Medicare Shared Savings Program Participation Waiver Notification

 

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limit innovations by ACO’s participating in the Medicare Shared Savings Program (“MSSP”). In accordance with the ACO Participation Waivers set forth in 76 Fed. Reg. 67992 (Nov. 2, 2011), Accountable Care Medical Group of Florida, Inc. (“ACMG”) seeks waiver protection for the arrangement described below: 

ACMG participates in the Medicare Shared Savings Program (MSSP) and certain waivers available to it through the MSSP. Specifically, ACMG has utilized the MSSP Participation Waivers in connection with the following program.  ACMG’s governing body made a bona fide determination that the arrangement between ACMG, its Participants and Laboratory Corporation of America Holdings (“LabCorp”) are reasonably related to the purposes of the MMSP.  As part of its efforts to: (1) promote better care for individuals; (2) promote better health for populations; and (3) lower growth expenditures, ACMG has contracted with LabCorp to assist in the implementation and on-going operation of care coordination in general and for the treatment and prevention ACMG’s Medicare beneficiaries with chronic kidney disease.  The care coordination support will help ACMG ACO facilitate its efforts to implement case management and care coordination of its MSSP attributed lives.  As ACMG implements the program across its ACO beneficiary population, ACMG will promote the better health of populations and lower growth expenditures. (76 Fed. Reg. at 68000 and 68002). 

 

I.     ACO Name and Location

Accountable Care Medical Group of Florida, Inc.
806 South Douglas Road, Suite 700

Coral Gables, FL  33135

 

II.    ACO Primary Contact

Primary Contact Name

Stephany Nino

Primary Contact Phone Number

786-878-5505

Primary Contact Email Address

snino@genuinehealthgroup.com

 

III.   Organizational Information

ACO PARTICIPANTS JOINT VENTURE
Addison Mizner Medical LLC No
Adult Medicine Of Lake County Inc No
Albert Humphrey, MD  No
Amicus Medical Center LLC No
Angel'S Medical Company No
Boyton Medical Group Inc No
Caps Medical Management LLC No
Carlos Delgado MD PA No
Carlos L Dominguez MD PA No
Central Medical Group, P.A. No
Deerfield Medical Group LLC No
Dr Jorge Travieso M D P A No
Empire Healthcare Consultants Inc No
Erica O Donnell No
Florida Institute Of Health Ltd Lllp No
Francisco J Mora MD PA No
Gilbert Leung, M.D., P.A. No
Gregory Singleton No
Hammock Medical Center Inc No
Ivan Castano No
John Bancroft Hylton M.D,P.A No
Jose David Suarez, M.D., P.A. No
Julian Marquez MD PA No
Juvenal E. Martinez, M.D., P.A. No
Manuel Perez-Espinosa MD PA No
Med-Care Medical Center Inc No
Medical Center Of Winston Towers Inc No
Nano Health Associates LLC No
Orangeburg Family Physicians, PA No
Ormond Internal Medicine LLC No
Physicians Associates PA No
Raypar Inc No
Royal Care Medical Center, Inc. No
Santee Family Medical Center, Inc. No
Steven Fields MD PA No
University Primary Care LLC No
Volusia Medical Center LLC No
Waldo Acebo, M.D., P.A. No

 

 

IV.   ACO Governing Body:

Member

Member's Voting Power – Expressed as a percentage or number

Membership Type

ACO Participant Legal Business Name/DBA, if Applicable 

Last Name

First Name

Title/Position

Montesino

Jenifer

COO and Board Chair

10%

Voting Member

-

Suarez, MD

Jose

CMO and Board Member

10%

ACO Participant and Voting Member

Jose David Suarez, M.D., P.A.

Marquez, MD

Richard

Board Member

10%

ACO Participant and Voting Member

Addison Mizner Medical, LLC

Leung, MD

Gilbert

Board Member

10%

ACO Participant and Voting Member

Gilbert Leung, M.D., P.A.

