The Opportunity

Attribution can be defined as the methodology used to assign patients, and their quality outcomes, to organizations or providers. The identification of accountable entities is used by payers, providers, and other measure users to determine how payment is distributed and ultimately who is responsible for improving care delivery, patient outcomes, and reducing cost.

As the U.S. healthcare system increasingly shifts to a performance-based payment system, the desire to identify accountable entities that can be held responsible for patients’ care has become an important consideration. As the financial stakes for measurement have grown, policy debates over physician payment have intensified, and care is increasingly provided within structures of shared accountability, guidance is needed regarding the assignment of attribution of patients and care episodes. Lack of clarity in attribution approaches remains a major limitation in the use of outcome and cost measures. The issues regarding attribution to individual clinicians, including primary care physicians, specialist physicians, physician groups, nurse practitioners and the full healthcare team have complicated the evaluation and implementation of performance measures. Measurement approaches are needed that recognize the multiple entities involved in delivering care, and their individual and joint responsibility to improve quality across the patient episode of care. These issues have become increasingly important in an environment of public reporting, pay for performance, and penalties, where improvements in outcomes may not be directly tied directly to a single provider.

Objectives

National Quality Forum (NQF) will conduct a multi-stakeholder review of these issues, leading to the development of a set of principles and approaches to measurement at different levels of analysis. The purpose of this work is to provide greater guidance to the field on approaches to the attribution issue. This project will produce a report that will provide an environmental scan of the current models of attribution, an analysis of the strengths and weaknesses of the models, and, finally, recommendations on a path forward to guide the selection and implementation of attribution models.

NQF Process

Over a 15-month period, NQF will commission an environmental scan using a contracted author and a multistakeholder Standing Committee, to examine the strengths and weaknesses of the attribution models identified in the environmental scan. The environmental scan will be used as a foundation for establishing a set of principles and recommendations for applying the models within a complex healthcare delivery system. Throughout this project, NQF will solicit input from NQF’s multistakeholder audience, including NQF membership and public stakeholders at key points throughout the project.

Funding

This project is funded by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

Contact Information

For more information, please contact the Kim Ibarra at 202-783-1300 or via email at attribution@qualityforum.org.