NC ACO Public Reporting – MSSP
ACO Name and Location:
Carolinas HealthCare System ACO, LLC
Previous Names: N/A
1000 Blythe Blvd.
Charlotte, NC 28203
ACO Primary Contact:
Abbie Gruseth
605-610-5966
Abbie.Gruseth@AtriumHealth.org
| ACO Participants | ACO Participant in Joint Venture (Enter Y or N) |
|---|---|
| AHSNF, Inc. | N |
| Arboretum Urgent Care Center | N |
| Aswad Surgical Group, PC | N |
| Barnett Family Practice | N |
| Cabarrus Gastroenterology Associates PLLC | N |
| Cabarrus Pathology Associates, P.A. | N |
| Carmel Family Physicians | N |
| Carolina Bone & Joint, P.A. | N |
| Carolinas Ambulatory Surgery, Inc. | N |
| Carolinas Emergency Physicians, P.A. | N |
| Carolinas Imaging Services, LLC | N |
| Charlotte Medical Center | N |
| Carolinas Medical Center at Home, LLC | N |
| Carolinas Palliative Care and Hospice Network, Inc. | N |
| Carolinas Pathology Group, PA | N |
| Carolinas Physicians Network Inc. | N |
| Eastover Obstetrics and Gynecology Associates, Inc. | N |
| Carolinas Rehabilitation | N |
| Carolinas-Anson Healthcare, Inc. | N |
| Charlotte Eye Ear Nose & Throat Associates, P.A. | N |
| Charlotte Medical Clinic, Inc. | N |
| Charlotte Obstetric and Gynecological Associates | N |
| Charlotte Radiology, P.A. | N |
| Christopherson Family Medicine, LLC | N |
| Cleveland Ambulatory Services, LLC | N |
| Columbus Regional Health Network | N |
| Cornerstone Ear Nose & Throat, P.A. | N |
| Cotswold Family Medicine | N |
| Davidson Clinic | N |
| East Carolina Surgical, P.A. | N |
| Eastland Urgent Care | N |
| Eastover University Obstetrics & Gynecology Associates | N |
| Eastridge Family Medicine | N |
| ENT Carolina, P.A. | N |
| Emergency Medicine Physicians of Mecklenburg County, PLLC. | N |
| Harrisburg Family Physicians | N |
| Hospice of Cabarrus County, Inc. | N |
| Lincoln Family Practice | N |
| Mecklenburg Medical Group | N |
| Medical Associates of Rock Hill | N |
| Mercy Hospital, Inc. | N |
| Northcross Family Physicians | N |
| Northeast Anesthesia & Pain Specialists, P.A. | N |
| OrthoCarolina, P.A. | N |
| Paragon Surgical Specialists, P.A. | N |
| Piedmont Gynecological and Obstetrical Associates | N |
| Pulmonary Clinic of The Carolinas, P.C. | N |
| Queen City Ear, Nose and Throat PLLC | N |
| Randolph Internal Medicine Associates | N |
| Riverbend Family Physicians | N |
| Scotland Regional Health Network | N |
| Scotland Memorial Hospital Inc. | N |
| South Charlotte Primary Care | N |
| Southeast Radiation Oncology Group, P.A. | N |
| Steele Creek Urgent Care | N |
| St. Luke's Physician Network, Inc. | N |
| St. Luke's Hospital, Inc. | N |
| Surgical Specialists of Charlotte, P.A. | N |
| The Medical Center of Central Georgia Inc. | N |
| Urology Specialists of The Carolinas | N |
| Carolinas Rehabilitation |
| Member Last Name | Member First Name | Member Title/Position | Member’s Voting Power - Expressed as a percentage or number | Membership Type | ACO Participant Legal Business Name and D/B/A, if applicable |
|---|---|---|---|---|---|
| Brady, MD | Jennifer | Co-Chair | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Collins, MD | Johnathon | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Bowe | Christopher | Voting Member (1) | ACO Participant Representative | CAROLINAS MEDICAL CENTER | |
| Terry | Jennifer | Member | Voting Member (1) | ACO Participant Representative | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY |
| Kauserud, MD | Susanne | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Broyhill, DNP, ACNP-BC, NP | Brittany | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Rose, MD | Geoffrey | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Zbinden, MD | Louis | Member | Voting Member (1) | ACO Participant Representative | SURGICAL SPECIALISTS OF CHARLOTTE, P.A. |
| Seeburg, MD | Robert | Member | Voting Member (1) | ACO Participant Representative | CHARLOTTE RADIOLOGY, P.A. |