O'Donnell, MD

Erica

Board Member

10%

ACO Participant and Voting Member

Erica O'Donnell MD

Zeiger

Sandi

Board Member

10%

ACO Participant and Voting Member

Central Medical Group, P.A.

Acebo, MD

Waldo

Board Member

10%

ACO Participant and Voting Member

Waldo Acebo M.D., P.A.

Marquez, MD

Julian

Board Member

10%

ACO Participant and Voting Member

Julian Marquez MD

Martinez, MD

Juvenal

Board Member

10%

ACO Participant and Voting Member

Juvenal Martinez MD PA

Singleton, MD

Gregory

Board Member

10%

ACO Participant and Voting Member

Gregory Singleton, MD

Sternberg

Fred

Board Member

0%

ACO Participant and Voting Member

ACO Beneficiary Representative 

 

Key ACO clinical and administrative leadership:

Joseph L. Caruncho

ACO Executive

Jose Suarez

Medical Director

Manuel Lopez

Compliance Officer

Ingrid Enamorado

Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name

Committee Leader Name and Position

Executive 

Joseph L. Caruncho, Chair

Information and Technology

Sean Leimbach, Chair

Medical Standards and Quality

Dr. Jose David Suarez, Chair

Compliance Officer

Manuel Lopez, JD, Chair

Preventive Health

Grace Giraldo, RN BSN MBA, Chair

 

Types of ACO participants, or combinations of participants, that formed the ACO:

  • Network of individual practices of ACO professionals

 

V.    Shared Savings and Losses

Amount of Shared Savings/Losses

Third Agreement Period

  • Performance Year 2020 $6,103,788

Second Agreement Period

  • Performance Year 2019, $8,816,386
  • Performance Year 2018, $4,658,586
  • Performance Year 2017, $4,561,189

First Agreement Period

  • Performance Year 2016, $3,422,384
  • Performance Year 2015, $4,117,497
  • Performance Year 2014, $0

Shared Savings Distribution

Third Agreement Period

Performance Year 2020

  • Proportion invested in infrastructure: 30%
  • Proportion invested in redesigned care processes/resources: 20%
  • Proportion of distribution to ACO participants: 50%

Second Agreement Period

Performance Year 2019

  • Proportion invested in infrastructure: 30%
  • Proportion invested in redesigned care processes/resources: 20%
  • Proportion of distribution to ACO participants: 50%

Performance Year 2018

  • Proportion invested in infrastructure: 30%
  • Proportion invested in redesigned care processes/resources: 20%
  • Proportion of distribution to ACO participants: 50%

Performance Year 2017

  • Proportion invested in infrastructure: 24%
  • Proportion invested in redesigned care processes/resources: 26%
  • Proportion of distribution to ACO participants: 50%

First Agreement Period

Performance Year 2016

  • Proportion invested in infrastructure: 23%
  • Proportion invested in redesigned care processes/resources: 27%
  • Proportion of distribution to ACO participants: 50%

Performance Year 2015

  • Proportion invested in infrastructure: 40%
  • Proportion invested in redesigned care processes/resources: 10%
  • Proportion of distribution to ACO participants: 50%

Performance Year 2014

  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

 

2020 Quality Performance:

Quality Performance Results:

 

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

Please note, the ACO-40 Depression Remission at 12 months quality measure is notincluded in public reporting due to low sample size.

Note: In the Quality Performance Results file(s) above, search for “Accountable Care Medical Group of Florida, Inc.” or “ACMG” to view the quality performance results. This ACO can also be found by using the ACO ID A2033 in the public use files on data.cms.gov.

 

Payment Rule Waivers

  • No, our ACO does not use the SNF 3-Day Rule Waiver.

 

Beneficiary Incentive Program

  • Our ACO did not participate in the Beneficiary Incentive Program (BIP).

 

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Copyright 2019 Accountable Care Medical Group of Florida, Inc. For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.