Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn

Shortell, Stephen M.; McClellan, Sean R.; Ramsay, Patricia P.; Casalino, Lawrence P.; Ryan, Andrew M.; Copeland, Kennon R.

doi:10.1111/1475-6773.12167

Cited by 69 publications

(61 citation statements)

References 33 publications

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“…The survey instrument has been described in detail elsewhere. 1 We measured compensation as the percentage of primary care physician compensation that was based on salary, productivity, clinical quality or patient experience, and other factors. Practices were classified as having substantial risk for primary care costs if they had some financial risk for all their health maintenance organization and point-of-service patients.…”

Section: Methodsmentioning

confidence: 99%

“…1 One question concerns compensation arrangements: how should practices in ACOs pay primary care physicians to Andrew M. Ryan create incentives for meeting quality measures while constraining costs? The ACO payment model provides incentives for efficiency that are on the continuum between no-risk, fee-for-service payment and full-risk, capitated payment.…”

Section: Introductionmentioning

confidence: 99%

“…The ACO payment model provides incentives for efficiency that are on the continuum between no-risk, fee-for-service payment and full-risk, capitated payment. 1,2 If ACOs bore financial risk only for primary care costs, salaried compensation would align the interests of physicians and ACOs to decrease primary care costs. ACOs are at risk, however, for the total cost of care, not just primary care costs.…”

Section: Introductionmentioning

confidence: 99%

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Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations

Ryan

Shortell

Ramsay

et al. 2015

The Annals of Family Medicine

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BACKGROUNDThe accountable care organization (ACO) is a new organizational form to manage patients across the continuum of care. There are numerous questions about how ACOs should be optimally structured, including compensation arrangements with primary care physicians.METHODS Using data from a national survey of physician practices, we compared primary care physicians' compensation between practices in ACOs and practices that varied in their financial risk for primary care costs using 3 groups: practices not participating in a Medicare ACO and with no substantial risk for primary care costs; practices not participating in an ACO but with substantial risk for primary care costs; and practices participating in an ACO regardless of their risk for primary care costs. We measured physicians' compensation as the percentage of compensation based on salary, productivity, clinical quality or patient experience, and other factors. Regression models estimated physician compensation as a function of ACO participation and risk for primary care costs while controlling for other practice characteristics.RESULTS Physicians in ACO and non-ACO practices with no substantial risk for costs on average received nearly one-half of their compensation from salary, slightly less from productivity, and about 5% from quality and other factors. Physicians not in ACOs but with substantial risk for primary care costs received two-thirds of their compensation from salary, nearly one-third from productivity, and slightly more than 1% from quality and other factors. Participation in ACOs was associated with significantly higher physician compensation for quality; however, participation was not significantly associated with compensation from salary, whereas financial risk was associated with much greater compensation from salary.CONCLUSION Although practices in ACOs provide higher compensation for quality, compared with practices at large, they provide a similar mix of compensation based on productivity and salary. Incentives for ACOs may not be sufficiently strong to encourage practices to change physician compensation policies for better patient experience, improved population health, and lower per capita costs.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations

Ryan

Shortell

Ramsay

et al. 2015

The Annals of Family Medicine

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“…Increasingly, physicians are forming or joining accountable care organizations (ACOs) to take on such contracts. 1-3 As of 2014, Medicare has entered into ACO agreements with 360 physician organizations caring for 5.3 million beneficiaries. 4 Combined with a similar growth in the private sector, an estimated 18 million persons in the United States have insurance coverage in which their physicians are in ACO arrangements.…”

mentioning

confidence: 99%

Changes in Health Care Spending and Quality 4 Years into Global Payment

et al. 2014

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BACKGROUND Spending and quality under global budgets remain unknown beyond 2 years. We evaluated spending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC). METHODS We compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality. RESULTS In the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P<0.001). This amount is equivalent to a 6.8% savings when calculated as a proportion of the average post-AQC spending level in the 2009 AQC cohort. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (P<0.001), 9.1% (P<0.001), and 5.8% (P = 0.04), respectively, by the end of 2012. Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization. Claims savings were exceeded by incentive payments to providers during the period from 2009 through 2011 but exceeded incentive payments in 2012, generating net savings. Improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally. CONCLUSIONS As compared with similar populations in other states, Massachusetts AQC enrollees had lower spending growth and generally greater quality improvements after 4 years. Although other factors in Massachusetts may have contributed, particularly in the later part of the study period, global budget contracts with quality incentives may encourage changes in practice patterns that help reduce spending and improve quality. (Funded by the Commonwealth Fund and others.)

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“…A recent (October 2013) survey found that nearly 75% of providers who responded participated in at least one value-based payment model. 4 Over 60% believed that these programs would be the majority model in future health care fi nance, whereas less than 30% agreed that the model incentivized the risks associated with this system appropriately. Now more than ever the fi scal strength of health care organizations will be tied directly to the clinical outcomes of the populations they serve.…”

mentioning

confidence: 99%

Physicians as Executives: Opportunities and Strategies for Health-System Pharmacy Leaders

2014

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To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services.

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Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn

Abstract: Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices.

Cited by 69 publications

References 33 publications

Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations

Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations

Changes in Health Care Spending and Quality 4 Years into Global Payment

Physicians as Executives: Opportunities and Strategies for Health-System Pharmacy Leaders

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