Public Disclosure of Arrangements Protected Under the ACO Participation Waiver
North Central Arizona Accountable Care, LLC (“the ACO”) is currently participating in the Medicare Shared Savings Program (“MSSP”) through a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”). The ACO’s Participation Agreement went into effect on January 1, 2015, and had a term of three years. The Participation Agreement has been renewed for an additional three years, starting on January 1, 2018.
The U.S. Department of Health & Human Services has provided a waiver of federal fraud and abuse laws for arrangements, entered into by an accountable care organization participating in the MSSP, that are reasonably related to the purposes of the MSSP (the “ACO Participation Waiver”). (See Interim final rule issued November 2, 2011, 76 Fed. Reg. 67992, and Final rule issued October 29, 2015, 80 Fed. Reg. 66726.)
One of the requirements of the ACO Participation Waiver is public disclosure of the arrangements. The purpose of this document is to provide the required public disclosure of arrangements involving the ACO, its participants, and/or its providers and suppliers, which fall under the Participation Waiver.
The ACO has duly authorized the arrangements described below.
The ACO has also made a bona fide determination that each arrangement is reasonably related to the purposes of the MSSP – specifically, promoting accountability for the quality, cost, and overall care for a Medicare patient population as described in the MSSP; managing and coordinating care for Medicare fee-for-service beneficiaries through an ACO; and encouraging investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare beneficiaries.
The ACO intends that these arrangements qualify for the ACO Participation Waiver as of January 1, 2015, which was the effective date of the ACO’s Participation Agreement with CMS.
Electronic Health Records Software and Services
On February 28, 2018 the ACO duly authorized Yavapai Community Hospital Association, dba Yavapai Regional Medical Center (“YRMC”), which is an ACO participant, to provide certain electronic health record (“EHR”) software and services to all physician practices that participate in the ACO. The purpose of these arrangements is to encourage physician ACO participants to implement the same EHR software that YRMC uses, and create a patient-centric, integrated, electronic medical record. (The arrangements are for ACO participants who are not employed by YRMC, because employed physicians already use the same EHR software as YRMC.)
The ACO believes these arrangements will give healthcare providers that participate in the ACO faster access to more comprehensive medical information about their patients, across different care settings. That will allow for more efficient delivery of care, better care coordination, increased security of patient information, lower administrative costs and burdens, and an overall improvement in the quality of care – all of which will benefit Medicare beneficiaries as well as other patients.
The terms and conditions of these arrangements will be set out in formal, written agreements between YRMC and each physician ACO participant that decides to accept the offer of EHR software and services.