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November 8, 2023
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David Burda
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Outcomes Policy System Dynamics
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Physician APM Participation Is Like Eating Cauliflower

My youngest child is a picky eater. He would say otherwise, but he is. He’s gone from eating zero of six pieces of cauliflower on his plate to now eating two of six pieces of cauliflower on his plate. That’s taken 20 years. Our goal is six of six by the time he’s 60. I’ll be 102, and I am determined to stick around that long if only to see him eat all his cauliflower. It’s a test of wills.

For what it’s worth, the above holds true under a variety of parental test conditions: boiled, steamed, broiled with breadcrumbs, deep-fried or Buffalo style.

If you replace my son in that equation with doctors and me with CMS or consumers, you understand the transition from fee-for-service, or FFS, payment systems to alternative payment models, or APMs.

If you don’t believe me, you should read the American Medical Association’s latest research report on physician participation in APMs. The 20-page report is based on an AMA survey of about 3,500 doctors. It’s the latest installment in a series of biennial surveys that began in 2012.

APMs are reimbursement models that put providers at financial risk for the care that they provide to their patients. APMs take many forms. The AMA report covers four basic forms: pay-for-performance, capitation, bundled payments and shared shavings.

Overall, the percentage of physicians who said they work in practices that receive at least some of their revenue from FFS payment arrangements dipped to 86.4% last year from 88.1% in 2021. It was 89.4% in 2012. Meanwhile, the percentage of physicians who said they work in practices that receive at some of their revenue from APMs also dipped last year to 64.3% from 66.8% in 2021. It was 57.6% in 2012.

In other words, over the past decade, FFS decreased just three percentage points, while APMs increased just 6.7%. The AMA used the word “stable” to describe physician participation in FFS arrangements over 10 years. The AMA used the word “stagnate” to describe physician participation in APMs over 10 years.

Here’s how physician participation broke down by the four APM types included in the report:

  • 41.4% in pay-for-performance last year, down from 44.5% in 2021
  • 25.5% in capitation last year, up from 23.8% in 2021
  • 39.6% in bundled payments last year, down from 40.1% in 2021
  • 22.2% in shared savings last year, up from 21.5%

That’s more like moving the cauliflower around on your plate so no one knows how much you really ate.

Thanks for reading.

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About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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