While accountable care organizations (ACOs) currently hold a small market share in healthcare, they are gaining ground. Research in the composition of compensation for primary care physicians participating is just beginning to be reported. One study indicates that payment for physicians in an ACO does not differ that much from those outside of ACOs.
Using data from a national survey of physician practices, researchers compared primary care physicians' compensation between practices in ACOs and practices that varied in their financial risk. The practices were divided into three mutually exclusive groups: 1) practices not participating in a Medicare ACO and with no substantial risk for primary care costs (76.1 percent of practices), 2) practices not participating in an ACO but with substantial risk for primary care costs (2.8 percent) and 3) practices participating in an ACO regardless of their risk for primary care costs (21.1 percent).
Researchers measured physicians' compensation as the percentage of compensation based on salary, productivity, clinical quality or patient experience, among other factors. Here are four findings:
There was substantial variance in compensation between the primary care physicians in ACOs and primary care practices not in ACOs but with substantial risk for primary care costs. Primary care physicians in ACO practices received, on average, 49 percent of their compensation from salary, 46.1 percent from productivity, 3.4 percent from quality and 1.5 percent from other factors.
In contrast, primary care physician practices not in ACOs but who had substantial risk for primary care costs received 66.6 percent of their compensation from salary, 32.2 percent from productivity, 0.8 percent from quality and 0.4 percent from other factors.
The primary care physician practices not in ACOs and without substantial risk for primary care costs had similar proportions of compensation to primary care physicians participating in ACOs.
Researchers found substantial risk for primary care costs was associated with a 35.5 percentage point increase in physicians' compensation from salary, though physicians in ACOs — conceivably with the most risk — had 17.6 percent smaller proportion of their compensation from salary.
How these findings apply to primary care pediatrics is not yet known. Read the full article in Annals of Family Medicine.