Physician Payment Models
As the US spends nearly three trillion dollars a year on health care, there have been numerous discussions and debates on how to change physician payment models in order to reduce health care spending.
Over the past few years, several payment models have been proposed in an effort to phase out the fee-for-service currently used in the US. Of particular interest to the American Medical Association (AMA) are models of payment for team-based care. “A physician-led team approach to care – with each member of the team playing the role they are educated and trained to play – helps ensure patients get high quality care and value for their health care spending,” said Dr. Rebecca J. Patchin, AMA Board Member.
During the House of Delegates’ interim meeting on Monday, November 18th, 2013, the (AMA) adopted payment model recommendations that support the physician-led team approach, and suggested physician leaders receive payment for services. Additionally, the AMA believes the physician leaders should, in turn, make decisions as to the amount each member of the team gets paid.
AMA Council on Medical Services Recommendations
The specific recommendations proposed by the AMA Council on Medical Services are as follows:
A. That the AMA advocates that physicians who lead team-based care in their practices receive the payments for health care services provided by the team, and establish payment disbursement mechanisms that foster physician-led team-based care.
B. That the AMA advocate that physicians make decisions about payment disbursement in consideration of team member contributions, including but not limited to:
- Volume of services provided
- Intensity of services provided
- Profession of the team member
- Training and experience of the team member
- Quality of care provided
C. That the AMA advocate that an effective payment system for physician-led team-based care should:
- Reflect the value provided by the team and that any savings accrued by this value should be shared by the team;
- Reflect the time, effort and intellectual capital provided by individual team members;
- Be adequate to attract team members with the appropriate skills and training to maximize the success of the team; and
- Be sufficient to sustain the team over the time frame that it is needed.
D. The AMA advocate that payment models for physician-led team-based care should be determined by physicians working collaboratively with hospital and payer partners to design models best suited for their particular circumstances.
E. That the AMA develop educational programs to assist members wishing to develop and implement physician-led team-based care payment methodologies at the individual team, practice, accountable care organization, hospital, and health system levels.
Pushing Back Against Unsupervised Care
According to the article in Modern Healthcare, the AMA continues to “push back hard against efforts to expand the scope of practice of other clinicians – most notably nurse practitioners – who have sought a larger role in providing unsupervised patient care.” While a recent survey by the American Association of Nurse Practitioners shows public support for easing supervision requirements for nurse practitioners, the AMA stands behind physician-led team requirements due to the extensive postgraduate education and clinical experience required of physicians versus that of nurse practitioners.
In a recent news release, Dr. Ardis Hoven, AMA President, quoted Dr. William Mayo, “It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient.” According to Dr. Hoven, “The AMA and the broader physician community firmly believe that this approach represents the future of health care delivery in America.”
American Medical Association House of Delegates Preliminary report. (2013). Retrieved online November 20, 2013 from: http://www.ama-assn.org/assets/meeting/2013i/i13-refcommj-annotated.pdf
American Medical Association. (2010). AMA Responds to IOM Report on Future of Nursing. Retrieved online, November 20, 2013 from:http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.page
American Medical Association News Room. (2013). AMA Passes Recommendations for Payment Models that Support New Approaches to Team-Based Health Care. Retrieved online, November 20, 2013 from: http://www.ama-assn.org/ama/pub/news/news/2013/2013-11-18-ama-passes-recommendation-for-payment-models.page
McKinney, M. (2013). AMA backs payment models for doc-led, team-based care. Modern Healthcare. Retrieved online November 20, 2013 from: http://www.modernhealthcare.com/article/20131119/NEWS/311199972