In a letter to CMS, the AMA listed six ways to help independent physicians to form accountable care organizations.
1. Create safe harbors from federal enforcement. Current federal enforcement favors hospital-based systems with employed physicians. But allowing individual physicians to band together in ACOs is "the best way to preserve opportunities for appropriate competition in health care and choice for patients."
2. Don't raise the minimum number of beneficiaries. While raising the minimum number of beneficiaries from the current level of 5,000 would "increase the statistical confidence of cost and quality measures," this would cut out small practices and make it more likely that there would be only be one ACO in many communities. Competing ACOs would allow for choice.
3. Don’t force ACOs to buy EMRs. "Purchasing and maintaining electronic health record systems is very expensive, particularly for small physician practices," and "there is no evidence that they are essential for physician practices to successfully coordinate care and manage costs," the AMA said.
4. Modify fee-for-service payments. Shared savings payments for ACOs "do not represent true payment reform; they are merely another form of a pay-for-performance bonus on top of a fundamentally broken payment system," the AMA said. Also, delays in calculating and paying bonuses may force physicians to lose money. CMS should consider either "authorizing new or higher payments for specific CPT codes or making flexible per-patient payments, such as through partial capitation or other methods."
5. Limit accountability when only one provider exists. When there is only one choice of provider in the community and that provider is not part of the ACO, the ACO should not be penalized for that provider's actions.
6. Provide timely, detailed data. Practices need data to help identify opportunities to make improvements in cost and quality and to successfully implement them. These data need to include all services received by patients, allow for detailed analysis and simulation, and be available in a timely basis.
Read the AMA letter to CMS (pdf).
Read more coverage on physicians forming ACOs.
-AMGA Offers Feedback to NCQA's 2011 ACO Criteria
-Four Medical Associations Release Joint Principles for ACOs
-AMA Establishes Principles for ACOs
1. Create safe harbors from federal enforcement. Current federal enforcement favors hospital-based systems with employed physicians. But allowing individual physicians to band together in ACOs is "the best way to preserve opportunities for appropriate competition in health care and choice for patients."
2. Don't raise the minimum number of beneficiaries. While raising the minimum number of beneficiaries from the current level of 5,000 would "increase the statistical confidence of cost and quality measures," this would cut out small practices and make it more likely that there would be only be one ACO in many communities. Competing ACOs would allow for choice.
3. Don’t force ACOs to buy EMRs. "Purchasing and maintaining electronic health record systems is very expensive, particularly for small physician practices," and "there is no evidence that they are essential for physician practices to successfully coordinate care and manage costs," the AMA said.
4. Modify fee-for-service payments. Shared savings payments for ACOs "do not represent true payment reform; they are merely another form of a pay-for-performance bonus on top of a fundamentally broken payment system," the AMA said. Also, delays in calculating and paying bonuses may force physicians to lose money. CMS should consider either "authorizing new or higher payments for specific CPT codes or making flexible per-patient payments, such as through partial capitation or other methods."
5. Limit accountability when only one provider exists. When there is only one choice of provider in the community and that provider is not part of the ACO, the ACO should not be penalized for that provider's actions.
6. Provide timely, detailed data. Practices need data to help identify opportunities to make improvements in cost and quality and to successfully implement them. These data need to include all services received by patients, allow for detailed analysis and simulation, and be available in a timely basis.
Read the AMA letter to CMS (pdf).
Read more coverage on physicians forming ACOs.
-AMGA Offers Feedback to NCQA's 2011 ACO Criteria
-Four Medical Associations Release Joint Principles for ACOs
-AMA Establishes Principles for ACOs