Primary Partner Care

Medicare Shared Savings Program ACO

Accountable Care Organization (ACO) Name and Location
Primary PartnerCare ACO Independent Practice Association, Inc.
Previous Legal Business Entity Name: Primary PartnerCare Associates IPA, Inc.
1010 Northern Boulevard, Suite 328
Great Neck, NY 11021
ACO Primary Contact
Primary Contact Name: Marion Davis, CEO
Primary Contact Phone Number: 516-233-2484
Primary Contact Email Address: mdavis@primarypartnercare.com

ACO Participants – 2020

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Advanced Family Medicine

N

Alan Antonelli, M.D., P.C.

N

Antonio Corona

N

Benjamin Z. Arbesfeld, MD, PC

N

Brian L. Vogel, MD

N

Brij M. Sharma, M.D., P.C.

N

Broadway Internal Medicine Associates, PC

N

Carefirst Family Medical, PC

N

Carl Korpi MD PC

N

Complete Health Medical P.C.

N

Dr Steven Berley & Dr Keith Hoerning Ptr

N

East End Geriatric & Adult Medicine, PLLC

N

Ebenezer Odoom MD PC

N

Edward S Bennett MD PLLC

N

Empire NY Medical Care PLLC

N

First Choice Medical PLLC

N

Fredric J Mintz MD PC

N

Glen Loria, MD

N

Harry S. Jacob M.D.

N

Heart and Lung Associates, PC

N

Howard Knoll

N

Ihor Magun MD

N

Island Family Medical Practice, PC

N

James A Stallone DO

N

James A. Higgins, D.O.

N

James W Ferguson, MD LLC

N

Jemtel Medical, PC

N

Jennifer Mingione, MD PC

N

Joseph A. Mackey, M.D.

N

Joseph Dic DO

N

Kathie Brand

N

Kings Park Medicine PC

N

Lawrence Family Medical Practice

N

Leslie Sean Ramsammy MD PC

N

Long Beach Family Medicine

N

Long Island Family Medical, PLLC

N

Long Island Health and Wellness Family Medicine PC

N

Mahendra G. Shah

N

Marc A Singer MD FACC

N

Maria Deiparine, M.D.

N

Mark A. Shapiro M.D.

N

Michael Salamatbad DO PC

N

Mitchell I Weinstein, D.O., P.C.

N

North Shore Gastroenterology Associates

N

Pedro J. Roque MD PLLC

N

Persaud Medical PLLC

N

Peter J Kurzweil

N

Ryan M. Cahill, D.O., P.C.

N

Sapna Shah Family Medicine PC

N

Scott V. Rankin M.D. P.C.

N

Shoba Menon MD PC

N

Sisselman Medical Group PC

N

Skender Murtezani, M.D. PLLC

N

Smithtown Medical Specialists, PC

N

Smithtown Primary Medical Care, P.C.

N

Sound Medical Care PC

N

South Island Family Medical, LLC

N

Termini Medical Care, P.C.

N

Thomas P. Mathew MD PC

N

Tomas Pattugalan MD

N

William M Duke MD

N

Woo Sup Kim MD PC

N

Yin-Lee Chin MD

N

ACO Governing Body

Member

Member’s Voting Power

Membership Type

ACO Participant TIN Legal Business Name/DBA, if Applicable

Last Name

First Name

Title/Position

Jacob Harry Chief Medical Officer & Director

1

ACO Physician Harry Jacob
Crafa Lawrence Treasurer & Director

1

ACO Physician Gary K Rachlin Do Pllc
Ramsammy Leslie Sean Director

1

ACO Physician Leslie Sean Ramsammy MD PC
Duke William Director

1

ACO Physician William Duke
Mann Jack Director

1

ACO Physician Heart and Lung Associates, PC
Stallone James Director

1

ACO Physician James Stallone
Persaud Aretha Director

1

ACO Physician Persaud Medical PLLC
Balsamo Donato Director

1

ACO Physician Long Island Health & Wellness Family Medicine, P.C.
Davis Marion Chief Executive Officer & Director

1

Other
Caldwell Robert Director

0

Other
DeBonet James Director

1

Beneficiary Representative

Key ACO Clinical and Administrative Leadership:

Marion Davis ACO Executive
Harry Jacob, MD Medical Director
Robert Sarnataro, MD Compliance Officer
James Stallone, DO Quality Assurance/Improvement Officer

Associated Committees and Committee Leadership:

Committee Name Committee Leader Name and Position
Quality Improvement James Stallone, DO, Chair
Medical Management Harry Jacob, MD, Chair
Credentialing/Recredentialing Stephen Sisselman, DO, Chair
Advanced AfterCare Ryan Cahill, DO, Chair

