Payment Model Resources for Physicians
The AMA is developing resources for physicians to help turn challenging new payment models into opportunities for physician-led patient-centric care, improved practice efficiencies, better coordination between specialists and primary care, and better margins.
The new health system reform law provides for a range of new pilot programs, including accountable care organizations, medical homes and bundled payments. The lessons learned from these pilots will form the roadmap for major payment and delivery reforms in Medicare and private sector health programs. To help physicians understand these reforms, AMA resources will include webinars, PowerPoint presentations, in-person seminars, practice toolkits and papers developed by experts in the new payment models.
Shared Savings Model update
On April 10, the Centers for Medicare & Medicaid Services announced the names of the first 27 accountable care organizations (ACOs) participating in the agency's Shared Savings Program.
Serving an estimated 375,000 Medicare patients in 18 states, the majority of the new ACOs are led by physicians. The AMA attributes this strong showing of physician participation to program changes CMS made at the AMA's request, which allowed greater opportunities for physicians to lead ACOs, including the Advance Payment ACO Model.
CMS also announced that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources.
5 Advanced Payment ACOs announced April 10:
- Coastal Carolina Quality Care, Inc. (New Bern, N.C.)
- Jackson Purchase Medical Associates, PSC (Paducah, K.Y.)
- North Country ACO (Littleton, N.H.)
- Primary Partners, LLC (Clermont, Fla.)
- RGV ACO Health Providers, LLC (Donna, Texas)
27 ACOs participating in Shared Savings Program
Accountable Care Organization/Collaborative Health Systems Partnerships
ACO Resources for Physicians
The AMA offers physicians resources to help them form an ACO, including a webinar, white paper, video and 'how-to' manual.
This video, taped during the AMA’s 2011 National Advocacy Conference in February, features a stimulating and informative presentation from Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, on the new physician payment models presented in the Affordable Care Act. Miller explores how physicians can lead and find success with new payment and delivery models, such as accountable care organizations and episode-of-care bundled payments.
In the 80-minute presentation, featuring an introduction from former AMA President J. James Rohack, MD, Miller gets beyond conceptual discussions of the proposed models and explores them through the lens of actual provider care scenarios. A lively Q&A session follows his presentation.
This seminar series, "AMA Pathways to Success: What physicians need to know about ACOs and the coming revolution in payment practices," will explain how physicians can lead new payment and delivery models, such as accountable care organizations and episode-of-care bundled payments, being tested in Medicare and adopted in the private sector.
Keynote speaker, Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, and other national and local experts, will explore how physicians can find success with new payment practices.
Pathways for physician success under healthcare payment and delivery reforms
To launch this activity, the AMA has commissioned a white paper by Harold D. Miller, a nationally recognized expert on accountable care organizations, regional health improvement collaboratives and other innovations in health care delivery. The paper, titled “Pathways for physician success under healthcare payment and delivery reforms,” explains the many ways that innovative payment models can translate into positive opportunities for physicians:
- The opportunities and challenges that new payment models present to physicians, especially those who practice independently of hospitals and large systems
- Key capabilities that practices need to overcome the barriers to success under each model
- Advantages and disadvantages of partnering with hospitals or insurance plans, and how physicians can succeed under a variety of organizational structures
- The implications of local health care markets for the way physicians may want to structure new payment models in their own communities
- Legal issues and regulations affecting the new arrangements, including self-referral, anti-kickback and antitrust issues
AMA Side-by-Side Chart on ACO/MSSP Final Rule
On June 16, 2011 the AMA submitted comments to the Center for Medicare and Medicaid Innovation (CMMI) on the concept of an Advance Payment Initiative for ACOs entering the Medicare Shared Savings Program.
On June 3, 2011 the AMA submited comments to HHS and CMS on the Medicare Shared Savings Program.
On June 3, 2011 the AMA sumbitted comments to the CMS on their proposed rule on Medicare ACOs.
On May 26, 2011 the AMA submitted comments to the Federal Trade Commission and the Department of Justice on the proposed Statement of Antitrust Enforcement Policy regarding ACOs participating in the Medicare Shared Savings Program.
On April 26, 2011, the AMA sent a letter to the House Energy and Commerce Committee on physician payment reform.
On April 8, 2011, the AMA sent this memo to state, county and specialty medical societies summarizing the proposed ACO regulations that were released on March 31.
Full text of the ACO Proposed Rule.
On December 2, the AMA submitted comments to a CMS Request for Information on ACOs outlining concrete recommendations for developing physician-led ACOs.
On October 5, the Federal Trade Commission, HHS Office of Inspector General, and the Centers for Medicare and Medicaid Services (CMS) convened a joint workshop on legal issues involved in accountable care organizations (ACOs) and the AMA provided these comments at the worshop.
On August 24, the Centers for Medicare and Medicaid Services held a call with interested organizations to solicit their thoughts on accountable care organizations. The AMA presented these talking points on the call.
AMA Principles on ACOs adopted by the House of Delegates at I-10
