Mary Washington Health Alliance MSSP Enhanced (2022-Current)

ACO Name and Location

Mary Washington Health Alliance, LLC.

2300 Fall Hill Ave.
Suite 308A
Fredericksburg, Virginia 22401

ACO Primary Contact

Primary Contact Name

Travis Turner

Primary Contact Phone Number

(540) 741-1557

Primary Contact Email Address

travis.turner@mwhc.com

Organizational Information

ACO Participants:

ACO Participants ACO Participant in Joint Venture
MARY WASHINGTON MEDICAL GROUP HOSPITALIST SERVICES, LLC N
MARY WASHINGTON HEALTHCARE PHYSICIANS N
RADIOLOGIC ASSOCIATES OF FREDERICKSBURG N
MEDICAL IMAGING OF FREDERICKSBURG, LLC N
VIRGINIA URGENT CARE LLC N
STAFFORD HOSPITAL, LLC N
OBHG VIRGINIA LLC N
ELITE WOMENS HEALTH INC N
MARY WASHINGTON HOSPITAL INC N
ACCESS EYE CENTERS, PC N
CENTERCARE FAMILY PRACTICE LLC N
RAPPAHANNOCK WOMEN'S HEALTH CENTER PC N
VIRGINIA CENTER FOR ALLERGY AND ASTHMA INC. N
FREDERICKSBURG EMERGENCY MEDICAL ALLIANCE, INC. N
GASTROENTEROLOGY ASSOCIATES OF FREDERICKSBURG, P.C. N
Pinnacle Dermatology, SC N
Polaris Heart and Vascular, PLLC. N
CARDIOLOGY ASSOCIATES OF FREDERICKSBURG, LTD. N
UROLOGY ASSOCIATES OF FREDERICKSBURG, PC N
CENTRAL VIRGINIA ORTHOPAEDICS & SPORTS MEDICINE N
PATHOLOGY ASSOCIATES OF FREDERICKSBURG PTR N
COLONIAL INTERNAL MEDICINE ASSOCIATES PC N
VIRGINIA ONCOLOGY CARE PC N
FALL HILL GASTROENTEROLOGY ASSOCIATES, LTD. N
DERMATOLOGY CENTER PC N
Dynamic Foot and Ankle Center LLC
CENTRAL VIRGINIA OB GYN GROUP PC N
ORACLE HEART & VASCULAR PLLC N
LEE'S HILL FAMILY PHYSICIANS, P.C. N
PULMONARY ASSOCIATES OF FREDERICKSBURG N
EAR NOSE AND THROAT AND FACIAL PLASTIC SURGERY CENTER OF FREDERICK N
NEW BEGINNINGS OB GYN PC N
Christopher Harrington MD PC
CENTRAL VIRGINIA INTERNAL MEDICINE PLC N
WOMENS HEALTH AND SURGERY CENTER N
OPTIMUM CARE LLC N
MEDICAL & URGENT CARE CENTER, PC N
Fredericksburg Christian Health Center N
PEDSPLUS URGENT CARE LLC N
MAP RC LLC N
FREDERICKSBURG ANESTHESIA SERVICES LLC N
METROPOLITAN HEALTH CARE PROVIDERS, INC. N
VISTA EYE SPECIALISTS PC N
NORTHERN VIRGINIA HEMATOLOGY ONCOLOGY ASSOCIATES PC N
BLUE NILE MEDICAL CENTER, P.C. N
THE CENTER FOR ORTHOPEDICS, INC. N
COMMONWEALTH INTERNAL MEDICINE PC N
SLEEP DISORDER CENTER OF FREDERICKSBURG PLC N
CENTRAL VIRGINIA SLEEP CENTER PLC N
MARY WASHINGTON EYE CARE CENTER, LLC N
METROHEALTH INTERNAL MEDICINE, PC N
FAMILY FOOT AND ANKLE CENTER N
RADIATION ONCOLOGY SPECIALISTS OF CENTRAL VIRGINIA PLC N
Vision Innovation Centers of Virginia LLC N
RAPIDAN MEDICAL CENTER N
FAMILY CARE OF FREDERICKSBURG PLC N
INTERNAL MEDICINE OF VIRGINIA, P.C. N
FREDERICKSBURG FOOT & ANKLE CENTER N
MCMANUS & ASSOCIATES INTERNAL MEDICINE PC N
DIABETES & THYROID ASSOCIATES N
CHANCELLOR PRIMARY CARE PLLC N
BELMONT AESTHETIC & RECONSTRUCTIVE PLASTIC SURGERY N
PSYCHIATRIC CARE INC N
DHMR CLINICS, INC N

ACO Governing Body:

Member's Last Name

Member's First Name

Member's Title/Position

Member's Voting Power (Expressed as a percentage) Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable

McDowell

Kenneth

DO,

Chairman/Voting Member

10%

ACO Participant Representative

Colonial Internal Medicine Associates PC

McDermott

Michael

MD, Vice Chair/Voting Member

10%

ACO Participant Representative

Mary Washington Hospital, Inc.

