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 314
Great Neck, NY 11021
ACO Primary Contact
Primary Contact Name: Marion Davis, CEO
Primary Contact Phone Number: 516-233-2485
Primary Contact Email Address: mdavis@primarypartnercare.com

ACO Participants – 2017

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Ryan M. Cahill, D.O., P.C.

N

Fredric J Mintz MD PC

N

Jennifer Mingione MD PC

N

Marc Singer

N

Eileen Korpi

N

Antonio Corona

N

Howard Knoll

N

Robert Carlin

N

James Stallone

N

Harry Jacob

N

Alan Seymour

N

Shoba Menon MD

N

Harry Jacob

N

Alan Seymour

N

Shoba Menon MD

N

Weymin Hago

N

Reena Patel

N

Jennifer Mingione

N

Mark Shapiro

N

Antoine Charles

N

Joseph Mackey

N

Glen Loria

N

James Higgins

N

Alan Antonelli

N

Ihor Magun MD

N

Brian Vogel

N

Mahendra Shah

N

Smithtown Medical Specialists, PC

N

Dix Hills Medical Association PC

N

Yin-Lee Chin MD PC

N

Joseph Dic DO

N

Leslie Bennett MD PC

N

Smithtown Primary Medical Care, P.C.

N

Mark Jagust

N

Brij M. Sharma Physician PC

N

James Ferguson

N

Peter J. Kurzweil, M.D., P.C.

N

Sound Medical Care PC

N

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

N

JEMTEL Medical PC

N

Broadway Internal Medicine Associates, PC

N

North Shore Gastroenterology Associates

N

Peconic Family Medicine PC

N

Tomas Pattugalan

N

Scott Bloom MD PC

N

Woo Sup Kim MD PC

N

Lawrence Family Medical Practice, P.C.

N

Gary K Rachlin Do Pllc

N

South Island Family Medical, LLC

N

Island Family Medical Practice, PC

N

Qazi K. Haider, Md, Pc

N

Heart and Lung Associates, PC

N

Benjamin Z. Arbesfeld, MD, PC

N

Eldad S. Benmen M.D. P.C

N

Carl Korpi

N

Cynthia Santiago

N

Kathie Brand

N

Christopher Ng

N

Queens Village Primary Medical Care

N

Maria Deiparine Sygaco

N

North Ocean Family Medicine

N

Stephen T Braun Do Pllc

N

William Duke

N

East End Geriatric & Adult Medicine, PLLC

N

Dr Steven Berley & Dr Keith Hoerning Ptr

N

Pedro J. Roque MD PLLC

N

Persaud Medical PLLC

N

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

N

Carefirst Family Medical Pc

N

Sisselman Medical Group, Pc

N

Edward S Bennett MD PLLC

N

John R Fernandez MD PLLC

N

Dr. Bellamy Brook D.O. P.C.

N

Leslie Sean Ramsammy MD PC

N

Complete Health Medical P.C.

N

Empire NY Medical Care Pllc

N

Thomas P. Mathew MD PC

N

Skender Murtezani, M.D. PLLC

N

Dulce M. Almanzar, M.D., Pc

N

Long Island Family Medical, PLLC

N

Michael Salamatbad DO PC

N

TMH Medical Home

N

Kings Park Medicine PC

N

Lisa Marx, DO, PLLC

N

CareMed Primary and Urgent Care PC

N

Termini Medical Care, P.C.

N

Long Beach Family Medicine Pc

N

Eastern Long Island Family Medicine PC

N

Long Island Health & Wellness Family Medicine, P.C.

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 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 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 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 2017

