54% of Physicians Participate in an Accountable Care Organization

September 24, 2019 - The majority of physicians now participate in an accountable care organization (ACO), the American Medical Association (AMA) recently reported.

Overall, 53.8 percent of physicians polled in September 2018 for the AMA’s Physician Practice Benchmark Survey reported participating in at least one ACO type that year. The percentage is up from 44.0 percent in 2016, the recently released research paper revealed.

More specifically, in 2018, 38.2 percent of physicians belonged to a Medicare ACO, 26.3 percent to a Medicaid ACO, and 39.0 percent to a commercial ACO, the data showed. Participation in each of the ACO types also increased significantly compared to 2016 by five to seven percentage points.

AMA researchers also found an uptick in medical home participation from 2016 to 2018. The number of physicians belonging to a medical home jumped from 25.7 percent in 2016 and 23.7 percent in 2014 to 32.0 percent by 2018, the data showed.

Participation in both ACOs and medical homes has been on the rise since the AMA first started to collect data for the Physician Practice Benchmark Survey in 2014. However, the increases in physician participation rates for medical homes and Medicare ACOs from 2016 to 2018 were significantly larger than the growth observed from 2014 to 2016, AMA pointed out.

For Medicare ACOs, physician participation grew from 28.6 percent in 2014 and 31.8 percent in 2016 to 38.2 percent by 2018.

AMA also observed significant increases in both Medicaid ACO participation, which went from 20.9 percent in 2016 to 26.3 percent in 2018, and commercial ACO participation, which increased from 31.7 percent in 2016 to 39.0 percent in 2018.

Physicians from multi-specialty practices were the most likely to participate in a medical home or ACO. Participation rates for each type of ACO and medical home were between 13 and 22 percentage points higher for physicians in multi-specialty practices compared to those in single-specialty practices, the data revealed.

Solo practitioners were the least likely to participate in any of the alternative payment and care delivery models. Among the physicians in solo practices, only 11.1 percent belonged to a medical home, 22.6 percent to a Medicare ACO, 14.6 percent to a Medicaid ACO, and 27.2 percent to a commercial ACO.

Medical home and ACO participation also differed among physicians in practices that are physician- or hospital-owned, the data revealed.

Participation in medical homes and Medicare ACOs was over 20.0 percentage points higher among physicians in hospital-owned practices. Participation in Medicaid and commercial ACOs was also 18.0 and 11.0 percentage points higher, respectively, AMA reported.

Hospital-owned practices may be better equipped to participate in the alternative payment and care delivery models, the report explained. Research shows that hospitals have the capital and infrastructure needed for quality reporting, data sharing, engagement across practices, and other value-based capabilities.

Although, another possibility is that practices with primary care physicians are more likely to be hospital-owned and whether a practice has primary care physicians is associated with increased medical home and ACO participation, AMA stated.

Participation in medical homes and each type of ACO was significantly higher among physicians in practices with at least some primary care physicians, the data uncovered.

Researchers saw the greatest difference in medical home participation, with rates being 26 percentage points higher among physicians in practices with some primary care physicians versus those in practices without any primary care physicians.

The difference was “smaller but still substantial” for Medicare ACOs (18.0 percentage points), Medicaid ACOs (11.0 percentage points), and commercial ACOs (12.0 percentage points).

“Overall, the data suggest that whether a practice has primary care physicians is a critical factor in the decision to participate in care delivery models such as medical homes and ACOs, a finding which is consistent with literature on this topic,” the report stated.

In general, medical home and ACO participation is helping physicians transition away from fee-for-service, the reported concluded.

In 2018, 42.0 percent of physicians reported at least some payment through pay-for-performance arrangements, which was an increase from 32.7 percent in 2014. Thirty-six percent also reported at least some payment through bundled payments and 18.9 percent received revenue from shared savings models.

Capitation was the only alternative payment model in which participation remained stable, if not decreasing, the AMA found. In 2018, 23.9 percent of physicians reported at least some payment through capitation versus 26.1 percent in 2014.

Despite increased participation in most alternative payment models, fee-for-service was still the dominant source of revenue for practices since many of the models are built on fee-for-service payments.