To best meet the goals of optimized, coordinated patient care and also help curb costs, physicians should be at the center of accountable care organizations (ACOs), the American Medical Association told the Centers for Medicare and Medicaid Services (CMS) in a Dec. 2 letter.

ACOs are an evolving model of patient care focused on improving care and driving down cost, efforts underpinned by healthcare information technology.

"The AMA's recommendations make it possible for physicians in all practice sizes and settings to successfully participate in ACOs, which will foster competition and innovation to benefit patients and our health system," said AMA President Cecil B. Wilson, MD.  "We urge CMS to adopt these recommendations so that these new models of care can meet their potential to optimize patient care and curb healthcare costs."

The AMA's recommendations to CMS on structuring physician-led ACOs include developing new payment models for physicians that move Medicare away from the existing physician payment system.

Pending Medicare physician payment cuts will impede physicians' efforts to improve care coordination, such as paying case managers and investing in infrastructure to monitor and improve quality, the AMA states.

The AMA recommends a range of specific new payment methods that CMS should consider in addition to shared savings, including an accountable medical home payment system and bundled payments for specific medical conditions, such as congestive heart failure.  Other recommendations include increased access to loans and grants for small physician practices, easing of antitrust restrictions that prevent physicians from collaborating, and timely access to quality data.
 
"The physician-led ACO model injects competition into the market by eliminating the need for consolidation under a hospital system," said Wilson. "Competition fosters innovation, which ultimately helps patients receive efficient high-quality care. Care coordination is vital, and physicians can work together with a healthcare team to keep patients healthy and out of the hospital while maintaining independent medical practices. CMS should adopt policies that facilitate physician-led ACOs and do not inadvertently bias participation in favor of large health systems and hospitals." 
 
"Our goal is to ensure that new models of care benefit patients, and for this to happen physicians must be able to successfully participate in and lead ACOs," Wilson said.