Abstract
Study findings have also shown that patients attributed to NPs receive care that is of similar quality to care provided by physicians.12 Although there is conflicting evidence from an unpublished study in the US Department of Veterans Affairs health care system,13 large-scale studies demonstrate that NP-driven primary care is less expensive than physician-driven care, in part because NPs use fewer and less costly services for similar patients.14,15 The high-value practice style of NPs aligns well with the population health goals of ACOs.16 To better understand the impact of excluding NPs from ACO attribution on the overall size and clinical severity of the attributed population, this analysis examines the results of a simulation that broadens the MSSP attribution rules to allow NPs to serve as linking clinicians. To determine beneficiary clinical severity, we calculated CMS hierarchical condition category (HCC) scores using version 21.17 This model produces multiple risk scores for each individual, including a community score for those who live at home, an institutional score for those who live in a nursing home, and an end-stage renal disease (ESRD) score for those who qualify for Medicare by virtue of the ESRD benefit. [...]home-based primary care (HBPC) is identified using Current Procedural Terminology codes in Medicare claims to find beneficiaries with 1 or more visit in the year. [...]for percent PCPs, we took the number of PCPs from the MSSP PUF and divided it by total providers associated with the ACO (primary + specialty care).