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: 516-233-2483
Primary Contact Email Address: mdavis@primarypartnercare.com

ACO Participants – 2017

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Mumtaz Mohidin, MD

N

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

N

Sylvester Ozoude

N

Fredric J Mintz MD PC

N

Jennifer Mingione MD PC

N

Marc Singer

N

Antonio Corona

N

Howard Knoll

N

Robert Carlin

N

James Stallone

N

Internal Medicine and Geriatrics Associates PLLC

N

Bay Family Medicine, PLLC

N

Harry Jacob

N

Alan Seymour

N

Shoba Menon MD

N

George Lowy

N

Weymin Hago

N

Frank Parasmo

N

Jennifer Mingione

N

Mark Shapiro

N

John Bania

N

Joseph Mackey

N

Howard Rosenfeld

N

James Higgins

N

Alan Antonelli

N

Rosanne Cebelenski

N

Brian Vogel

N

Mahendra Shah

N

George Lowy MD PC

N

Smithtown Medical Specialists, PC

N

Yuan T. Hwang MD and Matthew M. Lin, M.D., P.C.

N

Mahendra Shah

N

Yin-Lee Chin Md Pc

N

Joseph Dic DO

N

Leslie Bennett MD PC

N

Smithtown Primary Medical Care, P.C.

N

Brij M. Sharma Physician PC

N

Vicente H Salvador Md Pc

N

James Ferguson

N

Mark Shapiro

N

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

N

Sound Medical Care PC

N

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

N

Alan Seymour

N

JEMTEL Medical PC

N

Joseph Dic DO

N

Broadway Internal Medicine Associates, PC

N

North Shore Gastroenterology Associates

N

James Stallone

N

Howard Knoll

N

South Shore Family Practice DO PC

N

Tomas Pattugalan

N

Scott Bloom MD PC

N

Harry Jacob

N

Woo Sup Kim MD PC

N

Lawrence Family Medical Practice, P.C.

N

Peter S Gelfand DO PC

N

Pierre Collin

N

Howard Rosenfeld

N

Diala Jaber, MD, PC

N

South Island Family Medical, LLC

N

Island Family Medical Practice, PC

N

Robert Carlin

N

Heart and Lung Associates, PC

N

Benjamin Z. Arbesfeld, MD, PC

N

Eldad S. Benmen M.D. P.C

N

Cynthia Santiago

N

Tomas Pattugalan

N

Kathie Brand

N

James Ferguson

N

Christopher Ng

N

Joseph Mackey

N

Mumtaz Mohidin

N

Queens Village Primary Medical Care

N

Maria Deiparine Sygaco

N

North Ocean Family Medicine

N

Setauket Primary Medical Care, P.C.

N

William Duke

N

East End Geriatric & Adult Medicine, PLLC

N

Pedro J. Roque MD PLLC

N

Octavian G. Austriacu DO, PC

N

Persaud Medical PLLC

N

Bay Shore Medical Care PC

N

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

N

Stuart W Haber MD PC

N

Carefirst Family Medical Pc

N

Edward S Bennett MD PLLC

N

John R Fernandez MD PLLC

N

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

N

Shoba Menon MD

N

Leslie Sean Ramsammy MD PC

N

Complete Health Medical P.C.

N

Thomas P. Mathew MD PC

N

Skender Murtezani, M.D. PLLC

N

Mid Island Internal Medicine, 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

Amityville Medical Care P.C.

N

Termini Medical Care, P.C.

N

William Duke

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
Clinical Management Harry Jacob, MD, Chair
Credentialing/Recredentialing Stephen Sisselman, 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

 

First Agreement Period

 

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

 

Shared Savings Distribution

 

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 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 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