- More physician practices are willing to take on downside risk in payment models, according to a new survey from trade association AMGA. It found that nearly three quarters of physician groups surveyed said they would be ready to accept downside risk payments in the next two years, up from 42% in 2015.
- The survey showed 56% of member revenues in 2018 were risk-based in a federal setting and 28% in a commercial setting. Fee-for-service payments declined 20% between the first survey in 2015 and the latest report.
- Still, practices listed a number of barriers to the ongoing transition to value-based payments. Doctor groups cited lack of access to administrative claims data, no uniform data submission or reporting standard and problematic financial benchmarking and risk-adjustment methodologies. Internal impediments included lack of infrastructure and physician compensation issues, according to AMGA.
Value-based alternative payment models are becoming more standard but physician wariness of putting revenue on the line is one of the biggest roadblocks to more widespread adoption.
Providers have balked at attempts to force them to take on risk, but CMS has only pushed harder to get doctors on board. Revisions to the Medicare Shared Savings Program have pushed accountable care organizations in the model to take on risk earlier.
Announcing the change last year, CMS Administrator Seema Verma said the program needed to evolve. "It's time for ACOs to start taking upside and downside risk," she said. "What the data tells us is that ACOs taking two-sided risk are delivering better results."
And the recently announced Primary Cares Initiative includes a path for large physician practices that includes 100% shared risk.
The AMGA survey shows Medicare Advantage continues to dominate federal risk-based payments, accounting for 30% of revenues in 2018. From 2016 to 2018, full capitated MA payments bumped up from 10% to 24%.
Bundled payments, however, have not gained much traction, and make up only about 1% of federal or commercial revenues. That rate could tick up as the Center for Medicare and Medicaid Innovation continues to consider more alternative payment model options.