 

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

  • Networks of individual practices of ACO professionals

 

Shared Savings and Losses

 

Second Agreement Period

  • • Performance Year 2018, $7,383,593

    • Performance Year 2017, $4,979,555

First Agreement Period

  • • Performance Year 2016, $0
    • Performance Year 2015, $0
    • Performance Year 2014, $0

 

Shared Savings Distribution

 

Second Agreement Period

  • Performance Year 2018

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

  • Performance Year 2017

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

 

First Agreement Period

  • Performance Year 2016

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

  • Performance Year 2015

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

 

  • 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 Table 2018

Measure Number Performance Measure 2018 reporting period
ACO Performance rate Mean performance
rate for all ACOs
ACO #1 CAHPS: Getting Timely Care, Appointments, and Information 88.91 86.14
ACO #2 CAHPS: How Well Your Doctors Communicate 94.27 93.93
ACO #3 CAHPS: Patients’ Rating of Provider  91.91  92.45
ACO #4 CAHPS: Access to Specialists  81.13 81.50
ACO #5 CAHPS: Health Promotion and Education 63.40 59.26
ACO #6 CAHPS: Shared Decision Making 59.34 61.94
ACO #7 CAHPS: Health Status/Functional Status 74.69 73.35
ACO #34 CAHPS: Stewardship of Patient Resources 19.02 26.26
ACO #8 Risk Standardized, All Condition Readmission 14.80 14.98
ACO #35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 18.42 18.59
ACO #36 All-Cause Unplanned Admissions for Patients with Diabetes 34.98 37.01
ACO #37 All-Cause Unplanned Admissions for Patients with Heart Failure 76.00 76.75
ACO #38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 58.96 59.00
ACO #43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.69 1.98
ACO #11 Use of Certified EHR Technology 92.25 98.20
ACO #12 Medication Reconciliation 100.00 85.91
ACO #13 Falls: Screening for Future Fall Risk 96.44 79.73
ACO #44 Imaging Studies for Low Back Pain 55.56 64.36
ACO #14 Preventic Care and Screening: Influenza Immunization 90.87 72.71
ACO #15 Pneumonia Vaccination Status for Older Adults 82.15 75.97
ACO #16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 98.19 76.83
ACO #17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 100.00 72.81
ACO #18 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 94.19 66.74
ACO #19 Colorectal Cancer Screening 90.51 68.27
ACO #20 Breast Cancer Screening 84.72 71.96
ACO #42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 98.22 81.47
ACO #27 Diabetes Mellitus: Hemoglobin A1c Poor Control 17.86 15.51
ACO #41 Diabetes: Eye Exam 84.64 52.42
ACO #28 Hypertension (HTN): Controlling High Blood Pressure 80.41 73.10
ACO #30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 97.81 88.92

Note: ASC = ambulatory sensitive conditions, COPD = chronic obstructive pulmonary disease, PCP = primary care physician,

EHR = electronic health record, IVD = ischemic vascular disease, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.

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

  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

 

• 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

 

Note: In the Quality Performance Results file(s) above, search for “Primary PartnerCare ACO Independent Practice Association, Inc.” to view the quality performance results. This ACO can also be found by using the ACO ID A74238 in the public use files on data.cms.gov.

 

Payment Rule Waivers

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

 

Federal Waivers

Primary PartnerCare ACO Independent Practice Association, Inc. (“ACO”) is a Medicare Shared Savings Program ACO. The Secretary of the Department of Health and Human Services has provided four waivers of federal fraud and abuse laws in connection with the Medicare Shared Savings Program. The ACO Board of Directors has made a bona fide determination that an arrangement with Quest Diagnostics as described below is reasonably related to the purpose of the Medicare Shared Savings Program, and has authorized such arrangement. The collaboration is related to the purposes of the Medicare Shared Savings Program because it promotes accountability for the quality, cost and overall care for a Medicare population by managing and coordinating care for Medicare beneficiaries, and encouraging investment in infrastructure and redesigned care processes for high quality and efficient service delivery for Medicare beneficiaries. Specifically, ACO is seeking ACO Participation Waiver protection for its arrangement with Quest Diagnostics to:

 

• Promote evidence-based medicine and patient engagement
• Meet the requirements for reporting quality and cost measures coordinating care
• Establish clinical and administrative systems
• Meet the clinical integration requirements of the Medicare Shared Savings Program
• Evaluate the health needs of the ACO’s aligned population
• Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries
• Develop standards for beneficiary access and communication, including beneficiary access to medical records

 

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.