Medicare Reporting

ACO Executive: Kim Roberts

Medical Director: William Gerard, MD

Compliance Officer: Scott Pietras, JD

Quality Assurance/Improvement Officer: Molly Nichols

• Federally Qualified Health Centers (FQHC)
• Hospitals employing ACO professionals
• Partnerships or joint venture arrangements between hospitals and ACO professionals
• Network individual practices of ACO professionals
• Rural Health Clinics (RHC)

• Second Agreement Period
  • Performance Year 2020, $0
  • Performance Year 2019, $0
  • Performance Year 2018, $0
• First Agreement Period
  • Performance Year 2017, $7,863,011
  • Performance Year 2016, $9,657,590
  • Performance Year 2015, $8,474,728

• Second Agreement Period
  • Performance Year 2020
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A
  • Performance Year 2019
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A
  • Performance Year 2018
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A
• First Agreement Period
  • Performance Year 2017
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
  • Performance Year 2016
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
  • Performance Year 2015
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%

2020 Quality Performance Results

“Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.”

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.

Fraud and Abuse Waivers

ACO Participation Waiver:

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement.

Contact Center:

• Parties to the arrangement: ACO Participants
• Date of arrangement: 09/01/2021
• Items, services, goods, or facility provided: Provide affiliated ACO participants services to facilitate quality improvement through enhanced network clinical integration and collaboration, which, in turn, will maximize opportunities for care coordination, adherence to standardized care protocols, promote adoption of evidence-based medicine guidelines, and improvements in quality. Examples include central scheduling, after hours physician call center, and nurse triage.
• Date and nature of any amendments to the arrangement, if applicable: N/A

Education and Training:

• Parties to the arrangement: ACO Participants
• Date of arrangement: 09/01/2021
• Items, services, goods, or facility provided: Provide affiliated ACO participants various education and training opportunities to align and support clinicians and staff in providing quality care across MSSP beneficiaries. Examples include office & billing staff education, provider CME, education using SIM center, CPR, BLS/ALS, etc. training, annual safety/compliance training
• Date and nature of any amendments to the arrangement, if applicable: N/A

Technical Solutions/IT Support:

• Parties to the arrangement: ACO Participants
• Date of arrangement: 09/01/2021
• Items, services, goods, or facility provided: Provide affiliated ACO participants with Information Technology solutions to facilitate quality improvement through enhanced network clinical integration and collaboration, which, in turn, will maximize opportunities for care coordination, adherence to care protocols, acceleration of care redesign processes, avoidance of potential gaps or delays in care, promotion of efficient service delivery for MSSP patients and other Network patients, and improvements in quality measures. Examples include EHR Solution (Epic Community Connect), TelemedIQ, Kyruuus Online Scheduling, Telemedicine/Telehealth Solution, Referral Solution, Gaps in Care Patient Text Messaging, and Patient Satisfaction/Experience Tool.
• Date and nature of any amendments to the arrangement, if applicable: N/A

Physician Services Recruiting Arrangement:

• Parties to the arrangement: ACO Participants
• Date of arrangement: 09/01/2021
• Items, services, goods, or facility provided: Provide affiliated ACO participants support related to identification, selection and retention of quality physicians to meet the need of the community. Recruiting services may include: the ongoing evaluation of physician needs of the community; identification of prospective physician candidates; interview coordination, support and assistance; and assistance in contract negotiations and document development as requested.
• Date and nature of any amendments to the arrangement, if applicable: N/A

Supply Chain Management Services:

• Parties to the arrangement: ACO Participants
• Date of arrangement: 09/01/2021
• Items, services, goods, or facility provided: Provide affiliated ACO participants certain supply chain management services for and on behalf of the practice. Examples include a group purchasing organization (GPO) that, among other things, negotiates, directly and through third parties, vendor and distributor agreements on behalf of the practices.
• Date and nature of any amendments to the arrangement, if applicable: N/A