Measure Number Performance Measure 2017 reporting period
ACO Performance rate Mean performance
rate for all ACOs
ACO #1 CAHPS: Getting Timely Care, Appointments, and Information 77.98 80.60
ACO #2 CAHPS: How Well Your Doctors Communicate 92.73 93.13
ACO #3 CAHPS: Patients’ Rating of Provider 92.34 92.31
ACO #4 CAHPS: Access to Specialists 84.57 83.32
ACO #5 CAHPS: Health Promotion and Education 67.76 62.30
ACO #6 CAHPS: Shared Decision Making 76.29 75.85
ACO #7 CAHPS: Health Status/Functional Status 73.48 73.05
ACO #34 CAHPS: Stewardship of Patient Resources 26.06 25.68
ACO #8 Risk Standardized, All Condition Readmission 15.79 15.01
ACO #35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 19.50 18.46
ACO #36 All-Cause Unplanned Admissions for Patients with Diabetes 60.98 53.95
ACO #37 All-Cause Unplanned Admissions for Patients with Heart Failure 80.28 79.16
ACO #38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 62.86 61.74
ACO #43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.71 1.93
ACO #11 Use of Certified EHR Technology 78.26 98.48
ACO #12 Medication Reconciliation 100 75.32
ACO #13 Falls: Screening for Future Fall Risk 91.62 74.38
ACO #44 Imaging Studies for Low Back Pain 75.00 67.32
ACO #14 Preventic Care and Screening: Influenza Immunization 92.74 72.52
ACO #15 Pneumonia Vaccination Status for Older Adults 81.08 72.92
ACO #16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 94.88 70.69
ACO #17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 99.67 90.48
ACO #18 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 88.38 61.98
ACO #19 Colorectal Cancer Screening 93.17 64.58
ACO #20 Breast Cancer Screening 85.86 70.05
ACO #42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 93.58 79.89
ACO #27 Diabetes Mellitus: Hemoglobin A1c Poor Control 20.16 16.74
ACO #41 Diabetes: Eye Exam 76.61 50.37
ACO #28 Hypertension (HTN): Controlling High Blood Pressure 80.88 71.47
ACO #30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 93.63 86.86

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.

 

Quality Performance Results Table 2016

Measure Number Performance Measure 2016 reporting period
ACO Performance rate Mean performance
rate for all ACOs
ACO #1 CAHPS: Getting Timely Care, Appointments, and Information 80.72 79.9
ACO #2 CAHPS: How Well Your Doctors Communicate 92.62 92.63
ACO #3 CAHPS: Patients’ Rating of Provider 91.91 91.93
ACO #4 CAHPS: Access to Specialists 81.99 83.52
ACO #5 CAHPS: Health Promotion and Education 64.02 60
ACO #6 CAHPS: Shared Decision Making 77.48 75.28
ACO #7 CAHPS: Health Status/Functional Status 70.93 71.82
ACO #34 CAHPS: Stewardship of Patient Resources 28.08 27.52
ACO #8 Risk Standardized, All Condition Readmission 15.49 14.7
ACO #35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 17.91 18.17
ACO #36 All-Cause Unplanned Admissions for Patients with Diabetes 51.7 53.2
ACO #37 All-Cause Unplanned Admissions for Patients with Heart Failure 73.57 75.23
ACO #38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 60.79 59.81
ACO #9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive
Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)
8.27 9.27
ACO #10 Ambulatory Sensitive Conditions Admissions: Heart Failure
(AHRQ Prevention Quality Indicator (PQI) #8)
14.37 14.53
ACO #11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 44.12 82.72
ACO #39 Documentation of Current Medications in the Medical Record 99.54 87.54
ACO #13 Falls: Screening for Future Fall Risk 86.88 64.04
ACO #14 Preventive Care and Screening: Influenza Immunization 91.33 68.32
ACO #15 Pneumonia Vaccination Status for Older Adults 80.97 69.21
ACO #16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 98.65 74.45
ACO #17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 97 90.98
ACO #18 Preventive Care and Screening: Screening for Clinical Depression
and Follow-Up Plan
87.55 53.63
ACO #19 Colorectal Cancer Screening 81.44 61.52
ACO #20 Breast Cancer Screening 80.98 67.61
ACO #21 Preventive Care and Screening: Screening for High
Blood Pressure and Follow-Up Documented
98.36 76.84
ACO #42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 93.33 77.72
ACO #27 Diabetes Mellitus: Hemoglobin A1c Poor Control 17.5 18.24
ACO #41 Diabetes: Eye Exam 71.25
44.94
ACO #28 Hypertension: Controlling High Blood Pressure 79.81 70.52
ACO #30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 93.3 85.05
ACO #31 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 97.83 88.67
ACO #33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin
Reception Blocker (ARB) Therapy – for patients with CAD and
Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)
94.12 79.67

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 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