In a letter to CMS, the AMA is opposing the agency's option of attributing Medicare beneficiaries to an accountable care organization after care has been delivered, called retrospective attribution.
"Retrospective attribution is particularly problematic, since neither the patient nor the physician knows that CMS is assigning accountability to the physician for the costs of all of the patient’s care until after the care has already been delivered," the AMA stated.
The AMA argued that retrospective attribution could incent ACOs to not provide primary care services to new Medicare patients because "a single visit could result in all of the beneficiary’s healthcare costs being attributed to the ACO."
It added: "Without active patient support and participation, the ability of physicians to help patients improve their health, avoid unnecessary hospitalizations and reduce the use of unnecessary and duplicative services is inherently limited."
AMA made three recommendations on attributing patients to ACOs:
1. Only those patients who "voluntarily choose its physicians to provide or manage their care" should be attributed to an ACO.
2. CMS should not use "statistical attribution methodologies, particularly retrospective attribution."
3. Medicare beneficiaries should be educated and encouraged "to take actions that will help make ACOs successful." These actions include using a primary care physician as a medical home and selecting specialty physicians, hospitals and other providers that "coordinate effectively with their primary care medical home and each other."
Read the AMA letter to CMS (pdf).
Read more coverage on patient attribution in ACOs:
- 5 Problems With ACOs
- CMS Asks When Medicare Beneficiaries Should be Assigned to ACOs
- Why You Should Be Concerned With How Patients Are Attributed in ACOs
"Retrospective attribution is particularly problematic, since neither the patient nor the physician knows that CMS is assigning accountability to the physician for the costs of all of the patient’s care until after the care has already been delivered," the AMA stated.
The AMA argued that retrospective attribution could incent ACOs to not provide primary care services to new Medicare patients because "a single visit could result in all of the beneficiary’s healthcare costs being attributed to the ACO."
It added: "Without active patient support and participation, the ability of physicians to help patients improve their health, avoid unnecessary hospitalizations and reduce the use of unnecessary and duplicative services is inherently limited."
AMA made three recommendations on attributing patients to ACOs:
1. Only those patients who "voluntarily choose its physicians to provide or manage their care" should be attributed to an ACO.
2. CMS should not use "statistical attribution methodologies, particularly retrospective attribution."
3. Medicare beneficiaries should be educated and encouraged "to take actions that will help make ACOs successful." These actions include using a primary care physician as a medical home and selecting specialty physicians, hospitals and other providers that "coordinate effectively with their primary care medical home and each other."
Read the AMA letter to CMS (pdf).
Read more coverage on patient attribution in ACOs:
- 5 Problems With ACOs
- CMS Asks When Medicare Beneficiaries Should be Assigned to ACOs
- Why You Should Be Concerned With How Patients Are Attributed in ACOs