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

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		Membership Type	ACO Participant Legal Business Name/DBA, if Applicable
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	Bruce Romanello, 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 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 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

2018 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	85.34	86.14
ACO-2	CAHPS: How Well Your Providers Communicate	92.54	93.93
ACO-3	CAHPS: Patients’ Rating of Provider	90.77	92.45
ACO-4	CAHPS: Access to Specialists	83.26	81.50
ACO-5	CAHPS: Health Promotion and Education	62.33	59.26
ACO-6	CAHPS: Shared Decision Making	54.94	61.94
ACO-7	CAHPS: Health Status/Functional Status	71.76	73.35
ACO-34	CAHPS: Stewardship of Patient Resources	26.45	26.26
ACO-8	Risk Standardized, All Condition Readmission	15.69	14.98
ACO-35	Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)	19.55	18.59
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes	32.68	37.01
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure	71.00	76.75
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	56.47	59.00
ACO-43	Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)	2.07	1.98
ACO-11	Use of Certified EHR Technology	96.88	98.20
ACO-12	Medication Reconciliation Post-Discharge	98.92	85.91
ACO-13	Falls: Screening for Future Fall Risk	74.55	79.73
ACO-44	Use of Imaging Studies for Low Back Pain	82.50	64.36
ACO-14	Preventive Care and Screening: Influenza Immunization	60.27	72.71
ACO-15	Pneumonia Vaccination Status for Older Adults	56.77	75.97
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up	88.89	76.83
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	81.16	72.81
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	78.38	66.74
ACO-19	Colorectal Cancer Screening	62.64	68.27
ACO-20	Breast Cancer Screening	66.45	71.96
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	78.27	81.47
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	25.70	15.51
ACO-41	Diabetes: Eye Exam	51.75	52.42
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	73.15	73.10
ACO-30	Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet	95.18	88.92

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.

For 2018 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2018-Shared-Savings-Program-SSP-Accountable-Care-O/v47u-yq84/data
For 2017 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2017-Shared-Savings-Program-SSP-Accountable-Care-O/gk7c-vejx/data
For 2016 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2016-Shared-Savings-Program-SSP-Accountable-Care-O/3jk5-q6dr/data
For 2015 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/x8va-z7cu/data
For 2014 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/ucce-hhpu/data

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.

2016 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	76.91	80.51
ACO-2	CAHPS: How Well Your Providers Communicate	94.22	93.01
ACO-3	CAHPS: Patients’ Rating of Provider	91.31	92.25
ACO-4	CAHPS: Access to Specialists	83.88	83.49
ACO-5	CAHPS: Health Promotion and Education	60.41	60.32
ACO-6	CAHPS: Shared Decision Making	73.79	75.40
ACO-7	CAHPS: Health Status/Functional Status	68.61	72.30
ACO-34	CAHPS: Stewardship of Patient Resources	33.96	26.97
ACO-8	Risk Standardized, All Condition Readmission	15.71	14.70
ACO-35	Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)	19.73	18.17
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes	49.70	53.20
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure	78.32	75.23
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	60.61	59.81
ACO-9	Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)	11.81	9.27
ACO-10	Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8)	15.69	14.53
ACO-11	Percent of PCPs who Successfully Meet Meaningful Use Requirements	47.83	82.72
ACO-39	Documentation of Current Medications in the Medical Record	67.06	87.54
ACO-13	Falls: Screening for Future Fall Risk	37.05	64.04
ACO-14	Preventive Care and Screening: Influenza Immunization	23.32	68.32
ACO-15	Pneumonia Vaccination Status for Older Adults	5.72	69.21
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up	77.80	74.45
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	83.88	90.98
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	16.20	53.63
ACO-19	Colorectal Cancer Screening	25.91	61.52
ACO-20	Breast Cancer Screening	39.84	67.61
ACO-21	Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented	80.26	76.79
ACO-42	Statin therapy for the Prevention and Treatment of Cardiovascular Disease	77.23	77.72
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	32.22	18.24
ACO-41	Diabetes: Eye Exam	13.13	44.94
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	59.52	70.69
ACO-30	Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic	92.64	85.05
ACO-31	Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)	90.35	88.67
ACO-33	Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)	85.90	79.67

Table 3. 2015 Quality Performance Results Table

Table 4. 2012-2014 Quality Measure Reporting

Payment Rule Waivers

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