Vol. 24 Annals of Health Law 322
and outcomes that result in cost savings.” 336 HHS rules governing Medicare
ACOs337 detail the standards and specifications for ACOs with the objective
of incentivizing stakeholders to deliver comprehensive, improved quality
care to Medicare beneficiaries while reducing expenditures. 338 ACOs are
formulating, organizing, and exploring various approaches to adjust reimbursement in primary care and to incentivize advancements in effectiveness,
capacity, and care management. 339 Numerous productive ACO configurations are adopting a departure from quantity-based reimbursement to quali-ty-based reimbursement, and the development of population health management centers. 340
Ideally, PAs would have received beneficiary assignments; however, the
Centers for Medicare and Medicaid Services did not modify its standards
and therefore this remains within the sole purview of physicians. 341 The final rules allow patients who are cared for in certified rural health clinics and
federally qualified health centers, many of which are staffed by PAs, to enroll in ACOs. 342 Additionally, the PA’s role as an ACO professional was
preserved allowing for the complete participation of patients being treated
in certified Rural Health Clinics. 343 Patients treated chiefly by PAs could be
counted toward the 5,000-patient count required to set up an ACO. 344 A
portion of provisions within the ultimate regulation may support the incorporation of patients who do not personally receive care from a physician. 345
While it is anticipated that a clarification of the final language will fully include PA-provided patient care, such an interpretation is uncertain. 346 Nev-
337. Press Release, Ctrs. for Medicare & Medicaid Servs., HHS Announces New Incentives for Providers to Work Through Accountable Care Organizations (Oct. 20, 2011),
available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2011-
338. Michael Powe, Final ACO Rules Released, PA PRO NOW BLOG (October 26, 2011,
4:45 PM), available at http://www.aapa.org/news_and_publications/pa_pro_now/item.a
339. Kole, supra note 315, at 21.
341. See Powe, supra note 338.
342. Michelle Perron Pronsati, Final ACO Rules a Mixed Bag for NPs & PAs,
ADVANCE HEALTHCARE NETWORK (Dec. 1, 2011), available at http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Front-Center/Final-ACO-Rules-a-Mixed-Bag-for-NPs-PAs.aspx.
343. See id.
346. Id. Michael Powe, Vice President for Reimbursement and Professional Advocacy
at the AAPA, said there is a bright spot in language that may allow the inclusion of patients
who do not receive care directly from a physician. “AAPA staff will work with [CMS] in an
attempt to obtain an interpretation of the final language that will fully include PAs treating as
part of the physician-PA team.”