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)

Addison Mizner Medical LLC
ADULT MEDICINE OF LAKE COUNTY INC
Albert Humphrey, MD 
AMICUS MEDICAL CENTER LLC
Angel's Medical Company
Boyton Medical Group Inc
Caps Medical Management LLC
Carlos Delgado MD PA
Central Medical Group, P.A.
Deerfield Medical Group LLC
DR JORGE TRAVIESO M D P A
Empire Healthcare Consultants Inc
ERICA O DONNELL
FLORIDA INSTITUTE OF HEALTH LTD LLLP
FLORIDA MOBILE PHYSICIANS LLC
FRANCISCO J MORA MD PA
Gilbert Leung, M.D., P.A.
GREGORY SINGLETON
Hammock Medical Center Inc
IVAN CASTANO
JOHN BANCROFT HYLTON M.D,P.A
Jose David Suarez, M.D., P.A.
JULIAN MARQUEZ MD PA
Juvenal E. Martinez, M.D., P.A.
Manuel Perez-Espinosa MD PA
MED-CARE MEDICAL CENTER INC
MEDICAL CENTER OF WINSTON TOWERS INC
NANO HEALTH ASSOCIATES LLC
ORANGEBURG FAMILY PHYSICIANS, PA
ORMOND INTERNAL MEDICINE LLC
PAUL G PRESTE MD & ASSOCIATES
PHYSICIANS ASSOCIATES PA
RAYPAR INC
Royal Care Medical Center, Inc.
SANTEE FAMILY MEDICAL CENTER, INC.
Steven Fields MD PA
UNIVERSITY PRIMARY CARE LLC
VOLUSIA MEDICAL CENTER LLC
Waldo Acebo, M.D., P.A.
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
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.

 

         

Leung, MD

Gilbert

Board Member

1 of 16 Votes

ACO Participant and Voting Member

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

 

         

Zeiger

Sandi

Board Member

1 of 16 Votes

ACO Participant and Voting Member

Central Medical Group, P.A.

 

         

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

 

         

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 2020 $6,103,788
  • 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 2020
  • Proportion invested in infrastructure: 30%
  • Proportion invested in redesigned care processes/resources: 20%
  • Proportion of distribution to ACO participants: 50%

 

  • 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.