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). 

 

ACO Name and Location

Accountable Care Medical Group of Florida, Inc.
Previous Names: N/A
6355 NW 36 Street
Suite 604
Virginia Gardens, FL, FL 33166

 

ACO Primary Contact

Primary Contact Name

Ms. Chris Pertierra

Primary Contact Phone Number

786-427-1037

Primary Contact Email Address

CPertierra@ACMGroupFL.com

 

Organizational Information

ACO participants:

ACO Participants

ACO Participant in Joint Venture (Enter Y or N)

Gilberto Jimenez MD, Inc.

N

Med-Care Medical Center Inc

N

Singleton Health Center LLC

N

Comprehensive Medical Access (CMA), Inc.

N

Ivan Castano

N

Erica O Donnell

N

DEERFIELD MEDICAL GROUP LLC

N

Grace Medical Group

N

Lawrence A. Adjei, Apmc

N

ATLANTA PRIMARY CARE PEACHTREE, PC

N

Edwin Herrera, M.D., P.A.

N

Kumar Ravi Md Facc Pc.

N

STEVEN D CORK D.O. PL

N

Marion Heart Center, P.A

N

VOLUSIA MEDICAL CENTER LLC

N

Ronald Johnson

N

Family Practice of Jeffersonville LLC

N

Jeffersonville Family And Geriatric Medicine LLC

N

Little Havana Activities & Nutrition Center Of Dade County, Inc.

N

Green Neal

N

Gregory Singleton

N

Addison Mizner Medical LLC

N

A PRESTIGE WELLNESS CENTER PA

N

EFFINGHAM MEDICAL PARTNERS, LLC

N

Bertha Olazabal MD

N

Marc S. Rabinowitz, M.D., P.C.

N

COULTER CLINIC

N

Royal Care Medical Center, Inc.

N

Oph Medical

N

Eugenio Menendez, D.O., P.A.

N

JOSEFINA LOZANO, MD, PLLC

N

Medical Center of Santee LLC

N

ORMOND INTERNAL MEDICINE LLC

N

Craig Miller

N

Charles Raine

N

Virgilio Del Pino MD, P.A.

N

Herrera Medical Center, LLC

N

Nano Health Associates, L.L.C.

N

BAYVIEW MEDICAL LLC

N

Albert Humphrey, MD

N

Carl I Mitchell MD PA

N

Orangeburg Family Physicians, P.A.

N

CAMPBELL FAMILY PRACTICE

N

Orangeburg Medical Associates, P.A.

N

JUAN BARROSO

N

Fernando De La Cruz

N

Steven Fields, M.D. P.A.

N

Manuel Perez-Espinosa MD PA

N

John R. Parnell M.D., P.A.

N

David L. Berndt, D.O., P.A.

N

Francisco J. Mora MD PA

N

Ramon M Garciaseptien Pa

N

Diagnostic Clinic Medical Group, Inc.

N

RAYPAR, Inc.

N

ADULT MEDICINE OF LAKE COUNTY INC

N

CARLOS L DOMINGUEZ MD PA

N

SANTEE FAMILY MEDICAL CENTER, INC.

N

CENTRAL FLORIDA MEDICAL ASSOCIATES, INC

N

Grisel Mac Williams, M.D., P.A.

N

Physicians Associates, P.A.

N

Hammock Medical Center Inc

N

John Bancroft Hylton Pa

N

South Dade Primary Care

N

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

N

Miguel A. Chamah, M.D., P.A.

N

Julian Marquez Md Pa

N

Ramiro Coro, M.D., P.A.

N

Central Medical Group, P.A.

N

Dr. Jorge Travieso, M.D., P.A.

N

Carlos Delgado MD PA

N

Ramses Vega, M.D., P.A.

N

Angel's Medical Company

N

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

N

Project Access Foundation, Inc.

N

MCV Investment, Inc.

N

Integral Medicine Group Inc

N

Agustin Martinez, M.D., P.A.

N

Juvenal E. Martinez, M.D., P.A.

N

Rios Medical Center, Inc.

N

Susan Fox, D.O., P.A.

N

Waldo Acebo, M.D., P.A.

N

Seneca Healthcare District

N

 

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

Pertierra

Chris

CEO and Board Chair

1 of 16 Votes

Voting Member

ACMG

Suarez, MD

Jose

CMO and Board Member

1 of 16 Votes

ACO Participant and Voting Member

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

Leon, MD

Ramon

Board Member

1 of 16 Votes

ACO Participant and Voting Member

South Dade Primary Care

Mac Williams, MD 

Grisel

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Grisel Mac Williams, M.D., P.A.

Leung, MD

Gilbert

Board Member

1 of 16 Votes

ACO Participant and Voting Member

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

Menendez, MD

Eugenio

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Eugenio Menendez, D.O., P.A.

Zeiger

Sandi

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Central Medical Group, P.A.

Hernandez

Dr. Humerto

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Integral Medicine Group Inc

Singleton

Monnie

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Singleton Health Center, LLC

Rojas, MD

Michelle

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Grace Medical Group

 

Adjei, MD

Lawrence

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Lawrence A. Adjei, Apmc

Olazabal, MD

Bertha

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Bertha Olazabal, MD

Marquez, MD

Julian

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Julian Marquez MD

Martinez, MD

Juvenal

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Juvenal Martinez MD PA

Miranda, MD

Francisco

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Francisco Miranda MD PA

Sternberg

Fred

Board Member

1 of 16 Votes

ACO Participant and Voting Member

ACO Beneficiary Representative 

 

 

Key ACO clinical and administrative leadership:

Chris Pertierra

ACO Executive

Jose Suarez

Medical Director

Manuel Lopez

Compliance Officer

Susan Fernandez

Quality Assurance/Improvement Officer

 

 

Associated committees and committee leadership:

Committee Name

Committee Leader Name and Position

Executive and Fianance 

Chris Pertierra, Chair

Information and Technology

Caridad Heidys Rodriguez, Chair

Medical Standards and Quality

Dr. Jose David Suarez, Chair

Compliance Officer

Manuel Lopez, JD, Chair

Preventive Health

Susan Fernandez, Chair

 

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

  • ACO professionals in a group practice arrangement

 

Shared Savings and Losses

Amount of Shared Savings/Losses

  • 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

  • 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

 

Quality Performance Results:

 

2019 Quality Performance Results:  
     
ACO# Measure Name Rate
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 85.56
ACO-2 CAHPS: How Well Your Providers Communicate 91.48
ACO-3 CAHPS: Patients’ Rating of Provider 89.4
ACO-4 CAHPS: Access to Specialists 81.37
ACO-5 CAHPS: Health Promotion and Education 59.75
ACO-6 CAHPS: Shared Decision Making 55.97
ACO-7 CAHPS: Health Status/Functional Status 70.79
ACO-34 CAHPS: Stewardship of Patient Resources 25.04
ACO-45 CAHPS: Courteous and Helpful Office Staff 89.83
ACO-46 CAHPS: Care Coordination 84.83
ACO-8 Risk Standardized, All Condition Readmission 15.15
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 51.42
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) 1.78
ACO-13 Falls: Screening for Future Fall Risk 85.33
ACO-14 Preventive Care and Screening: Influenza Immunization 65.76
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 94.12
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 87.45
ACO-19 Colorectal Cancer Screening 76.23
ACO-20 Breast Cancer Screening 82.21
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 81.09
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 27.14
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 73.7
ACO-40 Depression Remission at 12 months -

 

  • 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.