Wednesday, June 13, 2012
Pondering a shared savings program? AMA offers advice
A new chapter in the AMA's "Evaluating and negotiating emerging payment models" manual provides practical guidance for physicians who are thinking about participating in a shared savings program.
The chapter explains the methodologies behind shared savings programs and what physicians must find out before they agree to participate. The chapter helps physicians evaluate their ability to succeed in such a program and identifies a number of existing shared savings programs in the public and private sectors.
Physicians who are interested in taking part in this risk-based payment arrangement will learn how to protect themselves from losses associated with unrealistic budget targets or high risk patients, unfair termination and diminishing financial returns. The chapter also shows physicians how to identify ways to easily save money in their practices.
Other topics discussed in the manual include payment bundling, pay-for-performance, withholds and risk pools, and capitation. A companion webinar recording also provides an overview of each of these concepts.
Contracted fee schedules can ensure accurate pay
A new educational resource from the AMA shows physicians how to include their contracted fees in their practice management systems.
Step-by-step instructions explain how to upload contracted fee schedules into a physician's practice software and generate regular reports about the amounts health insurers have agreed to pay for specific medical procedures and services. The resource also outlines what an insurer should include when it provides a copy of the contracted fee schedule. And it offers a template letter (AMA login required) that AMA members can use to request a copy of any fee schedules they do not already have on file.
Physicians who have a record of all their contracted fee schedules can easily monitor their payments to make sure they match the agreed-upon amount. The records also provide a simpler way to compare amounts different health plans pay and determine the total revenue individual procedures and services might generate.