Physician participation in accountable care organizations (ACOs) and medical homes has grown steadily since 2014, even as fee for service remains the most prevalent payment method and revenue generated by alternative payment models has stagnated, according to the results of an AMA survey of about 3,500 physicians.
More than one-third (34.4%) of physicians were in a practice that was an accredited or recognized medical home in 2022, compared with 32.3% in 2020 and 23.7% in 2014.
Participation in ACOs has seen similar growth, with 57.8% of physicians surveyed saying that their practice belonged to at least one type of ACO in 2022, compared with 44% in 2016.
Among the three types of ACOs, participation in commercial ACOs was the most prevalent, 45.1% in 2022, up from 42.7% in 2020; followed by Medicare ACOs, 38.1% in 2022, 36.7% in 2020; and Medicaid ACOs, 30% in 2022, 29.5% in 2020.
These findings are included in a new AMA Policy Research Perspectives report, “Payment and Delivery in 2022: Continued Growth in Accountable Care Organization While Alternative Payment Methods Stagnate” (PDF).
The biennial report draws on the AMA Physician Practice Benchmark Surveys, which are nationally representative surveys of post-residency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or the District of Columbia. The surveys have been done every other year since 2012 by the AMA.
Fee-for-service still dominates
The report analyzes participation growth in medical home and ACO care delivery models and the use of fee for service and alternative payment methods for practice payment.
Fee-for-service (FFS) remains the most common payment method with 86.4% of physicians reporting that their practice received a portion of their revenue that way in 2022. The report says 64.3% of physicians were in a practice that received revenue from an alternative payment method in 2022, which is down from 66.8% in 2020.
Pay for performance was the most common alternative payment method, with 41.4% saying that their practice received some revenue that way in 2022. Bundled payments were the next-most-popular method, at 39.6%; followed by capitation 25.5%; and shared savings, 22.2%.
“Despite the majority of physicians indicating they received at least some revenue from alternative payment methods, the data suggest the reliance of practice revenue on FFS has remained consistent,” the report says, noting that a roughly 70-30 split in the share of revenue coming from fee for service and alternative payment methods has been maintained since 2014.
A lower reliance on fee for service was seen among physicians in practices that participated in care delivery models compared to those that did not. In 2022, there was a 16-percentage point difference in fee-for-service revenue share for those participating in a Medicare ACO compared to those that were not, 21 percentage points for Medicaid ACO, and 16 percentage points for commercial ACO.
Trends by practice ownership, specialty
Doctors working in physician-owned private practices were “substantially less likely” than those hospital-owned practices to indicate their practice was involved in medical homes and ACOs in 2022, the AMA report says.
While 48.6% of doctors in hospital-owned practices took part in a Medicare ACO in 2022, only 29.4% of physicians in private practices did, a 19-percentage point gap. The gap between doctors in hospital-owned practices and those in private practices was 18 percentage points for Medicaid ACOs and 14 percentage points for commercial ACOs in 2022.
For each care-delivery model, doctors in practices with primary care physicians were more likely to indicate their practice belonged to an ACO or medical home than those in a practice without primary care physicians—between a 12- and 22-percentage point difference in 2022.
