Payment & Delivery Models

Alternative payment model design needs to be physician-led

Troy Parks , News Writer

As new payment models become a reality, physicians know that they are best poised to balance the goal of reducing costs while delivering high quality care. Physicians passed new policy Tuesday to ensure that those Medicare payment models are physician-led to allow for the resources and flexibility needed to implement their own solutions for improving care for patients, rather than letting regulators dictate the way care should be delivered.

No single approach to payment reform will yield the best outcome for every physician or every specialty. If properly structured, physician-focused payment models will create an opportunity for physicians to improve patient care in ways that are feasible in their unique practice environments.

Specialty-specific and condition-based models allow physicians to redesign care based on specific patient needs, and the goal of these models should be to break down the barriers that prevent physicians from taking advantage of opportunities to control cost and care.

Learn how physicians are developing new payment models for their specialties.

Current AMA policy calls for advocating with the Centers for Medicare & Medicaid Services (CMS) and Congress for alternative payment models (APM) developed in collaboration with specialty and state medical organizations so that the best possible care is available to patients.

After reviewing a report from the AMA Council on Medical Service, delegates at the 2016 AMA Annual Meeting adopted policy that recommends pursuing the following goals as part of an APM:

  • Provide resources to support the services physician practices need to deliver to patients, including mechanisms for regular updates to the amounts of payment to ensure they continue to be adequate to support the costs of high-quality care
  • Reduce burdens of health IT usage in medical practice
  • Promote physician-led team-based care coordination that is collaborative and patient-centered
  • Designed by physicians and provide the flexibility so that physicians can deliver the care their patients need
  • Limit physician accountability to aspects of spending and quality that they can reasonably influence
  • Avoid placing physician practices at substantial financial risk and minimize administrative burdens
  • Be feasible for physicians in every specialty and all practice sizes to participate in

Also, new policy was adopted to support many types of technical assistance for practices that are working to implement successful APMs, including:

  • Designing and employing a team approach
  • Obtaining the data and analysis needed to monitor and improve performance
  • Forming partnerships and alliances to share tools, resources and data
  • Obtaining the financial resources needed to make the transition to new payment models

The AMA is encouraging CMS and private payers to support technical assistance and will continue to work with appropriate organizations, including national medical specialty societies and state medical associations, to educate physicians on APMs and provide educational resources and support that encourage physician-led development and implementation of APMs.