Northwest Ohio Accountable Care Organization

ACO Name and Location:

Northwest Ohio ACO, LLC
4235 Secor Rd
Toledo, OH 43623

ACO Primary Contact

Primary Contact Name	Tim Poplawski
Primary Contact Phone Number	419-318-9447
Primary Contact Email Address	tpoplawski@toledoclinic.com

Organizational Information

ACO Participants	ACO Participant in Joint Venture (Enter Y or N)
Perrysburg Eye Center, Inc	Y
Toledo Clinic Incorporated	Y
Northwest Surgical Specialists Inc	Y
James M Croak Do Inc	Y
Neurosurgical Network, Inc	Y
Ophthalmology Associates of Northwestern Ohio,Inc	Y
Gary Swann DO	Y
John Rosenthal	Y
Wellcare Physicians Group, LLC	Y

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	Member's Voting Power	Membership Type
Elliot	Ian	Board President	1	Board	Toledo Clinic, Inc.
Jacob	Moshir	CMO	1	Board	Toledo Clinic, Inc.
Sternfeld	William	Compliance Officer	1	Board	Toledo Clinic, Inc.
Al-Bawab	Osama		1	Board	Toledo Clinic, Inc.
Ariss	Steven		1	Board	Toledo Clinic, Inc.
Bais	Sanjiv		1	Board	Toledo Clinic, Inc.
Naddaf	Henry		1	Board	Toledo Clinic, Inc.
Rao	Upamaka		1	Board	Toledo Clinic, Inc.
Salem	Mazin		1	Board	Toledo Clinic, Inc.
Mattison	Lalaine		1	Board	WellCare Physician Group
Rasor	Travis			Ex Officio	WellCare Physician Group
Croak	Andrew		1	Board	Northwest Ohio IPA
Rosenthal	Greg			Ex Officio	Northwest Ohio IPA
Wyatt	Duane		1	Board	Medicare Beneficiary Representative

Key ACO clinical and administrative leadership:

Tim Poplawski	ACO Executive Director
Moshir Jacob, MD	Medical Director
William Sternfeld, MD	Compliance Officer
Moshir Jacob, MD	Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Quality Committee	Moshir Jacob, MD.
Compliance Committee	William Sternfed, MD.

Types of ACO participants or combinations of participants that formed the ACO:
- ACO professionals in a group practice arrangement
- Network of individual practices of ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses

Second Agreement Period
- Performance Year 2016, $3,384,906
First Agreement Period
- Performance Year 2015, $0
- Performance Year 2014, $0
- Performance Year 2013, $0

Shared Savings Distribution

Second Agreement Period
- Performance Year 2016
  - Proportion invested in infrastructure: N/A
  - Proportion invested in redesigned care processes/resources: 20%
  - Proportion of distribution to ACO participants: 80%

First Agreement Period

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
Performance Year 2013
- 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

2016 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	80.96	79.9
ACO-2	CAHPS: How Well Your Providers Communicate	92.03	92.63
ACO-3	CAHPS: Patients' Rating of Provider	91.47	91.93
ACO-4	CAHPS: Access to Specialists	81.92	83.52
ACO-5	CAHPS: Health Promotion and Education	61.24	60
ACO-6	CAHPS: Shared Decision Making	76.27	75.28
ACO-7	CAHPS: Health Status/Functional Status	71.31	71.82
ACO-34	CAHPS: Stewardship of Patient Resources	31.01	27.52
ACO-8	Risk-Standardized, All Condition Readmission	13.62	14.7
ACO-35	Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)	16.35	18.17
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes	51.04	53.2
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure	68.14	75.23
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	53.49	59.81
ACO-9	Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)	9.35	9.27
ACO-10	Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 )	15.6	14.53
ACO-11	Percent of PCPs who Successfully Meet Meaningful Use Requirements	98.59	82.72
ACO-39	Documentation of Current Medications in the Medical Record	99.27	87.54
ACO-13	Falls: Screening for Future Fall Risk	67.48	64.04
ACO-14	Preventive Care and Screening: Influenza Immunization	47.18	68.32
ACO-15	Pneumonia Vaccination Status for Older Adults	63.44	69.21
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up	75.77	74.45
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	93.15	90.98
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	55.99	53.63
ACO-19	Colorectal Cancer Screening	62.65	61.52
ACO-20	Breast Cancer Screening	62.95	67.61
ACO-21	Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented	58.67	76.84
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	79.04	77.72
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	20.62	18.24
ACO-41	Diabetes: Eye Exam	52.92	44.94
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	72.95	70.52
ACO-30	Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic	85.75	85.05
ACO-31	Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)	87.23	88.67
ACO-33	Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy – for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)	82.52	79.67

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
For 2013 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/yuq5-65xt

Note: In the Quality Performance Results file(s) above, search for “Northwest Ohio ACO, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A71510 in the public use files on data.cms.gov.

