers for Medicare and Medicaid Services: What Does It Mean for Anesthesiologists?

Anesthesiologists influence outcomes across the perioperative continuum, yet payment model design has historically centered on hospitals and procedural specialists. This is changing. The Centers for Medicare and Medicaid Services has accelerated mandatory, accountability-driven payment models across the perioperative episode, and anesthesiology is increasingly implicated in their structure and consequences. This article examines three leading models: the Transforming Episode Accountability Model, the Ambulatory Specialty Model, and the Comprehensive Care for Joint Replacement Expanded Model. Under Transforming Episode Accountability Model and Comprehensive Care for Joint Replacement Expanded Model, hospitals bear the financial risk, but anesthesiology-driven decisions shape their performance. Ambulatory Specialty Model breaks from this pattern, placing mandatory, two-sided financial risk directly on individual clinicians, including anesthesiologists managing chronic low back pain. Together, these models create both opportunity and risk; proactive engagement in bundle governance, outcome measurement, and care pathway leadership will determine whether anesthesiologists shape these reforms or simply absorb their consequences.