Ama Policy

Prospective Payment Model Best Practices for Independent Private Practice H-385.904

Risk—Physicians Taking

1. Our AMA supports the consideration of prospective payment elements in the development of payment and delivery reform that are consistent with AMA principles.

2. Our AMA supports the following principles to support physicians who choose to participate in prospective payment models:

a. The AMA, state medical associations, and national medical specialty societies should be encouraged to continue to provide guidance and support infrastructure that allows independent physicians to join with other physicians in clinically integrated networks, independent of any hospital system.

b. Prospective payment model compensation should incentivize specialty and primary care collegiality among independently practicing physicians.

c. Prospective payment models should take into consideration clinical data, where appropriate, in addition to claims data.

d. Governance within the model must be physician-led and autonomous.

e. Physician practices should be encouraged to work with field advisors on patient attributions and a balanced mix of payers.

f. Quality metrics used in the model should be clinically meaningful and developed with physician input.

g. Administrative burdens, such as those related to prior authorization, should be reduced for participating physicians.

3. Our AMA will identify financially viable prospective payment models and develop educational opportunities for physicians to learn and collaborate on best practices for such payment models for physician practice, including but not limited to independent private practice.

Policy Timeline

CMS Rep. 2, A-22