title: Salary and Quality Compensation for Physician Practices Participating in Accountable Care Organizations.
abstract: BACKGROUND
  The accountable care organization (ACO) is a new organizational form to manage patients across the continuum of care. There are numerous questions about how ACOs should be optimally structured, including compensation arrangements with primary care physicians.
  
  
  METHODS
  Using data from a national survey of physician practices, we compared primary care physicians' compensation between practices in ACOs and practices that varied in their financial risk for primary care costs using 3 groups: practices not participating in a Medicare ACO and with no substantial risk for primary care costs; practices not participating in an ACO but with substantial risk for primary care costs; and practices participating in an ACO regardless of their risk for primary care costs. We measured physicians' compensation as the percentage of compensation based on salary, productivity, clinical quality or patient experience, and other factors. Regression models estimated physician compensation as a function of ACO participation and risk for primary care costs while controlling for other practice characteristics.
  
  
  RESULTS
  Physicians in ACO and non-ACO practices with no substantial risk for costs on average received nearly one-half of their compensation from salary, slightly less from productivity, and about 5% from quality and other factors. Physicians not in ACOs but with substantial risk for primary care costs received two-thirds of their compensation from salary, nearly one-third from productivity, and slightly more than 1% from quality and other factors. 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.
  
  
  CONCLUSIONS
  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. 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.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan amryan@umich.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California Berkeley, Berkeley, California.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California Berkeley, Berkeley, California.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Ramsay
authors.affiliation: Division of Healthcare Policy and Economics, Department of Health Policy and Economics, Weill Cornell Medical College, New York, New York.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration*; D006801:Humans; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data*; D014481:United States
keywords: accountable care organizations; health; insurance; physicians; reimbursement; value-based purchasing