Federal regulators are expected to release policies regarding CMS' accountable care organization demonstration project — a project created by the Patient Protection and Affordable Care Act — later this fall. One area that these policies will address is how patients are attributed to ACOs.
How attribution works
The Medicare Physician Group Practice demonstration, a precursor to the ACO demonstration, assigned patients retrospectively, meaning that physicians participating in the project did not know which of their patients were included until after the data had been received by CMS. Within the demonstration, CMS assigned patients to a physician based on claims data indicating which physician they had visited most regularly.
"The attribution is for quality and cost analysis purposes only, and does not restrict the patient from seeing other providers," says Chet Speed, vice president of public policy at the American Medical Group Association.
Prospective vs. retrospective attribution
Retrospective attribution can be challenging for physicians. In the Physician Group Practice demonstration, physicians often had to wait 18 months to receive data on their performance. "Essentially, physicians were measured on how well they reduced costs and increased quality, and with retrospective attribution you don't find out until the end whether or not a patient was included," says Donald W. Fisher, PhD, CAE, president and CEO of the AMGA. "It's important to have prospective attribution because you have to get the patients engaged." Without prospective attribution, physicians have to wait until the data is shared with them to know how their patients are doing, and this delayed analysis diminishes the opportunity for timely improvement, he says.
Learn more about the AMGA.
How attribution works
The Medicare Physician Group Practice demonstration, a precursor to the ACO demonstration, assigned patients retrospectively, meaning that physicians participating in the project did not know which of their patients were included until after the data had been received by CMS. Within the demonstration, CMS assigned patients to a physician based on claims data indicating which physician they had visited most regularly.
"The attribution is for quality and cost analysis purposes only, and does not restrict the patient from seeing other providers," says Chet Speed, vice president of public policy at the American Medical Group Association.
Prospective vs. retrospective attribution
Retrospective attribution can be challenging for physicians. In the Physician Group Practice demonstration, physicians often had to wait 18 months to receive data on their performance. "Essentially, physicians were measured on how well they reduced costs and increased quality, and with retrospective attribution you don't find out until the end whether or not a patient was included," says Donald W. Fisher, PhD, CAE, president and CEO of the AMGA. "It's important to have prospective attribution because you have to get the patients engaged." Without prospective attribution, physicians have to wait until the data is shared with them to know how their patients are doing, and this delayed analysis diminishes the opportunity for timely improvement, he says.
Learn more about the AMGA.