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A practical guide for physicians participating in ACOs, CINs and value-based contracts.
Shared-savings statements arrive looking authoritative: clean tables, precise dollar figures and risk scores carried to three decimal places. But precision is not accuracy. Every shared-savings number is the product of a chain of assumptions about attribution, risk, benchmark construction, trend, quality and distribution. Each step can materially change who appears to have created savings and who gets paid.
Physicians should not assume that an accountable care organization’s (ACO) distribution is correct simply because it comes from an actuary, a finance committee or a payer report. Over the past five years, I have identified material distribution errors that redirected hundreds of thousands of dollars to clinicians who had actually generated the savings.
The central question is not, “Did the ACO report savings?”
It is: “Can the ACO show how those savings were calculated, validate the result and explain why your practice was paid what it was paid?”