321 Physician Assistant Scope of Practice 2015
medical appointments outside of traditional office hours, particularly during
evenings and weekends. 325 PAs have been essential in broadening that access. 326 For example, a PA in Maryland joined Johns Hopkins Community
Physicians to assist in the implementation of a PCMH pilot at the Water’s
Edge clinic to increase the availability of same-day appointments. 327 Because of prior experience in urgent care and emergency medicine, this PA
was an ideal match for the clinic’s needs. 328
Ultimately, full utilization of PAs in PCMHs will require a cultural shift
that allows for the most qualified health professional to lead the metamorphosis of a practice. 329 This will only be achieved when organized medicine
fully understands and embraces the concept that such leadership does not
preempt physician leadership in many aspects of clinical medicine. 330 The
PCMH is intended to advance and enhance the coordination of care among
clinicians, while ACOs have the far-reaching goal of coordinating care
across the complete spectrum of healthcare, from physicians to facilities to
other clinicians. 331 PCMHs and ACOs are undeniably intertwined. 332
PCMHs are the core of ACOs, which provide the foundation for a team approach to healthcare delivery systems. 333
The concept of an “accountable care organization” originally described
arrangements committed to quality and efficiency with the goal and the
power to impose practice, reporting, and compensation standards across a
group of providers on behalf of the patient population. 334 An ACO is defined as “a group of healthcare providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients
get.” 335 An ACO’s payment is “tied to achieving healthcare quality goals
325. Id. at 24.
329. See ISSUE BRIEF, supra note 304 at 4.
331. David L. Longworth, Accountable Care Organizations, the Patient-Centered Medical Home, and Health Care Reform: What Does It All Mean? 78 CLEVELAND CLINIC J. MED.
571, 577 (2011), available at http://www.ccjm.org/content/78/9/571.long.
332. Id. at 571.
334. Stephen M. Shortell & Lawrence P. Casalino, Health Care Reform Requires Accountable Care Systems, 300 J. AM. MED. SOC’Y. 95, 95 (2008); see also Elliott S. Fisher et
al., Fostering Accountable Health Care: Moving Forward in Medicare, 28 HEALTH AFF.
219, 219 (2009) available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656392/;
STEPHEN M. Shortell et al., BERKLEY CTR. ON HEALTH ECON. & FAMILY SEC., IMPLEMENTING
ACCOUNTABLE CARE ORGANIZATIONS ii (2010).
335. Glossary: Accountable Care Organization, HEALTHCARE.GOV, available at
https://www.healthcare.gov/glossary/accountable-care-organization/ (last visited Nov. 16,