More medical practices are willing to take on financial risk under an alternative pay models, but they say they can't find insurance companies to partner up with.
Nearly 60% of American Medical Group Association members say they are ready to embrace alternatives to fee-for-service payments within two years. More than 450 multispecialty medical groups and integrated delivery systems and 177,000 physicians are members of the group.
But while Medicare is eager to participate in new payment models, few other payers are, even though the Medicare Access and CHIP Reauthorization Act (MACRA) offers incentives for those signing up to receive performance bonuses.
18% of respondents said they can't find any local insurance company that offers risk-based products. Another 46% reported that only 1% to 19% of plans were offering risk products in their markets.
Under MACRA, providers will use either the Merit-based Incentive Payment System, known as MIPS, or an alternative payment model. Under MIPS, physician payments will be based on a compilation of quality measures and the use of EHRs.
It's believed that most providers will choose MIPS because they can't take on a hefty amount of risk. Many don't have the capital to set up an alternative payment model or to risk losing money with subpar performance. Although MIPS requires putting some profits on the line, it is much less of a gamble than heading into an APM without experience and confidence that quality measures are high.
The AMGA is asking Congress to not level penalties against providers who can't find insurance partners in their local markets.
“These problems must be addressed or the laudable goal of transitioning the healthcare system to one that rewards value will be unnecessarily delayed at best, or grind to a halt at worst,” Chester Speed, vice president of public policy at AMGA said in a statement.
Earlier this year, the CMS estimated that more than 125,000 clinicians will participate in advanced APMs for the 2018 performance year of MACRA.