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:
TIN LBN | Sole Proprietor Flag |
---|---|
PIEDMONT CARDIOLOGY OF ATLANTA, LLC | N |
WMC TYRONE LLC | N |
NEPHROLOGY, INC | N |
KHAIR FAMILY PRACTICE, PC | N |
PIEDMONT INTERNAL MEDICINE, PC | N |
ATLANTA HEART ASSOCIATES | N |
PIEDMONT MEDICAL CARE CORPORATION | N |
BYRON F. HARPER, III, M.D., P.C. | N |
DIGESTIVE HEALTHCARE OF GEORGIA | N |
NEPHROLOGY CONSULTANTS OF GEORGIA, P.C. | N |
ATLANTA ID GROUP, P.C. | N |
HENRY INTERNAL MEDICINE, P.C. | N |
L & H INTERNAL MEDICINE PC | N |
PIEDMONT COLORECTAL ASSOCIATES, PC | N |
PIEDMONT PROVIDERS, LLC | N |
GEORGIA BONE & JOINT, LLC | N |
S RAO CHETI, MD, PC | N |
EAGLE'S LANDING LONGEVITY CENTER | N |
ALEX E. RIKHTER MD, PC | N |
AHMED FAMILY PRACTICE LLC | N |
CONYERS INTERNAL MEDICINE LLC | N |
CAEDEL MEDICAL GROUP | N |
ALPHA INTERNAL MEDICINE LLC | N |
FAMILY PRACTICE CENTER, P.C. | N |
FAMILY MEDICAL & URGENT CARE CENTER OF MCDONOUGH, LLC | N |
EASTSIDE INTERNAL MEDICINE, LLC | N |
CRABAPPLE FAMILY MEDICINE | N |
OPTIMAL PERFORMANCE MEDICINE LLC | N |
NORTH ROSWELL INTERNAL MEDICINE, PC | N |
NEXCLIN MEDICINE | N |
MED-SOUTH PRIMARY CARE | N |
INTERNAL MEDICINE ASSOCIATES OF JASPER, PC | N |
GEORGEIA INTERNAL MEDICINE | N |
THOMAS N KIAS MD PC | N |
THACKER & THOMPSON | N |
TAMARA BROWN, MD, LLC | N |
T DOUGLAS GURLEY MD LLC | N |
SOUTHERN CRESCENT FAMILY PRACTICE, LLC | N |
ROCKDALE FAMILY PRACTICE, PC | N |
PROACTIVE PHYSICIANS OF MARIETTA, PC | N |
HEALTH CARE FIRST | N |
JAMES F ZUMSTEIN MD LLC | N |
NITIN R DESAI MD PC | N |
ALLIANCE FAMILY CARE LLC | N |
PHOENIX MEDICAL OFFICE AT COLLEGE PARK,LLC | N |
INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, LLC | N |
PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC | N |
CONCIERGE MEDICINE OF COLUMBUS, INC | N |
OMNI PRIMARY CARE, PC | N |
JULIET ASHER MD PC | N |
NORTH FULTON INTERNAL MEDICINE GROUP | N |
MUSHARAF MOMIN INC | N |
CONEY & MINTER INTERNAL MEDICINE P.C. | N |
CREEKSIDE MEDICAL CLINIC LLC | N |
PEACHSTATE FAMILY CLINIC LLC | N |
BUCKHEAD INTERNAL MEDICNE | N |
ANDREW T MECCA MD PC | N |
MDVIP MEDICAL GROUP GA-ATL | N |
COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. | N |
ANGLYN FAMILY MEDICAL CENTER, LLC | N |
WILLIAM C. LAMBERT M.D. | N |
STARR'S MILL INTERNAL MEDICINE, LLC | N |
INTERNAL MEDICINE SPECIALISTS OF ATLANTA | N |
ASCENSION HEALTH SERVICES | N |
PIEDMONT ATHENS PRIMARY CARE, LLC | N |
LABADY MEDICAL ASSOCIATES, LLC | N |
COMPREHENSIVE INTERNAL MEDICINE | N |
COMPREHENSIVE INTERNAL MEDICINE | N |
REAGAN MEDICAL CENTER AT HAMILTON MILL | N |
PIEDMONT ATHENS SPECIALTY CARE LLC | N |
HARRIGAN MEDICAL CONSULTING SERVICES, INC | N |
YAGER FAMILY MEDICINE LLC | N |
EVANS FAMILY MEDICINE | N |
BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, P C | N |
LEGACY MEDICAL, LLC | N |
COMPASS PRIMARY CARE LLC | N |
PERSONAL CONCIERGE MD, LLC | N |
SPECTRUM INTERNAL MEDICINE, LLC | N |
WILLIAM E. ROUNDTREE M.D.,P.C. | N |
ZAM ZAM FAMILY CLINIC LLC | N |
CLEMENT AYANBADEJO LLC | N |
BRIDGEWATER FAMILY PRACTICE, PC | N |
WELLSTREET OF GEORGIA PC | N |
PIEDMONT ORTHOPEDICS, LLC | N |
NABIL KEITH MD LLC | N |
NEXT LEVEL MEDICAL MANAGEMENT, LLC | N |
SLEEP MEDICINE ASSOCIATES OF ATHENS | N |
MILTON MEDICAL GROUP LLC | N |
THE DOCTOR'S OFFICE AT ELLIJAY,PC | N |
PANDYA MEDICAL CENTER INC | N |
SMYRNA FAMILY MEDICINE, LLC | N |
ASCEND MEDICAL GEORGIA PC | N |
UMG PRIMARY CARE SOUTH CAROLINA LLC | N |
UNIVERSITY MEDICAL GROUP LLC | N |
UMG PROMPT CARE SOUTH CAROLINA LLC | N |
UMG PROMPT CARE LLC | N |
UNIVERSITY CARDIOLOGY ASSOCIATES LLC | N |
WELLNESS LIFE CENTER LLC | N |
KAO, LLC | N |
VNS LLC | N |
CAIRO MEDICAL CARE, LLC | N |
OCMULGEE PHYSICIANS, LLC | N |
