Accountable Care Organizations must be physician-led, patient-centric, and ensure voluntary participation from patients and physicians, including independent practitioners, under the American Medical Association's principles for ACOs.
“The AMA is committed to ensuring physicians in all practice sizes can lead and participate successfully in new models that allow them to provide the best care to their patients,” says AMA President Cecil B. Wilson, MD. “For this to happen, significant barriers must be addressed, including a lack of resources, existing antitrust rules and conflicting federal policies.
The principles were made public at the AMA's semi-annual policy-making meeting.
Wilson wants flexibility for physicians in all practice sizes to participate in ACOs.
Although ACOs and other models of patient care were recently authorized in the new health reform law, existing antitrust and fraud rules can make becoming part of an ACO difficult for physicians, especially those in small practices, AMA says.
The latest AMA Physician Practice survey found that 78% of office-based physicians in the United States work in practices with nine physicians or less. A majority of those are in either solo practices or practices of two to four physicians.
Key provisions of the 13-point set of principles adopted by the AMA include:
- Guiding Principle—The goal of an ACO is to increase access to care, improve the quality of care and ensure the efficient delivery of care. Within an ACO, a physician's primary ethical and professional obligation is the well-being and safety of the patient.
- ACO Governance—ACOs must be physician-led and encourage an environment of collaboration among physicians. ACOs must be physician-led to ensure that a physician's medical decisions are not based on commercial interests but rather on professional medical judgment that puts patients' interests first.
- Physician and patient participation in an ACO should be voluntary. Patient participation in an ACO should be voluntary rather than a mandatory assignment to an ACO by Medicare. Any physician organization or any other entity that creates an ACO must obtain the written consent of each physician to participate in the ACO. Physicians should not be required to join an ACO as a condition of contracting with Medicare, Medicaid or a private payer or being admitted to a hospital medical staff.
- The savings and revenues of an ACO should be retained for patient care services and distributed to the ACO participants.
- Flexibility in patient referral and antitrust laws. Federal and state anti-kickback and self-referral laws and the federal Civil Monetary Penalties statute should be flexible to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs. This is particularly important for physicians in small- and medium-sized practices who may want to remain independent but otherwise integrate and collaborate with other physicians in the ACO.
See also:
Could Health Plans Derail ACOs?
John Commins is the news editor for HealthLeaders.