@article{a4a98d6709424aa5a3d571353c8a6c5a,
title = "Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data",
abstract = "Importance: It is critical to develop a better understanding of the strategies provider organizations use to improve the performance of frontline clinicians and whether ACO participation is associated with differential adoption of these tools. Objectives: Characterize the strategies that physician practices use to improve clinician performance and determine their association with ACOs and other payment reforms. Data Sources: The National Survey of Healthcare Organizations and the National Survey of ACOs fielded 2017-2018 (response rates = 47 percent and 48 percent). Study Design: Descriptive analysis for practices participating and not participating in ACOs among 2190 physician practice respondents. Linear regressions to examine characteristics associated with counts of performance domains for which a practice used data for feedback, quality improvement, or physician compensation as dependent variables. Logistic and fractional regression to examine characteristics associated with use of peer comparison and shares of primary care and specialist compensation accounted for by performance bonuses, respectively. Principal Findings: ACO-affiliated practices feed back clinician-level information and use it for quality improvement and compensation on more performance domains than non-ACO-affiliated practices. Performance measures contribute little to physician compensation irrespective of ACO participation. Conclusion: ACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.",
keywords = "Accountable Care Organizations, financial incentives, physician practices, quality improvement",
author = "Meredith Rosenthal and Stephen Shortell and Shah, {Nilay D.} and David Peiris and Lewis, {Valerie A.} and Barrera, {Jacob A.} and Benjamin Usadi and Colla, {Carrie H.}",
note = "Funding Information: Joint Acknowledgment/Disclosure Statement: This work was supported, in part, by the Agency for Healthcare Research and Quality's (AHRQ's) Comparative Health System Performance Initiative under Grant # 1U19HS024075, which studies how health care delivery systems promote evidence-based practices and patient-centered outcome research in delivering care. The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of AHRQ. The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from IQVIA information services: OneKey subscription information services 2010-2017, IQVIA Incorporated, all rights reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Incorporated or any of its affiliated or subsidiary entities. AMA is the source for the raw physician data. Wave 4 of the National Survey of ACOs was supported by the Commonwealth Fund (Grant No 20160616), the National Institute of Mental Health of the National Institutes of Health (Grant No R01MH109531), and the California Health Care Foundation (Grant No 20249). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Joint Acknowledgment/Disclosure Statement : This work was supported, in part, by the Agency for Healthcare Research and Quality's (AHRQ's) Comparative Health System Performance Initiative under Grant # 1U19HS024075, which studies how health care delivery systems promote evidence‐based practices and patient‐centered outcome research in delivering care. The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of AHRQ. The statements, findings, conclusions, views, and opinions contained and expressed in this article are based in part on data obtained under license from IQVIA information services: OneKey subscription information services 2010‐2017, IQVIA Incorporated, all rights reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Incorporated or any of its affiliated or subsidiary entities. AMA is the source for the raw physician data. Wave 4 of the National Survey of ACOs was supported by the Commonwealth Fund (Grant No 20160616), the National Institute of Mental Health of the National Institutes of Health (Grant No R01MH109531), and the California Health Care Foundation (Grant No 20249). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: The National Survey of Healthcare Organizations and Systems (NSHOS), funded by the Agency for Health Research and Quality and led by the Dartmouth‐Berkeley‐Harvard‐High Value Health Collaborative Center of Excellence, was fielded in 2017 and 2018 and included a physician practice survey that we use here (practice response rate = 47 percent). The physician practice survey sample was extracted from the IQVIA OneKey database that included all primary care or multispecialty medical practice with at least three primary care physicians (general practice, family practice, internal medicine, or geriatrics). Practices are defined as a set of providers delivering care as a group at a single location, and they could be independent or part of a larger medical group (eg, with multiple practice sites) or health care system (eg, integrated delivery system or hospital system). Being part of an ACO, for the purposes of this study, is defined as a practice that participates in any one of four ACO contract models: Medicare ACO upside‐only risk‐bearing contracts, Medicare ACO risk‐bearing contracts, Medicaid ACO contracts, and Commercial ACO contracts. A stratified‐cluster sampling design was used to draw samples of physician practices under different organizational structures, ranging from those within multitiered corporate structures to those that are independent operations. The NSHOS includes a wide range of questions about practice characteristics, including practice size and ownership, payment models, and the use of specific mechanisms to improve the effectiveness and efficiency of health care delivery. Respondents were typically a practice manager/administrator (69 percent), a currently practicing physician (18 percent), medical director (6 percent), or executive (6 percent). The surveys themselves and the methods for fielding, managing, and analyzing the survey data were approved by the Dartmouth College Institutional Review Board. Two questions involving the standardization of performance management and the distribution of shared savings compensation practices from the National Survey of ACOs (NSACO) were used to help interpret the findings. This survey was fielded from July 2017 to February 2018. The survey sample, which included ACO entities that participated in any type of ACO contract including those sponsored by public and private payers, was identified through multiple sources, including CMS data, Internet data collection, and information from Leavitt Partners. It included an estimated 862 ACOs with available contact data as of July 2017. Fifty‐five percent returned a survey, and we analyzed 419 complete surveys (adjusted response rate: 48 percent). Respondents typically had leadership roles in the ACO, such as executive director (29 percent), CEO (14 percent), vice president (9 percent), or medical director (7 percent), with a variety of other executive and staff titles making up the remainder. Publisher Copyright: {\textcopyright} Health Research and Educational Trust",
year = "2019",
month = dec,
day = "1",
doi = "10.1111/1475-6773.13238",
language = "English (US)",
volume = "54",
pages = "1214--1222",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "6",
}