MIDDLE GEORGIA CHEST AND MEDICAL CENTER, LLC | N |
LIVI FAMILY MEDICINE LLC | N |
SAMRAJ MEDICAL CLINIC, P.C. | N |
PICKENS PRIMARY CARE LLC | N |
GRAY FAMILY HEALTH LLC | N |
COMPLETE CARE FAMILY MEDICINE CLINIC LLC | N |
WEST ATLANTA PRIMARY CARE | N |
JUNO MEDICAL PRACTICE | N |
TOTAL CARE FAMILY MEDICINE PC | N |
PATRICE D. BODDIE | N |
PREMIER FAMILY WELLNESS CENTER | N |
FAMILY FIRST MEDICAL CARE, P.C. | N |
LONG'S DRUGS OF SANDERSVILLE GEORGIA INC | N |
PINNACLE ENTERPRISES PC | N |
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, Designated Representative |
Motiwala | Shabbir | Voting Member | 1 | ACO Participant Representative | Columbus Ambulatory Healthcare Services |
Master | Moiz | Voting Member | 1 | ACO Participant Representative | Piedmont Medical Care Corporation |
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. |
Hawk | Elizabeth | Voting Member | 1 | ACO Participant Representative | Piedmont Internal Medicine 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, 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 | John Seiler, 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 | Thomas Wells, M.D., Chair, and Michael Manning, 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 2022, $15,400,718
- Performance Year 2021, $15,664,221
- 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 2022
- Proportion invested in infrastructure: $4,930,636 / 33%
- Proportion invested in redesigned care processes/resources: TBD
- Proportion of distribution to ACO participants: $10,162,068 / 67%
- Performance Year 2021
- Proportion invested in infrastructure: $5,220,525 / 33%
- Proportion invested in redesigned care processes/resources: N/A
- Proportion of distribution to ACO participants: $10,443,696 / 67%
- Performance Year 2020
- Proportion invested in infrastructure: $6,000,000 / 40%
- Proportion invested in redesigned care processes/resources: N/A
- Proportion of distribution to ACO participants: $9,015,308 / 60%
- Performance Year 2022
- 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
2022 Quality Performance Results:
Measure # | Measure Name | Reported Performance Rate | Current Year Mean Performance Rate (SSP ACOs) |
---|---|---|---|
001 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control2 | 11.54 | 10.71 |
134 | Preventative Care and Screening: Screening for Depression and Follow-up Plan | 89.12 | 76.97 |
236 | Controlling High Blood Pressure | 67.35 | 76.16 |
318 | Falls: Screening for Future Fall Risk | 92.31 | 87.83 |
110 | Preventative Care and Screening: Influenza Immunization | 73.43 | 77.34 |
226 | Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention | 82.35 | 79.27 |
113 | Colorectal Cancer Screening | 66.78 | 75.32 |
112 | Breast Cancer Screening | 77.10 | 78.07 |
438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 86.41 | 86.37 |
370 | Depression Remission at Twelve Months | 9.76 | 16.03 |
321 | CAHPS for MIPS3 | N/A | N/A |
479 | Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups2 | 0.1546 | 0.1510 |
MCC1 | All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)2 | 32.34 | 30.97 |
CAHPS-1 | Getting Timely Care, Appointments, and Information | 86.94 | 83.96 |
CAHPS-2 | How Well Providers Communicate | 95.01 | 93.47 |
CAHPS-3 | Patient’s Rating of Provider | 93.97 | 92.06 |
CAHPS-4 | Access to Specialists | 77.49 | 77.00 |
CAHPS-5 | Health Promotion and Education | 63.99 | 62.68 |
CAHPS-6 | Shared Decision Making | 62.45 | 60.97 |
CAHPS-7 | Health Status and Functional Status | 74.59 | 73.06 |
CAHPS-8 | Care Coordination | 87.70 | 85.46 |
CAHPS-9 | Courteous and Helpful Office Staff | 91.96 | 91.97 |
CAHPS-11 | Stewardship of Patient Resources | 30.16 | 25.62 |
[1] A lower performance rate corresponds to higher quality.
