Provider Attribution Models

athenaClinicals

This is an overview of the logic behind the provider attribution models available for quality programs and Clinical Guidelines in athenaClinicals. Note that the terms patient attribution, provider attribution, and program attribution are often used interchangeably, but it will be referred to as provider attribution going forward.

 

Quality programs rely on algorithms, or predetermined methodologies, to yield valid performance results.

 

Provider attribution is how quality programs determine a provider’s performance – by assigning or “attributing” certain patients to a particular provider and then evaluating that patient’s data. There are a number of reasons why provider attribution can be challenging:

  • Patients may see several physicians during a given time frame, often for similar care
  • Patients may have a different PCP than the provider to whom they are attributed
  • A provider may not know a patient is attributed to him or her at the time of service, as attribution is often retroactive
  • In some cases, lists of attributed patients are sent to groups – these can be challenging to manage

 

In athenaClinicals, for a patient to be attributed to a provider in a quality program two things must already be true:

  • The provider is enrolled in the given program and measure
  • The patient qualifies for the measure (i.e. meets age, gender, diagnosis requirements, etc.)

 

The provider attribution model is also used to generate and run population health campaigns, such that a patient who is attributed to a particular provider, will receive a call, email, secure message, or SMS from that provider, based on the greetings set up for that provider for that campaign.

 

 

 

 

Definition: During the reporting timeframe, any provider who was the supervising (i.e. billing) provider for an eligible encounter2 as indicated on the claim, will have the patient attributed to him or her.

 

Reporting implications: For the given program/measure, a patient could be attributed to more than one provider, if the patient has encounters in which more than one provider was the supervising (i.e. billing) provider.

 

Programs that utilize this attribution model:

  • MIPS: Quality Program
  • MIPS: Promoting Interoperability
  • MIPS: Improvement Activities
  • ACO Medicare Shared Savings Program

 

 

 

Definition: During the reporting timeframe, any provider who was the rendering provider for an eligible encounter* will have the patient attributed to him or her.

 

Reporting implications: For the given program/measure, a patient could be attributed to more than one provider, if the patient has encounters in which more than one provider was the rendering provider.

 

Programs that utilize this attribution model:

  • HEDIS*
  • PCMH NCQA Accelerator
  • Most custom programs or other payer-specific programs
  • Primary Care First

*Program steward allows additional attribution when there is evidence of a provider patient relationship such as a medication order (an encounter may not be required)

 

 

 

Definition: During the reporting timeframe, a patient is attributed to the provider who is listed as his/her Usual Provider from the Quickview.

 

Reporting implications: For the given program/measure, a patient will only be attributed to a single provider. If the provider listed in the drop down is not actually enrolled in the given program (or that provider’s specialty is not enrolled in the Clinical Guideline), then the patient will not get attributed to any provider. If the Usual Provider field is blank, then the patient will not be attributed to any provider, and measures within the applicable program will not display on the QM Tab for any enrolled providers.

 

Programs that utilize this attribution model:

  • Hospital PI Medicare
  • All Clinical Guidelines (except for Healthcare Resource Utilization Guidelines, Ebola Guidelines, Zika)
  • HEDIS (Usual provider)

 

 

 

Definition: During the reporting period or look-back timeframe, a patient is attributed to the provider with whom they have an established relationship and have had the most encounters. An established relationship between the patient and provider is defined as having an encounter that meets the measure’s denominator criteria. A patient could have an established relationship with more than one provider. The next step in the attribution process is to identify the provider with whom the patient has had the most encounters. In the event of a “tie” the patient is attributed to the provider with the most recent encounter.

 

Reporting implications: A patient is only attributed to a single provider. For programs that require reporting of data at frequent intervals, the established relationship could change easily. Attribution could change from one reporting quarter to the next. The established relationship requirement also means patients can only be attributed to providers who have been documenting in athenaClinicals for more than 12 months.

 

 

 

The UDS Table Report data are pulled from the Practice Level Program. Below are the details about how the attribution models for each program support the purposes of that program. In both programs the measure calculations are exactly the same.

 

 

 

 

On the Main Menu, click Settings > Clinicals. In the left menu,under Practice Links — Quality Management, click Quality Program Provider Attribution

 

 

 

To assign a provider attribution model to a quality program, you must have the Clinicals Admin: Quality Manager Admin role.

 

 

 

Practice managers must review and ensure the correct program guidelines are assigned to each provider.

 

 

 

The Practice Level UDS program uses a model known as "UDS Attribution". The UDS Attribution Model attributes every patient to all providers enrolled in the Practice Level program. This attribution model supports the goal of submitting Health Center level data to HRSA at the end of the reporting year. By attributing patients to every provider enrolled in the program, athenaNet effectively attributes patients to the entire Health Center.

 

You will see the Practice Level program available in the Quality Management Report (QMR) as Uniform Data System - Practice Level. As a result of the attribution model, you will see the same numerator and denominator values associated to every provider when you run the QMR. This is because every patient is attributed to all enrolled providers.

 

The Practice Level program provides the data that populates Tables 6B and 7 of the UDS Table Reports in Report Library. These reports facilitate your UDS submission.

 

The Practice Level program supports the measures surfaced in the Quality Tab to provide point-of-care reminders to close care gaps.

 

 

 

The Provider Level UDS program uses the rendering attribution model. The rendering attribution model is used in a specific way that is important to understand for your UDS performance management efforts. In the case of UDS, patients may be attributed to more than one provider if there was more than one provider involved in the care of that patient. For example, a patient may be attributed to the rendering provider, and also the Usual Provider if one exists in the patient chart. As UDS is an organizational level program, we want to provide flexibility for your performance management efforts by identifying all of the providers potentially involved in a patient's quality care gap closure.

 

You will see the Provider Level program available in the QMR as Uniform Data System - Provider Level. You can use this report to understand and manage performance at a provider level.

 

As one program year ends, your providers that are enrolled in the UDS programs will be automatically carried into the next year’s UDS programs.

 

 

 

  1. Display the Quality Program Provider Attribution Rules page: on the Main Menu, click Settings. Under ADMIN, click Clinicals. Under PRACTICE LINKS – Quality Management, click Quality Program Provider Attribution. A list of active programs in your practice appears.
  2. Click edit next to one of the programs.
  3. Rule — Select an attribution model.
  4. Click Save.
  5. athenaNet must review all changes you submit to this page. Changes you make go into effect in approximately one week.

 

 

 

For more information on quality management with athenahealth, visit the Quality Resource Overview on the Success Community where you can review guides, FAQs, and more, as well as start discussions with other athenahealth practices or contact your Customer Success Manager. For inquiries specific to your practice, open a Support case.