Does ACO Payment Influence Primary Care Physicians’ Quality?
By - Accountable care organizations (ACOs) involve the collaborative execution of patient management across the care spectrum. ACOs – created by the Patient and Protection and Affordable Care Act (PPAC) – are developed partnerships between hospitals and physicians. They are a relatively green facet of the healthcare industry, having gained widespread traction less than a decade ago.
Matters of compensation and quality in relation to ACOs have become a trending topic of conversation as ACOs continue to evolve. There is little difference in how those primary care physicians (PCPs) are compensated by accountable care organizations compared to non-ACO PCPs, confirms a recent study from the Annals of Family Medicine led by Andrew M. Ryan, PhD, Associate Professor with the University of Michigan’s Department of Health Management and Policy, and colleagues.
Researchers assessed whether practices in ACOs pay their primary care physicians like they do for other practices, or if they instead utilize compensation policies mirroring those practices that assume significant primary care cost risk.
According to data collected from the 2012-2013 National Survey of Physician Organizations, PCPs in Medicare ACOs received less than half of their income from a flat salary, confirm researchers. Forty-six percent of this amount relates to productivity. Nearly 3.5 percent relates to quality.
Comparatively, for PCPs in non-ACOs with some level of risk, 66 percent of their compensation is tied to salary, 32 percent is connected to productivity, and nearly one percent is associated with quality.
“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,” the researchers confirm, additionally noting their ACO findings are indeed subject to various means of interpretation due to variation factors.
It is possible a higher compensation for quality in ACOs may indicate those physicians and practices involved in ACOs are “better aligned” to achieve those quality measures rewarded by the Centers for Medicare and Medicaid Services (CMS), researchers add. ACOs also connect to cost management tactics in regard to electronic health records (EHRs), high-risk patients’ care coordination, and internal report production – all connected to a physician’s performance, they add.
“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,” they add. “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.”
Researchers pose the question: “If physicians in ACOs and physicians outside ACOs are paid similarly, will they practice differently?” Although they confirm more time is needed for practices to more directly align physicians with effective compensation policies, ongoing evaluations will hopefully help pose a solution, say researchers.
“[If] incentives are not aligned between practices and physicians, the ACO programs may have limited effects on costs and quality in the short-term,” the researchers conclude.
As further ACO analysis is conducted and analyzed, it is hopeful such information will prove valuable and actionable for those healthcare payers truly looking to maximize their continued success within the healthcare industry.
