Physicians increasingly report participating in an accountable care organization (ACO) or other alternative payment model (APM), but fee-for-service payments still make up the bulk of practice revenue, continuing a yearslong trend.
These are among the findings of a new study from the American Medical Association, which draws on survey data collected between 2012 and 2022.
“Despite the majority of physicians indicating their practice received at least some payment from alternative payment methods, roughly 70% of practice revenue was from fee-for-service and 30% from alternative payment methods,” the researcher wrote. “These average shares have been consistent since 2014, although the data show a shift away from complete reliance on fee-for-service and a shift towards using a blend of alternative payment methods and fee for service.”
In recent years, the Centers for Medicare & Medicaid Services has stated its aim to transition all Medicare patients to value-based care arrangements by 2030. Meanwhile, commercial payers increasingly offer their own value-based contracts.
Physician participation in various such models – including medical homes and ACOs via Medicare, Medicaid, and commercial payers – grew modestly in 2022, according to the study. For instance, 38.1% of survey respondents worked in a practice that belonged to a Medicare ACO compared to 36.7% in 2020 and 29% in 2014.
A majority (64.3%) of survey respondents also worked in practices that received at least some revenue from an APM for care they provided in 2022. This represents a slight decrease – from 66.8% – in 2020 despite a general trend up from 57.6% in 2012.
But an even larger share of respondents (86.4%) said their practices received at least some revenue from fee-for-service payments. Coupled with the data showing that practice revenue from fee-for-service payments is more than double that of value-based payments, on average, this indicates that practices remain reliant on traditional models, the study author notes.
Physician uptake and awareness of value-based care models vary widely among specialties and across practice settings. Survey data show multi-specialty practices, those with primary care physicians, and hospital-owned practices were more likely to participate in ACOs and APMs than solo practices, those without primary care physicians, and independent practices.
Meanwhile, the share of physician respondents who didn’t know whether their practice belonged to an ACO continues to fall, a change the researcher attributes to increased awareness among employed physicians.
The Texas Medical Association is currently surveying member physicians about value-based care. Please check your inbox to respond.
You also can find more information about APMs on TMA’s new Accountable Care webpage.
Emma Freer
Associate Editor
(512) 370-1383