MSSP ACO
ACO Name and Location
Piedmont Clinic ACO LLC
Previous Names: N/A
2727 Paces Ferry Road
Building 1, Suite 800
Atlanta, Georgia 30339
ACO Primary Contact
Primary Contact Name: Francis LaRossa
Primary Contact Phone Number: 470-271-2210
Primary Contact Email Address: francis.larossa@piedmont.org
ACO PARTICIPANTS:
Legal Business Name | ACO Participant in Joint Venture |
---|---|
ABSOLUTECARE, INC | No |
AHMED FAMILY PRACTICE LLC | No |
ALEX E. RIKHTER MD, PC | No |
ALLIANCE FAMILY CARE LLC | No |
ALPHA INTERNAL MEDICINE LLC | No |
ANDREW T MECCA MD PC | No |
ANGLYN FAMILY MEDICAL CENTER, LLC | No |
ASCENSION HEALTH SERVICES | No |
Atlanta Heart Associates | No |
Atlanta ID Group, P.C. | No |
BRIDGEWATER FAMILY PRACTICE, PC | No |
BUCKHEAD INTERNAL MEDICNE | No |
BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, P C | No |
Byron F. Harper, III, M.D., P.C. | No |
CAEDEL MEDICAL GROUP | No |
CHEROKEE FAMILY MEDICAL CENTER, INC | No |
CLEMENT AYANBADEJO LLC | No |
COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. | No |
COLUMBUS MEDICAL ASSOCIATES | No |
COMPASS PRIMARY CARE LLC | No |
COMPREHENSIVE INTERNAL MEDICINE | No |
COMPREHENSIVE INTERNAL MEDICINE | No |
CONCIERGE MEDICINE OF COLUMBUS, INC | No |
CONEY & MINTER INTERNAL MEDICINE P.C. | No |
CONYERS INTERNAL MEDICINE LLC | No |
CRABAPPLE FAMILY MEDICINE | No |
Cranford Powell and Morris Advanced Surgical Specialists, LLC | No |
CREEKSIDE MEDICAL CLINIC LLC | No |
DENISE DEVERANEZ | No |
Digestive Healthcare Of Georgia | No |
EAGLE'S LANDING LONGEVITY CENTER | No |
EASTSIDE INTERNAL MEDICINE, LLC | No |
EVANS FAMILY MEDICINE | No |
FAMILY MEDICAL & URGENT CARE CENTER OF MCDONOUGH, LLC | No |
FAMILY PRACTICE CENTER, P.C. | No |
GEORGEIA INTERNAL MEDICINE | No |
Georgia Bone & Joint, Llc | No |
HARRIGAN MEDICAL CONSULTING SERVICES, INC | No |
HEALTH CARE FIRST | No |
Henry Internal Medicine, P.C. | No |
INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, LLC | No |
INTERNAL MEDICINE ASSOCIATES OF JASPER, PC | No |
INTERNAL MEDICINE SPECIALISTS OF ATLANTA | No |
JAMES F ZUMSTEIN MD LLC | No |
JOHN A DRUMMOND MD PC | No |
JULIET ASHER MD PC | No |
KEVIN ONEAL | No |
Khair Family Practice, PC | No |
KRISNIR CORPORATION | No |
L & H Internal Medicine PC | No |
LABADY MEDICAL ASSOCIATES, LLC | No |
LEGACY MEDICAL, LLC | No |
Mastercare Medical Center | No |
MDVIP MEDICAL GROUP GA LLC | No |
MDVIP MEDICAL GROUP GA-ATL | No |
MED-SOUTH PRIMARY CARE | No |
MUSHARAF MOMIN INC | No |
Nephrology Consultants of Georgia, P.C. | No |
Nephrology, Inc | No |
NEXCLIN MEDICINE | No |
NITIN R DESAI MD PC | No |
NORTH FULTON INTERNAL MEDICINE GROUP | No |
NORTH ROSWELL INTERNAL MEDICINE, PC | No |
OMNI PRIMARY CARE, PC | No |
OPTIMAL PERFORMANCE MEDICINE LLC | No |
PEACHSTATE FAMILY CLINIC LLC | No |
Peachtree City Physicians Group | No |
PERSONAL CONCIERGE MD, LLC | No |
PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC | No |
Piedmont Athens Primary Care, LLC | No |
PIEDMONT ATHENS REGIONAL FIRSTCARE LLC | No |
PIEDMONT ATHENS SPECIALTY CARE LLC | No |
Piedmont Cardiology of Atlanta, LLC | No |
Piedmont Colorectal Associates, PC | No |
Piedmont Internal Medicine, PC | No |
Piedmont Medical Care Corporation | No |
PIEDMONT ORTHOPEDICS, LLC | No |
Piedmont Providers, LLC | No |
PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC | No |
PROACTIVE PHYSICIANS OF MARIETTA, PC | No |
REAGAN MEDICAL CENTER AT HAMILTON MILL | No |
ROCKDALE FAMILY PRACTICE, PC | No |
S Rao Cheti, MD, PC | No |
