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:

ACO GOVERNING BODY

ADDITIONAL ACO INFORMATION

Key ACO Clinical and Administrative Leadership:

Associated Committees and Committee Leadership:

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%

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

• 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.

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