Practices' transition to new payment models will likely be an area of high focus in the coming year. Some medical groups have already begun their journey, but according to a new report from the American Medical Association (AMA), not all physicians are even sure how far they've traveled.
For both medical homes and accountable care organizations (ACOs), almost 25 percent of physicians participating in the AMA's 2014 Benchmark Survey did not know their practice's participation status. In general, physicians in solo practices were more informed about these details.
Additional highlights of the study included the following:
- Overall, 23.7 percent of physicians were part of a medical home in 2014, while 28.6 percent were part of a Medicare ACO. Participation in both models was highest among multi-specialty practices and lowest in solo practices.
- Being owned by a hospital significantly increased the odds a group belonged to an ACO or medical home. Among hospital-owned single-specialty practices, 36 percent participated in an ACO while 31.4 percent were part of a medical home.
- In 2014, 59 percent of physicians worked in practices that received payment through at least one alternative payment model, though very few groups had eliminated fee-for-service reimbursement entirely.
Several developments, including the Medicare Access and CHIP Reauthorization Act, are pushing physicians closer to value-based pay and bundled payment, noted a recent article from NEJM Catalyst.
Success in these models relies on reducing variability within episodes of care "by providing consistent care that follows accepted guidelines with predictable outcomes and costs," the authors noted.
Two common denominators among organizations that do this well are disciplined care redesign based on institutional guidelines and a culture of provider accountability in which utilization is monitored and managed by leadership. Finally, cases that don't fit the typical mold because of comorbidities or other factors should be considered "bundle breakers" with their own default payment structure, according to the article.