SOUTHERN CRESCENT FAMILY PRACTICE, LLC | No |
SPECTRUM INTERNAL MEDICINE, LLC | No |
STARR'S MILL INTERNAL MEDICINE, LLC | No |
T DOUGLAS GURLEY MD LLC | No |
TAMARA BROWN, MD, LLC | No |
THACKER & THOMPSON | No |
THOMAS N KIAS MD PC | No |
VANDANA SETIA | No |
VINE MEDICAL ASSOCIATES, PC | No |
WALNUT CREEK FAMILY PRACTICE PC | No |
WELLSTREET OF GEORGIA PC | No |
WILLIAM C. LAMBERT M.D. | No |
WILLIAM E. ROUNDTREE M.D.,P.C. | No |
WMC Tyrone LLC | No |
YAGER FAMILY MEDICINE LLC | No |
ZAM ZAM FAMILY CLINIC LLC | No |
CAPRI MEDICAL GROUP | No |
MILTON MEDICAL GROUP, LLC | No |
NEXT LEVEL MEDICAL MANAGEMENT, LLC | No |
PANDYA MEDICAL CENTER INC | No |
SLEEP MEDICINE ASSOCIATES OF ATHENS | No |
SY-MED LLC | No |
THE DOCTORS OFFICE AT ELLIJAY, PC | No |
SMYRNA FAMILY MEDICINE, LLC | No |
ACO GOVERNING BODY
Member | Member’s Voting Power | Membership Type | ACO Participant TIN Legal Business Name/DBA, if Applicable | ||
Last Name | First Name | Title/Position | |||
Railey | Patrick | Chair | 1 | ACO Participant Representative, ACO Medical Director | Piedmont Medical Care Corporation |
Lloyd | Christopher | President | 1 | ACO Executive | N/A |
Latimer | Jim | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
Dalton | Booker | Voting Member | 1 | ACO Participant Representative | Digestive Healthcare of Georgia PC |
Master | Moiz | Voting Member | 1 | ACO Participant Representative | Mastercare Medical Center |
Andrews | Philicia | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
Brown | Charles | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
Hengel | Richard | Voting Member | 1 | ACO Participant Representative | Atlanta ID Group, P.C. |
Coleman | Patrick | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
Wells | Thomas | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
Brooks | Darryl | Voting Member | 1 | Medicare Beneficiary Representative | N/A |
Arnold | Thomas | Voting Member | 1 | ACO Secretary | N/A |
ADDITIONAL ACO INFORMATION
Key ACO Clinical and Administrative Leadership:
Christopher Lloyd | ACO Executive |
Patrick Railey, M.D. | Medical Director |
Chris Terrell | Compliance Officer |
Francis LaRossa | Quality Assurance/Improvement Officer |
Associated Committees and Committee Leadership:
Committee Name | Committee Leader Names and Position |
Clinical Governance Council – Neurosciences | Michele Johnson, M.D., Chair, and Eugene Morris, M.D., Vice-Chair |
Clinical Governance Council – Pulmonary | Jermaine Jackson, M.D., Chair, and Jane Parks, M.D., Vice-Chair |
Clinical Governance Council – Orthopedics | Xavier Duralde, M.D., Chair, and Todd Schmidt, M.D., Vice-Chair |
Clinical Governance Council – Oncology | William Jonas, M.D., Chair, and Andrew Pippas, M.D., Vice-Chair |
Clinical Governance Council – Primary Care | Patrick Railey, M.D., Chair, and Moiz Master, M.D., Vice-Chair |
Quality Committee | Moiz Master, M.D. |
Types of ACO participants, or combinations of participants, that formed the ACO:
Network of individual practices of ACO Professionals
SHARED SAVINGS AND LOSSES
Amount of Shared Savings/Losses
- Second Agreement Period
- Performance Year 2020, $15,015,308
- First Agreement Period
- Performance Year 2019, $15,190,478
- Performance Year 2018, $0
- Performance Year 2017, $0
Shared Savings Distribution
- Second Agreement Period
- Performance Year 2020
-
- Proportion invested in infrastructure: $6,000,000 / 40%
- Proportion invested in redesigned care processes/resources: TBD
- Proportion of distribution to ACO participants: $9,015,308 / 60%
