Helping private practices play their part in new payment models

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The AMA and other medical associations can do their part to guide physicians, including independent physicians in private practice, in participating in forward-looking payment models. The new policy offers guidance on collaborating with other medical practices while maintaining autonomy, reducing administrative burdens and improving quality metrics.

Interest in value-based or alternative payment models has gained traction over the past 10 years among public and private payers concerned about rising health care costs and quality outcomes. In 2020, according to a report that was adopted at the 2022 AMA Annual Meeting in Chicago.

“Prospective, appropriately funded payment models provide a solution to provide potential stability and predictability of payment for certain practices when demand for services declines,” the AMA Medical Services Council report states.

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But significant barriers remain. Payment models have become increasingly complex and the lack of up-to-date data and operational errors have also hindered their adoption. Expensive health information technology has been a major barrier. Small private practices interested in collecting real-time actionable data may not have an IT system that supports a forward-looking payment model.

Physicians practicing independently would benefit from new principles to address the unique challenges of contracting with other practices on prospective payments.

With this in mind, the AMA House of Delegates adopted a new policy to “support the consideration of potential payment elements in the development of payments and delivery reform that are consistent with the principles of WADA”.

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Delegates also adopted a policy to uphold the following principles to support physicians choosing to participate in prospective payment models:

  • The AMA, state medical associations, and national medical specialty societies should be encouraged to continue to provide guidance and a support infrastructure that enables independent physicians to join other physicians in clinically integrated networks, independent of any hospital system.
  • Remuneration of the prospective payment model should encourage specialty and primary care collegiality among independently practicing physicians.
  • Forward-looking payment models should consider clinical data, if available, in addition to claims data.
  • Governance within the model should be physician-led and autonomous.
  • Medical practices should be encouraged to work with field advisors on patient allocations and a balanced mix of payers.
  • The quality parameters used in the model should be clinically meaningful and developed with input from physicians.
  • Administrative burdens, such as those related to prior authorisation, should be reduced for participating physicians.

Delegates also asked the AMA to “identify potential payment models that are financially viable and develop training opportunities for physicians to learn and collaborate on best practices for such payment models for practice.” private independent”.

Check out other highlights from the 2022 AMA Annual Meeting.

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