The U.S. Department of Health and Human Services has set an ambitious goal of tying more than 90% of Medicare payments to quality by 2018 and shifting more than half of payments to alternative payment models, such as accountable care organizations (ACOs) and bundled payments (1). The hope is that this move from fee-for-service will improve coordination and integration of care. Unfortunately, in this rapid shift to new payment models, the issue of attribution has received insufficient attention.

Patients receive care from a broad array of providers, including hospitals, physicians, and nurses (2). Attribution models are sets of rules used to determine which provider (or group of providers) is responsible for a patient's care from a quality, cost, or payment perspective. The models vary widely and may be complex. For example, under the Medicare Shared Savings Program, a patient is assigned to an ACO if the largest portion of primary care services was furnished by primary care practitioners at the participating ACO. If a patient did not receive care from a primary care practitioner in an ACO, the patient may be attributed to the ACO if the greatest portion of selected services was furnished by specialists at the ACO (1).

中文翻译：

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提高归因标准

美国卫生与公共服务部设定了一个雄心勃勃的目标，即到2018年将90％以上的Medicare付款与质量挂钩，并将超过一半的付款转移到其他付款模式，例如责任医疗组织（ACO）和捆绑式付款（ 1）。希望这种从按服务收费的转变将改善护理的协调和整合。不幸的是，在这种迅速转移到新的支付模式的过程中，归因问题尚未引起足够的重视。

患者从各种各样的提供者那里得到护理，包括医院，医生和护士（2）。归因模型是一组规则，用于从质量，成本或付款角度确定哪个提供者（或一组提供者）负责患者的护理。模型差异很大，可能很复杂。例如，根据“医疗保险共享储蓄计划”，如果最大的初级保健服务由参与的ACO的初级保健从业者提供，则将患者分配到ACO。如果患者未从ACO的初级保健医生那里获得护理，则如果所选服务的绝大部分是由ACO的专家提供的，则该患者可能会归因于ACO（1）。