Ama Policy

Physician-Focused Alternative Payment Models H-385.913

Risk—Physicians Taking

1. Our AMA recognizes that the physician is best suited to assume a leadership role in transitioning to alternative payment models (APMs).

2. Our AMA supports that the following goals be pursued as part of an APM:

A. Be designed by physicians or with significant input and involvement by physicians;

B. Provide flexibility to physicians to deliver the care their patients need;

C. Promote physician-led, team-based care coordination that is collaborative and patient-centered;

D. Reduce burdens of Health Information Technology (HIT) usage in medical practice;

E. Provide adequate and predictable resources to support the services physician practices need to deliver to patients, and should include mechanisms for regularly updating the amounts of payment to ensure they continue to be adequate to support the costs of high-quality care for patients;

F. Limit physician accountability to aspects of spending and quality that they can reasonably influence;

G. Avoid placing physician practices at substantial financial risk;

H. Minimize administrative burdens on physician practices; and

I. Be feasible for physicians in every specialty and for practices of every size to participate in.

3. Our AMA supports the following guidelines to help medical societies and other physician organizations identify and develop feasible APMs for their members:

A. Identify leading health conditions or procedures in a practice;

B. Identify barriers in the current payment system;

C. Identify potential solutions to reduce spending through improved care;

D. Understand the patient population, including non-clinical factors, to identify patients suitable for participation in an APM;

E. Define services to be covered under an APM;

F. Identify measures of the aspects of utilization and spending that physicians can control;

G. Develop a core set of outcomes-focused quality measures including mechanisms for regularly updating quality measures;

H. Obtain and analyze data needed to demonstrate financial feasibility for practice, payers, and patients;

I. Identify mechanisms for ensuring adequacy of payment; and

J. Seek support from other physicians, physician groups, and patients.

4. Our AMA encourages CMS and private payers to support the following types of technical assistance for physician practices that are working to implement successful APMs:

A. Assistance in designing and utilizing a team approach that divides responsibilities among physicians and supporting allied health professionals;

B. Assistance in obtaining the data and analysis needed to monitor and improve performance;

C. Assistance in forming partnerships and alliances to achieve economies of scale and to share tools, resources, and data without the need to consolidate organizationally;

D. Assistance in obtaining the financial resources needed to transition to new payment models and to manage fluctuations in revenues and costs; and

E. Guidance for physician organizations in obtaining deemed status for APMs that are replicable, and in implementing APMs that have deemed status in other practice settings and specialties.

5. Our AMA will continue to work with appropriate organizations, including national medical specialty societies and state medical associations, to educate physicians on alternative payment models and provide educational resources and support that encourage the physician-led development and implementation of alternative payment models.

Policy Timeline 

CMS Rep. 09, A-16 Reaffirmed: CMS Rep. 10, A-17 Reaffirmed: CMS Rep. 10, A-19 Reaffirmed: BOT Rep. 13, I-20 Reaffirmed: CMS Rep. 2, A-22