A new AMA analysis of physician practice trends shows that more practices are taking part in alternative payment models (APMs), accountable care organizations (ACOs), and patient-centered medical homes. At the same time, the research shows that fee for service remains the dominant source of physician practice revenue.
The AMA Policy Research Perspective report (PDF) tracks physician practice participation in care-delivery models from 2014–2024.
The biennial report draws on the AMA Physician Practice Benchmark Surveys, which are nationally representative surveys of postresidency physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and who practice in one of the 50 states or the District of Columbia. The surveys have been conducted every other year since 2012 by the AMA.
In 2014, 28.6% of physicians were in a practice that participated in a Medicare ACO, which rose to 37.6% in 2024. In that same period, participation in Medicaid ACOs reached 28.6% and climbed to 40.8% in commercial ACOs. Overall, 53.5% of physicians reported that their practice participated in at least one type of ACO in 2024. The survey has tracked commercial ACO participation since 2016, when 31.7% of responding physicians reported working in a practice that was part of one. That figure rose to 40.8% by 2024.
Participation in medical homes, meanwhile, rose from 23.7% in 2014 to 34.4% in 2022, then dropped to 25.6% by 2024.
For each of these value-based care arrangements, the 2024 participation rates represent a dip or stagnation from those seen in 2022. It is unclear why that is the case, but one potential reason is that the rise in employed physicians means that more doctors are unfamiliar with their organization’s contracting status. That could be driving an increase in “don’t know” responses in surveys, even if actual participation rates are similar. For commercial ACOs, for example, the “don’t know” response rose from 25.5% in 2022 to 31.8% in 2024.
The AMA has numerous resources, developed by industry experts and validated by those with real-world experience, to help ease participation in value-based care arrangements for physicians and their practices.
Fee for service remains dominant
Even as participation in value-based care arrangement grew, fee for service remained the primary revenue source for physician practices. The AMA report shows that 82.8% of physicians reported that their practice received some fee-for-service payments in 2024, and that two-thirds of total practice revenue came from such payments.
Still, APMs are gaining ground. While 59% of physicians reported that their practices collected some APM revenue in 2014, that figure rose to 62.4% by 2024. Revenue share also shifted: For every $100 in practice revenue, $32.30 came from APMs in 2024, compared to $28.10 a decade earlier. Meanwhile, total reliance on fee for service fell. In 2024, 28% of physicians reported that all revenue came from fee for service, down from 33.6% in 2014.
On the flip side, the share of physicians in practices that received all of their revenue from APMs rose from 6.5% to nearly 11%. Many APMs are based on the fee-for-service structure but add incentives to improve quality and efficiency. A hybrid system is emerging in which fee for service and value-based structures coexist says the AMA report.
Differences by practice settings
Participation in ACOs and APMs often correlates with practice type, ownership and specialty mix.
- Physicians in primary care practices were more likely to participate than those in practices without primary care physicians. 44.3% of physicians in practices with them reported Medicare ACO participation compared to 25.6% of those without.
- Physicians in multispecialty practices participated at the highest rate. Nearly half reported taking part in Medicare or commercial ACOs, compared with just 17% to 24% of physicians in solo practices.
- Physicians in hospital-owned practices reported participation rates up to 17 percentage points higher than physicians in physician-owned practices, depending on the care delivery model.
As the share of physicians in private practice falls, more decisions about participation in value-based care arrangements are made by larger health systems and hospital-owned networks, which are more likely to participate in ACOs and medical homes.
“The data also show differences across ownership structures, where physicians in hospital-owned practices were significantly more likely to report that their practices participated in each of the care delivery models than physicians in physician-owned practices,” says the report. “These differences ranged from 10 to 17 percentage points.”