| Anderson | Matthew | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Senft, MD | Daniel | Member | Voting Member (1) | ACO Participant Representative | LINCOLN FAMILY PRACTICE |
| Little, MD | Gary | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Steinbacher, MD | Erika | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Kersten, MD | Brian | Member | Voting Member (1) | Medicare Beneficiary Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
| Sheppard | Ellen | Member | Voting Member (1) | Medicare Beneficiary Representative | N/A |
| Still open | Member | Voting Member (1) | Community Stakeholder | N/A | |
| Rebecca | Chassie | Member | Voting Member (1) | ACO Participant Representative | CAROLINAS PHYSICIAN NETWORK, INC. |
Key ACO Clinical and Administrative Leadership
ACO Executive: Jennifer Brady, MD
Medical Director: Brian Kersten, MD
Compliance Officer: Alicia Bowers
Quality Assurance/Improvement Officer: John Schooley
Associated Committees and Committee Leadership
| Committee Name | Committee Leader Name and Position |
|---|---|
| Network Development Committee | Cara Pearsall, Chair |
| Clinical Effectiveness Committee | Zeev Neuwirth, MD, Co-Chair Louis Zbinden, MD, Co-Chair |
| Finance Committee | Daniel Senft, MD, Co-Chair Stuart Burri, MD, Co-Chair |
| Operations Committee | Garry Little, MD, Chair |
| Nominating Committee | Jennifer H. Brady, MD, Co-Chair Open Position |
Types of ACO participants, or combinations of participants, that formed the ACO:
- ACO professionals in a group practice arrangement
- Hospital employing ACO professionals
- Network of individual practices of ACO professionals
- Partnership or joint venture arrangement between hospitals and ACO professionals
Shared Savings and Losses
Amount of shared savings/losses:
- Second Agreement Period
- Performance Year 2020, $0
- First Agreement Period
- Performance Year 2018, $0
Shared Savings Distribution
Second Agreement Period
- Performance Year 2020
- Proportion invested in infrastructure: N/A%
- Proportion invested in redesigned care processes/resources: N/A%
- Proportion of distribution to ACO participants: N/A%
First Agreement Period
- 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%
Quality performance results are based on CMS Web Interface.
| Measure # | Measure Name | Rate | ACO Mean |
|---|---|---|---|
| 001 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control | 5.56 | 12.46 |
| 134 | Preventative Care and Screening: Screening for Depression and Follow-up Plan | 76.60 | 74.38 |
| 236 | Controlling High Blood Pressure | 72.82 | 74.87 |
| 318 | Falls: Screening for Future Fall Risk | 93.73 | 87.03 |
| 110 | Preventative Care and Screening: Influenza Immunization | 87.26 | 80.52 |
| 226 | Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention | 96.00 | 80.97 |
| 113 | Colorectal Cancer Screening | 81.21 | 73.63 |
| 112 | Breast Cancer Screening | 81.85 | 75.11 |
| 438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 87.76 | 84.24 |
| 479 | Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups | 0.1505 | 0.1540 |
| MCC1 | All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC) | 37.11 | 33.99 |
| CAHPS-1 | Getting Timely Care, Appointments, and Information | 85.78 | 84.67 |
| CAHPS-2 | How Well Providers Communicate | 95.58 | 93.56 |
| CAHPS-3 | Patient’s Rating of Provider | 92.59 | 92.19 |
| CAHPS-4 | Access to Specialists | 83.72 | 78.80 |
| CAHPS-5 | Health Promotion and Education | 62.02 | 61.61 |
| CAHPS-6 | Shared Decision Making | 63.17 | 60.89 |
| CAHPS-7 | Health Status and Functional Status | 72.21 | 71.78 |
| CAHPS-8 | Care Coordination | 88.20 | 85.66 |
| CAHPS-9 | Courteous and Helpful Office Staff | 94.69 | 91.88 |
| CAHPS-11 | Stewardship of Patient Resources | 31.02 | 24.71 |
Please note, the Quality ID #: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.
“Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.”
For previous years’ financial and quality performance results, visit data.cms.gov.
Payment Rule Waivers
No, our ACO does not use the SNF 3-Day Rule Waiver.
Fraud and Abuse Waivers
ACO Pre-Participation Waiver:
The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.
[For each arrangement, provide the following information]:
- Parties to the arrangement: N/A
- Date of arrangement: N/A
- Items, services, goods, or facility provided: N/A
- Date and nature of any amendments to the arrangement, if applicable: N/A N/A
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.
[For each arrangement, provide the following information]:
- Parties to the arrangement: N/A
- Date of arrangement: N/A
- Items, services, goods, or facility provided: N/A
- Date and nature of any amendments to the arrangement, if applicable: N/A N/A
Accountable Care Organization (ACO) & Medicare Shared Savings Program Frequently Asked Questions
An accountable care organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to improve quality, cost, and coordination of care you receive in the healthcare setting.
- An ACO does not change your Medicare benefits.
- An ACO is not a Health Maintenance Organization (HMO), managed care, or an insurance plan. An ACO can’t tell you which healthcare providers to see or hospital to visit, and can’t limit your Medicare benefits.
- You still have the right to choose any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t a part of an ACO. Your doctor or healthcare provider may make recommendations, but it is always your choice on what doctors or hospitals you use.
Doctors and healthcare providers that participate in an ACO must display a poster that notifies you of your doctor’s participation in an ACO.
For general information about ACOs, call 1-800-MEDICARE.
- Your doctors will have a more complete picture of your health through talking with your other healthcare providers.
- Medicare will share certain health information with us about the care you receive from your doctors and other healthcare providers unless you ask Medicare not to share it. Medicare may also share your health information with other ACOs in which your doctors or healthcare providers participate.
With an ACO you are the center of care, and your satisfaction is one of the goals. Over time, you may notice that:
- You don’t have to fill out as many medical forms with the same information.
- The doctors and healthcare providers that you see all know what’s going on with your health because they communicate with each other.
- You don’t need to repeat medical tests because your results are shared among your doctors and healthcare providers.
- If you want Medicare to share information about the healthcare you received with Atrium Health ACO, LLC or with other ACOs in which your doctors or healthcare providers participate, there's nothing more you need to do.
- If you do not want Medicare to share your health care information, you need to call 1-800 MEDICARE (1-800-633-4227) and tell the representative that your doctor is part of an ACO and you don't want Medicare to share your health information. TTY user should call 1-877-486-2048.
- If you change your mind in the future, you can call 1-800-MEDICARE and tell the representative what you have decided. We can't communicate with Medicare on your behalf.
- Even if you decline to share your healthcare information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your healthcare information with ACOs when measuring the quality of care given by healthcare providers participating in those ACOs.
Public Website Disclaimer Statement
The Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services’ Office of Inspector General have made available waivers of certain federal fraud and abuse laws in connection with the operation of accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).
Carolinas HealthCare System ACO, LLC (the “Company”) is an ACO participating in MSSP. The Company has entered into an agreement with CVS Pharmacy, Inc. (“CVS”) under which CVS will provide education, outreach and medication adherence support services for certain Medicare beneficiaries attributed to the Company.
The Company’s Board authorized the application of the Participation Waiver to the CVS Agreement on April 3, 2019. The Company’s Board, as the governing body of the Company, has made a bona fide determination that the CVS Agreement supports the goals of the Company and is reasonably related to the purposes of the MSSP as the services rendered by CVS are designed to help improve patient experience of care, improve population health by providing education and medication adherence support services, and reduce the costs of healthcare.