Newman

Christopher

MD,

Secretary/Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Frazier

Jeffrey

MD,

Treasurer/Voting Member

5%

ACO Participant Representative

Radiologic Associates of Fredericksburg, Ltd.

Nakave Abhijeet

MD, Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Thott

Kurian

MD, Voting Member

5%

ACO Participant Representative

Womens Health and Surgery Center

Szlyk

Gregory

MD, Voting Member

5%

ACO Participant Representative

Urology Associates of Fredericksburg, PC

Amory

Charles

MD

0

Other – Community Physician

Chancellor Pediatrics

DeTrane

Frank

MD

5%

ACO Participant Representative

Gastroenterology Associates of Fredericksburg

Vacant

MD, Voting Member

0

ACO Participant Representative

TBD

Sims

Adam

MD, Voting Member

5%

ACO Participant Representative

Fredericksburg Emergency Medical Alliance, Inc.

Woodford

Dan

MD,

Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

McManus

Patrick

MD,

Voting Member

5%

ACO Participant Representative

McManus & Associates Internal Medicine, PC

Gamache Donna

MD, Voting Member

5%

ACO Participant Representative

Lee's Hill Family Physicians, PC

Brown

Dana

MD, Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Sherwood

Timothy

MD, Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Aiken

Matthew

DO, Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Branscome

Ronald

Voting Member

5%

Medicare Beneficiary Representative

N/A

Davis

Bruce

Voting Member

5%

Community Stakeholder Representative

N/A

Barden

Sean

Voting Member

5%

ACO Participant Representative

Mary Washington Hospital, Inc.

Key ACO Clinical and Administrative Leadership:

ACO Executive: Travis Turner

Medical Director: Richard Lewis, MD

Compliance Officer: Lauren Blalock

Quality Assurance/Improvement Officer: Dan Woodford, MD

Associated Committees and Committee Leadership:

  • Kenneth McDowell, DO; MWMD Board Chair
  • Dan Woodford, MD; Chair, Clinical Quality Committee
  • Kurian Thott, MD; Chair, Communications and Education Committee
  • Jeffrey Frazier, MD; Chair, Finance and Contracting Committee
  • Gregory Szlyk, MD; Chair, Information Technology Committee
  • Patrick McManus, MD; Chair, Nominating and Membership/Operations Committees

Types of ACO Participants, or Combinations of Participants, That Formed the ACO:

  • Networks of individual practices of ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses:

  • First Agreement Period
    • Performance Year 2021, N/A
  • Second Agreement Period
    • Performance Year 2022, $3,807,505

Shared Savings Distribution:

  • First Agreement Period
    • Performance Year 2021
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
  • Second Agreement Period
    • Performance Year 2022
      • Proportion invested in infrastructure: 50%
      • Proportion invested in redesigned care processes/resources: 35%
      • Proportion of distribution to ACO participants: 15%

