Office of Rep. Derek Kilmer announcement.
On Dec. 21, U.S. Representative Derek Kilmer (WA-06) introduced the bipartisan ACO Assignment Improvement Act of 2021 (H.R. 6308) which aims to improve access to high-quality, coordinated health care for patients and providers in rural areas. The bill addresses a shortcoming in current law by bolstering assignment to Medicare Accountable Care Organizations (ACOs) to include nurse practitioners, physician assistants, and clinical nurse specialists.
ACOs are groups of hospitals, doctors, and other health care providers who voluntarily join together to coordinate care for a specific patient population. In ACOs, health care providers are responsible for effectively managing the health and wellness of patients. When an ACO delivers high-quality care at a lower cost than traditional fee-for-service spending, the ACO recoups part of the savings. According to the Centers for Medicare & Medicaid Services, ACOs have been highly effective in responding to the COVID-19 pandemic – while saving Medicare approximately $1.9 billion in 2020, the fourth consecutive year of net savings.
Currently, Medicare beneficiaries are assigned to an ACO based on a visit with a primary care physician – excluding the many beneficiaries in rural or medically underserved areas who receive primary care from non-physician providers. The ACO Assignment Improvement Act aims to address this inequity in rural access to ACO coordinated care by allowing ACO assignment based on primary care visits with nurse practitioners, physician assistants, and clinical nurse specialists.
“No matter where you live, you ought to be able to go to a health care provider,” said Rep. Kilmer. “Folks who live in rural communities shouldn’t be disadvantaged because they see a nurse practitioner or a physician assistant or clinical nurse specialist. Every American should be able to get medical care close to home and stay healthy without breaking the bank. This legislation will help with that. And it rewards primary care providers who are focused on improving the quality of care and putting their patients first.”
The legislation co-sponsored by Reps. Kathleen Rice (NY-04), Mike Gallagher (WI-08), and Adrian Smith (NE-03) – and is endorsed by the National Association of ACOs, the American Association of Nurse Practitioners, the American Association of Physician Assistants, the National Rural Health Association, the Washington State Hospital Association, MultiCare, NW Momentum Health Partners, and Physicians of Southwest Washington.
“Americans in rural areas such as Nebraska’s Third District depend on Physician Assistants, Nurse Practitioners, and Clinical Nurse Specialists, as well as doctors, to provide essential primary care,” said Rep. Adrian Smith (NE-03). “H.R. 6308 will afford those serving these rural patients more opportunities to continue providing high quality, coordinated care by removing barriers to participation in Medicare Accountable Care Organizations.”
“This legislation will both improve patients’ access to care, especially in rural America and reduce inequities by removing the statutory requirement that patients have at least one primary care visit with a physician during the year in order to be assigned to an ACO. Removing this requirement will allow nurse practitioners, physician assistants, and other nonphysician providers (NPPs) to contribute toward ACO assignment even if their patients never see a physician for a qualifying visit during the year,” said Clif Gaus, Sc.D., President and CEO of the National Association of ACOs, in a letter supporting the legislation.