ACO PCP pay not all that different from FFS so far, study finds

Primary care incentives for ACOs may not be strong enough to accomplish the goals of improving patient experiences, population health and high costs.

“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,” according to a new study in the Annals of Family Medicine.

The study of how primary care physicians are being paid by ACOs used the 2012-2013 National Survey of Physician Organizations to compare primary care physician (PCP) compensation in ACOs with non-ACOs.

They compared Medicare ACOs with exposure to some financial risk related to utilization, non-ACOs with contracted financial risk for primary care costs and those without any ACO or risk-based contract.

They found that PCPs in Medicare ACOs received just under half of their income from a flat salary, 46 percent tied to productivity and 3.4 percent tied to quality.

PCPs in non-ACOs with some risk got 66 percent of their compensation from salary, 32 percent tied to productivity and a bit less than one percent from 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,” wrote University of Michigan professor Andrew Ryan and colleagues.