Medicare Reporting

• Greenwood Obstetrics & Gynecology Pa – N
• Carolinas Center for Advanced Management of Pain PA – N
• John Humeniuk – N
• Pathology Associates of Greenville – N
• Baptist Easley Hospital – N
• The Greenwood Endoscopy Center, Inc – N
• The Center for Advanced Eye Care – N
• Upstate Plastic Surgery – N
• Foothills Family Medicine of Westminster PA – N
• EASLEY HEAD & NECK SURGERY PA – N
• Foot Clinic of South Carolina LLC – N
• Greenwood Eye Clinic, P.A. – N
• The Surgery Center @ Self Memorial Hospital, Llc. – N
• Carolina Pulmonary & Sleep Disorder, LLC – N
• Carolina Pathology Associates, LLP – N
• Greenville Health System – N
• Greenville Kidney Care LLC – N
• Riley Family Practice Associates, Pa – N
• Doctor for Life, LLC – N
• Allergic Disease & Asthma Center Pa – N
• Montgomery & Riddle Eyecare, P.A. – N
• Highlands Center for Women, P.A. – N
• Digestive Disease Group PA – N
• Newberry Family Health Center, PA – N
• Greenwood Urological – N
• Jervey Eye Group, PA – N
• UPSTATE PODIATRY GROUP PA – N
• Greenwood Ear Nose And Throat Assoc Pa – N
• Regenesis Organization Community Health – N
• Upstate Medical Associates PA – N
• Abbeville County Memorial Hospital – N
• Carolina Integrative Medicine, PA – N
• Palmetto Bone & Joint, PA – N
• Oakview Medical Associates LLC – N
• Parkside Pediatrics, P.A. – N
• Gastroenterology Associates, PA – N
• Greenville Dermatology LLC – N
• Palmetto Internal Medicine & Primary Care – N

• Oconee Surgery, PA – N
• Jervey Eye Center, LLC – N
• Brio Medical, PC – N
• Carolina Nephrology PA – N
• HILLCREST EYECARE, PA – N
• Greenwood Center for Gynecology, LLC – N
• Newberry Internal Medicine LLC – N
• Turning Point Women’s Center, PA – N
• Carolina Surgery – N
• HHD Enterprises LLC – N
• Self Regional Healthcare – N
• Primary Care Associates, PC – N
• APEX ALLERGY & IMMUNOLOGY, P.C. – N
• The Surgery And Laser Center At Professional Park – N
• Golden Corner Family Prac – N
• Self Medical Group – N
• Piedmont Retina Assoc Pa – N
• Partners In Health – Rural Health – N
• Piedmont Neurology – N
• Greenville Endoscopy Center – N
• PIEDMONT PULMONARY MEDICINE LLC – N
• Dermatology Associates, P.A. – N
• Palmetto Surgery Associates, PA – N
• Zachary Seymour – N
• Bruce A Marshall MD PA – N
• Pathology Consultants, Inc. – N
• John Humeniuk – N
• Pelham Family Practice, LLC – N
• Newberry County Memorial Hospital – N
• GHS Partners in Health, Inc. – N
• ANDERSON HEART P C – N
• New Haven Medical Services, PA – N
• Upper Savannah Radiological Associates, PA – N
• Carolina Lung & Sleep Center Llc – N
• Clemson Eye, PA – N
• Oconee Kidney Center LLC – N
• Anesthesiology of Greenwood PA – N
• Upstate Affiliate Organization – N

• William Marshall, MD – ACO Executive
• Peter Tilkemeier, MD – Medical Director
• Scott Pietras, JD – Compliance Officer
• Scott Hultstrand – Quality Assurance/Improvement Officer

• Compliance Committee: Scott Pietras, JD, Chair
• Finance Committee: Daniel Grover, MD,  Chair
• Network Participation Committee: Pat Crawford, MD Chair
• Primary Care Committee: Meg Carter, MD Chair
• Quality and Care Delivery Committee: Peter Tilkemeier, MD Chair

• 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 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 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%

2018 Quality Performance Results

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

Payment Rule Waivers

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

• Waiver for Payment for Telehealth Services:
  • No, our ACO clinicians do not provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.

The Centers for Medicare & Medicaid Services (CMS) has made available certain waivers of federal fraud and abuse laws in connection with the operation of an Accountable Care Organization (ACO) that has entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”). In accordance with the public disclosure requirements of the ACO Participation Waiver, the following describes arrangements between MyHealth First Network, LLC (MyHFN) and its participants.

The ACO has an arrangement in which it offers a technology platform for population health and clinical integration (“MyHFN PH/CI System”) that gathers, analyzes and reports on data regarding patient needs, the delivery of care, quality indicators, population health in local communities, and patient outcomes to its members including its physician members. MyHFN member hospitals support the costs of such system in the proportions that their communities represent in comparison to the entire service area population served by MyHFN.

The ACO has an arrangement in which it provides incentive compensation (the “Physician Performance Payment System”) that will compensate MyHFN physicians for their work in quality improvement and care coordination for MSSP Patients and other patients; and the Physician Performance Payment System will be funded by a portion of any MSSP shared savings payments.

MyHFN Board of Managers determined that the Physician Performance Payment System and the Population Health and Clinical Integration Support Arrangement are reasonably related to the purposes of the Medicare Shared Savings Program.  Furthermore, the MyHFN Board of Managers approved the Physician Performance Payment System and the Population Health and Clinical Integration Support Arrangement. The program commenced on January 1, 2015 and continues to be in effect.

Approved by MyHFN Board of Managers November 15, 2017.