Innovative ideas that focus on specific diseases and patient populations could soon be tested with physician specialists through new care delivery and payment models the Centers for Medicare & Medicaid Services (CMS) plans to support. The AMA and national physician specialty societies have been submitting recommendations for what these models might look like.
In response to the agency’s request for information, the AMA recently recommended detailed actions the agency should take in developing new specialty payment models, including allowing flexibility, offering risk protection for physicians and providing timely, accurate data so physicians can benchmark their progress. The AMA has been working with specialty societies to identify ways patient care can be improved while health care spending can be reduced through new payment models.
The AMA suggested CMS allow specialty physicians and groups to submit ideas for innovative care concepts, giving adequate time for these groups to develop proposals and submit them to the agency, then get feedback to improve them and potential technical and financial assistance to implement changes.
While the health conditions seen by different specialists have unique issues, barriers to the current payment and care delivery systems have common elements. “A relatively small number of different types of payment reforms can be developed that will be applicable to a broad range of specialties and the majority of patients within each specialty,” the AMA comments said.
If CMS proposes specific payment models for physicians to consider, the AMA emphasized that the new models should include the following elements:
- Flexibility. Physicians should be able to implement innovative care delivery in the most effective, efficient way possible without suffering financial penalties.
- Accountability. Physicians should be held accountable only for costs and quality measures that they can influence.
- Sustainability. New models should be grounded in data analysis, and savings expectations should be realistic and achievable.
- Protection. Physicians shouldn’t have to absorb the financial risk for caring for patients with unusual problems or for choices patients or other providers have made. Instead, new models should phase in financial risk and recognize the need for upfront transition costs.
CMS also should be prepared to provide timely, accurate data and feedback on performance, so physicians can easily track the service utilization and costs of patients participating in new models.
The AMA also suggested some payment models that CMS should consider in addition to the procedural episodes and complex chronic disease approaches for which it sought comments. For example, a model designed around uncomplicated chronic disease management could help prevent patients from developing more advanced disease and experiencing acute episodes.
Another potential model is specialty-specific, risk-adjusted global payments, in which larger practices or multi-specialty groups could design comprehensive, specialty-specific or condition-specific global payments. These payments would cover all services needed to treat a specific condition managed by that specialty.
The AMA and a number of specialty societies also made recommendations on how CMS should approach issuing to physicians a request for applications for new payment models.
Shaping care delivery and payment models is part of the AMA’s work to improve Professional Satisfaction and Practice Sustainability. Included in this work is the creation of tools that will enable physicians to adopt proven health care delivery and payment models that fit with their specific practice setting and diversity of services as well as continued efforts to shape government policy and legislation that will help these models gain momentum and flourish.
The AMA also recently submitted comments to CMS in response to another request for information, outlining recommendations for the kinds of support physician practices will need to enhance quality and lower costs in new models of care and payment.
