MSSP ACO

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 NameACO Participant in Joint Venture
ABSOLUTECARE, INCNo
AHMED FAMILY PRACTICE LLCNo
ALEX E. RIKHTER MD, PCNo
ALLIANCE FAMILY CARE LLCNo
ALPHA INTERNAL MEDICINE LLCNo
ANDREW T MECCA MD PCNo
ANGLYN FAMILY MEDICAL CENTER, LLCNo
ASCENSION HEALTH SERVICESNo
Atlanta Heart AssociatesNo
Atlanta ID Group, P.C.No
BRIDGEWATER FAMILY PRACTICE, PCNo
BUCKHEAD INTERNAL MEDICNENo
BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, P CNo
Byron F. Harper, III, M.D., P.C.No
CAEDEL MEDICAL GROUPNo
CHEROKEE FAMILY MEDICAL CENTER, INCNo
CLEMENT AYANBADEJO LLCNo
COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.No
COLUMBUS MEDICAL ASSOCIATESNo
COMPASS PRIMARY CARE LLCNo
COMPREHENSIVE INTERNAL MEDICINENo
COMPREHENSIVE INTERNAL MEDICINENo
CONCIERGE MEDICINE OF COLUMBUS, INCNo
CONEY & MINTER INTERNAL MEDICINE P.C.No
CONYERS INTERNAL MEDICINE LLCNo
CRABAPPLE FAMILY MEDICINENo
Cranford Powell and Morris Advanced Surgical Specialists, LLCNo
CREEKSIDE MEDICAL CLINIC LLCNo
DENISE DEVERANEZNo
Digestive Healthcare Of GeorgiaNo
EAGLE'S LANDING LONGEVITY CENTERNo
EASTSIDE INTERNAL MEDICINE, LLCNo
EVANS FAMILY MEDICINENo
FAMILY MEDICAL & URGENT CARE CENTER OF MCDONOUGH, LLCNo
FAMILY PRACTICE CENTER, P.C.No
GEORGEIA INTERNAL MEDICINENo
Georgia Bone & Joint, LlcNo
HARRIGAN MEDICAL CONSULTING SERVICES, INCNo
HEALTH CARE FIRSTNo
Henry Internal Medicine, P.C.No
INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, LLCNo
INTERNAL MEDICINE ASSOCIATES OF JASPER, PCNo
INTERNAL MEDICINE SPECIALISTS OF ATLANTANo
JAMES F ZUMSTEIN MD LLCNo
JOHN A DRUMMOND MD PCNo
JULIET ASHER MD PCNo
KEVIN ONEALNo
Khair Family Practice, PCNo
KRISNIR CORPORATIONNo
L & H Internal Medicine PCNo
LABADY MEDICAL ASSOCIATES, LLCNo
LEGACY MEDICAL, LLCNo
Mastercare Medical CenterNo
MDVIP MEDICAL GROUP GA LLCNo
MDVIP MEDICAL GROUP GA-ATLNo
MED-SOUTH PRIMARY CARENo
MUSHARAF MOMIN INCNo
Nephrology Consultants of Georgia, P.C.No
Nephrology, IncNo
NEXCLIN MEDICINENo
NITIN R DESAI MD PCNo
NORTH FULTON INTERNAL MEDICINE GROUPNo
NORTH ROSWELL INTERNAL MEDICINE, PCNo
OMNI PRIMARY CARE, PCNo
OPTIMAL PERFORMANCE MEDICINE LLCNo
PEACHSTATE FAMILY CLINIC LLCNo
Peachtree City Physicians GroupNo
PERSONAL CONCIERGE MD, LLCNo
PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLCNo
Piedmont Athens Primary Care, LLC No
PIEDMONT ATHENS REGIONAL FIRSTCARE LLCNo
PIEDMONT ATHENS SPECIALTY CARE LLCNo
Piedmont Cardiology of Atlanta, LLCNo
Piedmont Colorectal Associates, PCNo
Piedmont Internal Medicine, PCNo
Piedmont Medical Care CorporationNo
PIEDMONT ORTHOPEDICS, LLCNo
Piedmont Providers, LLCNo
PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INCNo
PROACTIVE PHYSICIANS OF MARIETTA, PCNo
REAGAN MEDICAL CENTER AT HAMILTON MILLNo
ROCKDALE FAMILY PRACTICE, PCNo
S Rao Cheti, MD, PCNo
SOUTHERN CRESCENT FAMILY PRACTICE, LLCNo
SPECTRUM INTERNAL MEDICINE, LLCNo
STARR'S MILL INTERNAL MEDICINE, LLCNo
T DOUGLAS GURLEY MD LLCNo
TAMARA BROWN, MD, LLCNo
THACKER & THOMPSONNo
THOMAS N KIAS MD PCNo
VANDANA SETIANo
VINE MEDICAL ASSOCIATES, PCNo
WALNUT CREEK FAMILY PRACTICE PCNo
WELLSTREET OF GEORGIA PCNo
WILLIAM C. LAMBERT M.D.No
WILLIAM E. ROUNDTREE M.D.,P.C.No
WMC Tyrone LLCNo
YAGER FAMILY MEDICINE LLCNo
ZAM ZAM FAMILY CLINIC LLCNo

 

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
Brooks Darryl Voting Member 1 Medicare Beneficiary Representative N/A
Arnold Thomas Voting Member 1 ACO Financial Director 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: TBD
      • Proportion invested in redesigned care processes/resources: TBD
      • Proportion of distribution to ACO participants: TBD
  • 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:

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.

©2021 Piedmont Clinic

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