Ama Policy

Physician Payment Reform H-390.849

Risk—Physicians Taking

1. Our AMA will advocate for the development and adoption of physician payment reforms that adhere to the following principles:

a) promote improved patient access to high-quality, cost-effective care;

b) be designed with input from the physician community;

c) ensure that physicians have an appropriate level of decision-making authority over bonus or shared-savings distributions;

d) not require budget neutrality within Medicare Part B;

e) be based on payment rates that are sufficient to cover the full cost of sustainable medical practice;

f) ensure reasonable implementation timeframes, with adequate support available to assist physicians with the implementation process;

g) make participation options available for varying practice sizes, patient mixes, specialties, and locales;

h) use adequate risk adjustment methodologies;

i) incorporate incentives large enough to merit additional investments by physicians;

j) provide patients with information and incentives to encourage appropriate utilization of medical care, including the use of preventive services and self-management protocols;

k) provide a mechanism to ensure that budget baselines are reevaluated at regular intervals and are reflective of trends in service utilization;

l) attribution processes should emphasize voluntary agreements between patients and physicians, minimize the use of algorithms or formulas, provide attribution information to physicians in a timely manner, and include formal mechanisms to allow physicians to verify and correct attribution data as necessary; and

m) include ongoing evaluation processes to monitor the success of the reforms in achieving the goals of improving patient care and increasing the value of health care services.

2. Our AMA opposes bundling of payments in ways that limit care or otherwise interfere with a physician’s ability to provide high quality care to patients.

3. Our AMA supports payment methodologies that redistribute Medicare payments among providers based on outcomes, quality and risk-adjustment measures only if measures are scientifically valid, verifiable, accurate, and based on current data.

4. Our AMA will continue to monitor health care delivery and physician payment reform activities and provide resources to help physicians understand and participate in these initiatives.

5. Our AMA supports the development of a public-private partnership for the purpose of validating statistical models used for risk adjustment.

Policy Timeline

CMS Rep. 6, A-09 Reaffirmation A-10 Appended: Res. 829, I-10 Appended: CMS Rep. 1, A-11 Appended: CMS Rep. 4, A-11 Reaffirmed in lieu of Res. 119, A-12 Reaffirmed in lieu of Res. 122, A-12 Modified: CMS Rep. 6, A-13 Reaffirmation I-15 Reaffirmation: A-16 Reaffirmed in lieu of: Res. 712, A-17 Reaffirmed: BOT Action in response to referred for decision: Res. 237, I-17 Reaffirmation: A-19 Reaffirmed: BOT Action in response to referred for decision Res. 111, A-19 Reaffirmed: BOT Action in response to referred for decision Res. 132, A-19 Reaffirmed: Res. 212, I-21, Reaffirmed: Res. 240, A-22Reaffirmation: A-22