- First Agreement Period
- Performance Year 2017
-
- 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
-
- Performance Year 2019
- Proportion invested in infrastructure: $7,000,000 / 46%
- Proportion invested in redesigned care processes/resources: N/A
- Proportion of distribution to ACO participants: $8,190,478 / 54%
- Performance Year 2019
2020 Quality Performance Results:
ACO # | Measure Name | Rate | ACO Mean |
ACO-13 | Falls: Screening for Future Fall Risk | 85.19 | 84.97 |
ACO-14 | Preventive Care and Screening: Influenza Immunization | 74.82 | 76.03 |
ACO-17 | Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 81.25 | 81.67 |
ACO-18 | Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan | 86.76 | 71.46 |
ACO-19 | Colorectal Cancer Screening | 66.55 | 72.59 |
ACO-20 | Breast Cancer Screening | 78.57 | 74.05 |
ACO-42 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 82.78 | 83.37 |
ACO-27 | Diabetes Mellitus: Hemoglobin A1c Poor Control | 10.56 | 14.70 |
ACO-28 | Hypertension (HTN): Controlling High Blood Pressure | 62.86 | 72.87 |
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
- Waiver for Payment for Telehealth Services:
- Yes, our ACO clinicians do provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.
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.
- ACO’s governing body has duly authorized the below arrangements that qualify for the ACO Fraud and Abuse Waivers, and specifically the ACO Participation Waiver, through Resolutions adopted by unanimous consent. The ACO Board of Directors has made a bona fide determination that the following arrangement(s) is reasonably related to the purposes of the MSSP because it promotes accountability for the quality, cost, and overall care for a Medicare population as described in the MSSP, provides for
the management and coordination of care for Medicare fee-for-service beneficiaries through ACO, and/or encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare beneficiaries. Thus the ACO, pursuant to its governing body’s authorization, is asserting the ACO Participation Waiver’s protection over all of the ACO arrangements entered into as of the beginning of the current MSSP Participation Agreement term (January 1, 2017). - To comply with the ACO Participation Waiver’s requirements, the ACO is publicly disclosing the below arrangement(s). ACO will publicly disclose additional arrangements that qualify for the ACO Participation Waiver as they are authorized by its governing board on this website, in compliance with CMS’s public disclosure requirements.
- ProviderMatch Arrangements: under the ProviderMatch Arrangements, ACO will furnish to all Piedmont Clinic providers a care coordination technology platform known as Kyruus ProviderMatch for Network Care Coordination (“ProviderMatch”), which consists of a suite of search, scheduling and referral products designed to help health networks optimize enterprise-wide patient access and care management.
- ACO’s governing body has duly authorized the below arrangements that qualify for the ACO Fraud and Abuse Waivers, and specifically the ACO Participation Waiver, through Resolutions adopted by unanimous consent. The ACO Board of Directors has made a bona fide determination that the following arrangement(s) is reasonably related to the purposes of the MSSP because it promotes accountability for the quality, cost, and overall care for a Medicare population as described in the MSSP, provides for
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