[2] For PY 2022, the CMS Web Interface measures Quality ID #438 and Quality ID #370 do not have benchmarks, and therefore, were not scored.
[3] CAHPS for MIPS is a composite measure, so numerator, denominator, and performance rate values are not applicable (N/A). The CAHPS for MIPS composite score is calculated as the average number of points across scored Summary Survey Measures (SSMs) (86 FR 65256). Refer to Table 5 for details on CAHPS for MIPS performance.
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. Medicare Shared Savings Program ACO Participation Waiver Disclosure
CMS and the U.S. Department of Health and Human Services Office of Inspector General have promulgated the MSSP “participation” waiver that, for an arrangement covered by the participation waiver, waives application of the federal Ethics in Patient Referrals Act of 1989, 42 U.S.C. § 1395nn (the “Stark Law”), and the federal anti-kickback statute, 42 U.S.C. § 1320a-7b(b) (the “Anti-Kickback Statute”). Piedmont Clinic ACO LLC (“ACO”) is currently participating in the MSSP pursuant to a Participation Agreement with CMS. The ACO seeks participation waiver protection for the arrangement(s) described below: The Piedmont Clinic, Inc. (“Piedmont Clinic”), the sole member of the ACO, operates a clinically integrated healthcare provider network on behalf of its provider members which include individual physicians, some of whom are employed by a Piedmont Healthcare affiliate and some of whom are independent. Certain but not all Piedmont Clinic members have entered into an agreement with the ACO to participate in the MSSP. From time to time, providers in the ACO refer MSSP patients attributed to the ACO to Piedmont Clinic members who do not participate in the ACO. On June 6, 2017, the ACO Board of Directors duly authorized the provision to all Piedmont Clinic members of 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. At the time, the ACO Board of Directors determined that the provision of Kyruus ProviderMatch to all Clinic Members (in addition to other benefits) would facilitate and optimize care coordination for MSSP patients attributed to the ACO among ACO participants and, when necessary, within the broader Piedmont Clinic network. On May 23rd, 2023, the ACO Board of Directors determined that the continued provision of the provider directory functionality of ProviderMatch continues to serve the purposes of the MSSP by facilitating specialist selection at the point of referral to optimize coordination of care for MSSP patients, and duly authorized the continued provision of the provider directory functionality to all Piedmont Clinic members. However, the ACO Board of Directors authorized a material modification of the ProviderMatch arrangement to cease the provision of the ProviderMatch search and scheduling functionalities to all Piedmont Clinic members.The ACO desires to furnish to all Piedmont Clinic members an advanced care coordination technology platform known as DexCare, which consists of a suite of provider search and scheduling products to complement the Kyruus ProviderMatch provider directory functionality and enhance enterprise-wide patient access and care management. The ACO determined that the use of DexCare by Piedmont Clinic members will facilitate quality improvement through optimization of the provider-patient match and through enhanced network clinical integration, which, in turn, will maximize the opportunities for coordination of care and application of network quality measures. On May 23rd, 2023, the ACO Board of Directors duly authorized the provision of DexCare to all Piedmont Clinic members and made a bona fide determination that each arrangement is reasonably related to the purposes of the MSSP for the reasons stated above.
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