Payment Rule Waivers

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

Participation Waiver
- The Centers for Medicare and Medicaid Services (“CMS”) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available waivers of certain 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”).
- In order to receive the benefit of such waivers, the governing body of Northwest Ohio ACO, LLC (“Northwest Ohio ACO”) has made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP.
- Northwest Ohio ACO has authorized a waiver of certain federal fraud and abuse laws for the development of an ambulatory surgery center (“ASC”) among certain physicians, some of whom are participating providers in Northwest Ohio ACO and/or affiliated with The Toledo Clinic, Inc., a participant in Northwest Ohio ACO, which provides dialysis vascular and peripheral arterial disease services to patients within the community, including Medicare beneficiaries attributed to Northwest Ohio ACO (the “Arrangement”). As part of the Arrangement, the ASC will create a plan of clinical integration with Northwest Ohio ACO, which may include, without limitation, the ASC sharing quality and claims data for purposes of enhancing the triple aim.
- The governing body of Northwest Ohio ACO authorized the application of the waiver to the Arrangement on April 11, 2017, following a determination that the Arrangement supports the goals of Northwest Ohio ACO and is reasonably related to the purposes of the MSSP, in each case because the Arrangement: (i) increases the quality of vascular/PAD services and reduces the costs of healthcare for the community, which include Medicare beneficiaries attributed to Northwest Ohio ACO; (ii) allows for greater access to vascular/PAD services in the community, including for Medicare beneficiaries attributed to Northwest Ohio ACO; (iii) encourages investment in infrastructure for high quality and efficient service delivery for patients, including Medicare beneficiaries attributed to Northwest Ohio ACO; and (iv) enhances physician engagement for driving true performance and clinical integration, including for physicians affiliated with Northwest Ohio ACO participants.
DME Waiver
- The Centers for Medicare and Medicaid Services (“CMS”) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available waivers of certain 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”).
- In order to receive the benefit of such waivers, the governing body of Northwest Ohio ACO, LLC (“Northwest Ohio ACO”) has made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP.
- Northwest Ohio ACO has authorized a waiver of certain federal fraud and abuse laws for the development of an ambulatory surgery center (“ASC”) among certain physicians, some of whom are participating providers in Northwest Ohio ACO and/or affiliated with The Toledo Clinic, Inc., a participant in Northwest Ohio ACO, which provides dialysis vascular and peripheral arterial disease services to patients within the community, including Medicare beneficiaries attributed to Northwest Ohio ACO (the “Arrangement”). As part of the Arrangement, the ASC will create a plan of clinical integration with Northwest Ohio ACO, which may include, without limitation, the ASC sharing quality and claims data for purposes of enhancing the triple aim.
- The governing body of Northwest Ohio ACO authorized the application of the waiver to the Arrangement on April 11, 2017, following a determination that the Arrangement supports the goals of Northwest Ohio ACO and is reasonably related to the purposes of the MSSP, in each case because the Arrangement: (i) increases the quality of vascular/PAD services and reduces the costs of healthcare for the community, which include Medicare beneficiaries attributed to Northwest Ohio ACO; (ii) allows for greater access to vascular/PAD services in the community, including for Medicare beneficiaries attributed to Northwest Ohio ACO; (iii) encourages investment in infrastructure for high quality and efficient service delivery for patients, including Medicare beneficiaries attributed to Northwest Ohio ACO; and (iv) enhances physician engagement for driving true performance and clinical integration, including for physicians affiliated with Northwest Ohio ACO participants

Contact Info

Northwest Ohio ACO
4235 Secor Rd.
Toledo, OH 43623

P: 419-318-9447

E: tpoplawski@toledoclinic.com

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