Definition · Value-based care

Patient attribution

Patient attribution is how a payer assigns patients to the provider, practice, or ACO accountable for their cost and quality of care. In the Medicare Shared Savings Program, CMS assigns beneficiaries mainly based on where they received the plurality of their primary care services. The attributed list defines whose outcomes count.

What patient attribution is

Attribution answers one question: whose patients are these? Value-based contracts pay or penalize based on the cost and quality of a defined group. That group is set by attribution rules, not by who a practice thinks its patients are. A patient seen once last year may be attributed, and a long-time patient may not.

In the MSSP, CMS calls this assignment. A beneficiary is generally assigned to the ACO whose clinicians provided the plurality of their primary care services, measured by allowed charges. CMS looks at primary care practitioners first, then certain specialists. Beneficiaries can also choose voluntary alignment by naming their primary clinician, for example on Medicare.gov.

ACOs choose prospective assignment or preliminary prospective assignment with retrospective reconciliation. Either way, the assignment file is the starting point for gap lists and outreach. Rivvi lets staff upload that file, enrich it against CMS and NPI registry data, and ask questions about the panel in chat.

Questions

Patient attribution, answered

What is prospective vs retrospective attribution?

Prospective assignment fixes the patient list at the start of the performance year, based on prior claims. The ACO knows up front who it is accountable for. Preliminary prospective assignment with retrospective reconciliation gives lists during the year. The final list is set after year end, based on where patients actually got primary care.

What is voluntary alignment?

Voluntary alignment lets a Medicare beneficiary name their primary care clinician, for example through their Medicare.gov account. If that clinician participates in an ACO, the beneficiary can be assigned to that ACO based on their choice. It generally takes precedence over claims-based assignment and gives patients a direct say.

Why does my attribution list keep changing?

Attribution follows claims. Patients fall off the list when they see other primary care providers, move, enroll in Medicare Advantage, or die. New patients can be added. Under retrospective reconciliation the final list is not known until after year end. Comparing each new file to the last shows who moved.

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Patient attribution

What patient attribution is

Patient attribution, answered

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