Quality Performance Results

2022 Quality Performance Results:

Measure # Measure Name Collection Type Reported Performance Rate Current Year Mean Performance Rate (SSP ACOs)
CAHPS_1 Getting Timely Care, Appointments, and Information CAHPS for MIPS Survey 84.1 83.96
CAHPS_2 How Well Providers Communicate CAHPS for MIPS Survey 94.6 93.47
CAHPS_3 Patient’s Rating of Provider CAHPS for MIPS Survey 93.7 92.06
CAHPS_4 Access to Specialists CAHPS for MIPS Survey 77.2 77
CAHPS_5 Health Promotion and Education CAHPS for MIPS Survey 57.3 62.68
CAHPS_6 Shared Decision Making CAHPS for MIPS Survey 63.9 60.97
CAHPS_7 Health Status and Functional Status CAHPS for MIPS Survey 74.0 73.06
CAHPS_8 Care Coordination CAHPS for MIPS Survey 87.1 85.46
CAHPS_9 Courteous and Helpful Office Staff CAHPS for MIPS Survey 93.1 91.97
CAHPS_11 Stewardship of Patient Resources CAHPS for MIPS Survey 16.3 25.62
Measure_479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups [1] Administrative Claims 0.1605 0.1510
Measure_484 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions [1] Administrative Claims 36.1 30.97
QualityID_318 Falls: Screening for Future Fall Risk CMS Web Interface 82.9 87.83
QualityID_110 Preventative Care and Screening: Influenza Immunization CMS Web Interface 73.5 77.34
QualityID_226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention CMS Web Interface 66.7 79.27
QualityID_134_WI Preventative Care and Screening: Screening for Depression and Follow-up Plan CMS Web Interface 54.0 76.97
QualityID_113 Colorectal Cancer Screening CMS Web Interface 67.5 75.32
QualityID_112 Breast Cancer Screening CMS Web Interface 83.3 78.07
QualityID_438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease CMS Web Interface 92.5 86.37
QualityID_370 Depression Remission at Twelve Months CMS Web Interface 5.0 16.03
QualityID_001_WI Diabetes: Hemoglobin A1c (HbA1c) Poor Control [1] CMS Web Interface 15.8 10.71
QualityID_236_WI Controlling High BP CMS Web Interface 75.0 76.16
QualityID_321 CAHPS for MIPS [3] CMS Web Interface N/A N/A

For Previous Years’ Financial and Quality Performance Results, Please Visit data.cms.gov

Payment Rule Waivers

  • Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
    • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.
  • Waiver for Payment for Telehealth Services:
    • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.

Fraud and Abuse Waivers

ACO Pre-Participation Waiver:

Our ACO is not using any Pre-Participation Waivers

ACO Participation Waiver:

The Secretary of the Department of Health and Human Services (HHS) has made available a participation waiver of 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) with the Centers for Medicare & Medicaid Services (CMS).

The Mary Washington Health Alliance (ACO) Governing Body has duly authorized the arrangements below and made a bona fide determination that each arrangement is reasonably related to the purposes of the MSSP because the arrangements will promote accountability for the quality, cost and overall care for Medicare beneficiaries assigned to ACO. The descriptions of relevant arrangements are set forth below for the purpose of ACO availing itself of the protections afforded under the MSSP Waivers:

  1. ACO has implemented a care coordination arrangement beginning January 1, 2016, pursuant to which the ACO identifies certain Medicare beneficiaries as being at high risk or rising risk and actively engages such beneficiaries under a navigation program constituting an evidenced-based approach to improving patient engagement and improving the overall efficiency of care.
  2. ACO has entered into a Hospital Quality and Efficiency Program with Mary Washington Hospital, of the ACO’s providers/suppliers as of January 1, 2016, for purposes of the implementation by the ACO of quality initiatives that will support the efficiency and efficacy of various transitions of care processes in a manner that is transparent to patients, has detailed quality controls and implements safeguards to ensure compliance with applicable laws. Specifically, the ACO Governing Body has made a bona fide determination that the program promotes accountability for the quality and cost of overall care for Medicare beneficiaries assigned to the ACO.
  3. The ACO has approved the Surgical Advanced Practitioner Arrangement (the “Arrangement”) which will begin on or about September 1, 2016. Under the Arrangement, the ACO will employ a full-time qualified, experienced, and appropriately licensed allied health professional (e.g., a nurse practitioner or physician assistant) (“Allied Health Professional”) who will be located at Mary Washington Hospital (“MWH”) or Stafford Hospital (“SH”) for the purpose of assisting physician-participants of the ACO with respect to surgical procedures performed in MWH and SH. Such duties shall be assigned by the ACO, and may evolve from time to time, but shall include clinical and administrative activities designed to optimize the coordination among and engagement of health care team members and the patient in promotion of the ACO’s quality and cost objectives.

The Arrangement is designed to promote MWHA’s population health management capabilities, improve management and coordination of patient care for Medicare beneficiaries to encompass the hospital setting, and represents a key investment in MWHA’s infrastructure and redesigned care processes to achieve high quality and efficient service delivery for patients, including Medicare beneficiaries. This Arrangement will be located at MWH and SH for the purpose of assisting physician-participants of MWHA with respect to surgical procedures performed in MWH and SH. Specifically, the ACO Governing Body has made a bona fide determination that the program promotes accountability for the quality and cost of overall care for Medicare beneficiaries assigned to the ACO.

Types of ACO Participants or Combinations of Participants that Formed the ACO:

  • Networks of individual practices of ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals