Raising the Bar in Attribution

Ideas and Opinions19 September 2017Raising the Bar in AttributionAteev Mehrotra, MD, Helen Burstin, MD, MPH, and Carol Raphael, MPAAteev Mehrotra, MDFrom Harvard Medical School, Boston, Massachusetts; National Quality Forum, Washington, DC; and Independent Consultant, New York, New York.Search for more papers by this author, Helen Burstin, MD, MPHFrom Harvard Medical School, Boston, Massachusetts; National Quality Forum, Washington, DC; and Independent Consultant, New York, New York.Search for more papers by this author, and Carol Raphael, MPAFrom Harvard Medical School, Boston, Massachusetts; National Quality Forum, Washington, DC; and Independent Consultant, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0655 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The U.S. Department of Health and Human Services has set an ambitious goal of tying more than 90% of Medicare payments to quality by 2018 and shifting more than half of payments to alternative payment models, such as accountable care organizations (ACOs) and bundled payments (1). The hope is that this move from fee-for-service will improve coordination and integration of care. Unfortunately, in this rapid shift to new payment models, the issue of attribution has received insufficient attention.Patients receive care from a broad array of providers, including hospitals, physicians, and nurses (2). Attribution models are sets of rules used ...References1. Centers for Medicare & Medicaid Services. Better care. Smarter spending. Healthier people: paying providers for value, not volume. Accessed at www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-01-26-3.html on 15 March 2017. Google Scholar2. Pham HH, Schrag D, O'Malley AS, Wu B, Bach PB. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356:1130-9. [PMID: 17360991] CrossrefMedlineGoogle Scholar3. Centers for Medicare & Medicaid Services. Shared Savings and Losses and Assignment Methodology. Accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/Shared-Savings-Losses-Assignment-Spec-V4.pdf on 15 March 2017. Google Scholar4. Mehrotra A, Adams JL, Thomas JW, McGlynn EA. The effect of different attribution rules on individual physician cost profiles. Ann Intern Med. 2010;152:649-54. [PMID: 20479030]. doi:10.7326/0003-4819-152-10-201005180-00005 LinkGoogle Scholar5. National Quality Forum. Attribution: Principles and Approaches. Accessed at www.qualityforum.org/Publications/2016/12/Attribution_-_Principles_and_Approaches.aspx on 15 March 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Medical School, Boston, Massachusetts; National Quality Forum, Washington, DC; and Independent Consultant, New York, New York.Note: Dr. Burstin is an employee of the National Quality Forum, and the ideas presented here summarize discussions from a National Quality Forum committee on attribution.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0655.Corresponding Author: Ateev Mehrotra, MD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; e-mail, [email protected]med.harvard.edu.Current Author Addresses: Dr. Mehrotra: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.Dr. Burstin: National Quality Forum, 1030 15th Street NW, Suite 800, Washington, DC 20005.Ms. Raphael: 11 Riverside Drive, 13LW, New York, NY 10023.Author Contributions: Conception and design: A. Mehrotra, H. Burstin, C. Raphael.Analysis and interpretation of the data: C. Raphael.Drafting of the article: A. Mehrotra, H. Burstin, C. Raphael.Critical revision of the article for important intellectual content: H. Burstin.Final approval of the article: A. Mehrotra, H. Burstin, C. Raphael.Obtaining of funding: H. Burstin.Administrative, technical, or logistic support: A. Mehrotra, H. Burstin.This article was published at Annals.org on 29 August 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAssessment of Patient Attribution to Care From Medical Oncologists, Surgeons, or Radiation Oncologists After Newly Diagnosed CancerVariability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time pointsModernizing Medical Attribution 19 September 2017Volume 167, Issue 6Page: 434-435KeywordsAccountable care organizationsBreast cancer screeningDisclosureElectronic medical recordsHealth care policyMedicareMotivationOutpatient clinicsPatientsPhysicians ePublished: 29 August 2017 Issue Published: 19 September 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...