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Scripps Accountable Care Organization (ACO)

A Scripps physician talks with a mature male patient in a clinic hallway.

A Medicare Shared Savings Program participant

ACO name and location

Scripps Accountable Care Organization, LLC

Previous names: N/A

10140 Campus Point Drive

San Diego, California 92121

ACO primary contact

Primary contact name

Cindy Gipson

Primary contact phone number

Primary contact email address

ACO Participants

ACO participants

ACO participant in joint venture (Y/N)

Acute Care Associates, INC.

N

Adema Family Medicine Inc

N

Ali Salami

N

Alisa L Williams, Md, Facog, Inc.

N

ASIM GUHA ROY

N

Balboa Park Internal Medicine, Medical Associates Inc

N

Bijan Razi

N

Billie Green, Medical Corporation

N

Bradley L. Spitz, M.D. Inc

N

BRETT J. BERMAN, M.D., PROFESSIONAL CORPORATION

N

Bruce Kimura

N

Cardiac Arrhythmia Associates A Medical Corporation

N

Catharine Marshall MD

N

Cesar Pena

N

Chia-Lin Charles Liu,D.O.,Inc

N

Chula Vista Heart Clinic, Inc.

N

Clara Lucy Polak, M.D. Inc.

N

Coastal Cardiovascular Care Inc

N

Coastal Pain & Spinal Diagnostics Medical Group, Inc.

N

CRAIG SCLAR

N

Dan I Giurgiu M D Professional Corporation

N

Dana P. Launer, M.D. And M.Jonathan Worsey, M.D, A Professional Corp.

N

Daniel Michaels, MD, INC 

N

Danielle Weiss

N

Dennis Costello

N

Elahe Toulouie, Md, Inc

N

Enlightened Healthcare Alliance Medical Corporation

N

Francisco S. Pardo MD PC

N

Frank E. Mayer, M.D., A Professional Corporation

N

Frederick J De La Vega Md

N

Gregory P Ranches MD ACP

N

Hanh M Bui Md Apmc

N

HOUMAN DAHI M.D., APC

N

INTERNAL MEDICINE ASSOCIATES MEDICAL GROUP OF SAN DIEGO, INC.

N

James Santiago Grisolia, M.D. Inc

N

Jay Berenter

N

Jeffry A Mullvain Md Inc

N

Jerrold Glassman,.M.D., A Medical Corporation

N

JOSE R PENA MD PC

N

JOSEPH CAPERNA MD A PROFESSIONAL CORPORATION

N

Joseph Resnikoff MD

N

Julian Lichter Md A Professional Corporation

N

Kelly S. Keefe MD, Inc

N

KESHAV R NAYAK MD AMC

N

Kiyon Chung, MD

N

L Dale Lapp M D Inc

N

La Jolla Cardiovascular Medical Assoc Inc

N

La Jolla Gastroenterology Medical Group, Inc

N

La Jolla Pulmonary And Critical Care Inc

N

Lars R Newsome Md Inc.

N

Leila Rhodes MD Inc

N

Leticia Uwedjojevwe Md Medical Corporation

N

Luis M Marquez,MD Inc

N

Luis Sanchez

N

Maria Lourdes S Mara Md - A Medical Corp

N

Medicus M D Inc A Deleware Corporation

N

Michael Sise

N

Michael T Couris, M.D., Inc.

N

Michael Torrente

N

Ngocbich Nguyen, M.D., Inc.

N

North County Gastroenterology Medical Group Inc

N

North County Oncology Medical Clinic, Inc

N

Olde Del Mar Surgical Medical Group Inc

N

Pain Management Consultants A Professional Medical Corporation

N

Paul Phillips

N

Perry W. Sexton, Md Professional Corporation

N

Peter Friend

N

Peter Morcos Md Inc

N

Richard Friedman

N

Ritvik Mehta Md, Pc

N

Rj Fernandez Md Inc Apc.

N

Robert Houghton Md Inc

N

Salami Nuclear Cardiology Medical Group Inc

N

San Diego Arrhythmia Associates, A Medical Corporation

N

San Diego Cardiovascular Associates Medical Group Inc

N

San Diego Gastroenterology Medical Associates

N

SAN DIEGO HEART ARRHYTHMIA CENTER, AMC

N

San Diego Heart Rhythm Center, A Medical Corporation

N

San Diego Orthopaedic Associates Medical Group, Inc.

N

Scott A Eisman Md Inc

N

Scott Mercer, Md, Inc

N

Scripps Health

N

Southern California Health Providers Medical Grp Inc

N

Spinezone Medical Fitness INC

N

Steven C. Wong M.D., Apc

N

Stewart L Frank, M.D., Inc.

N

Sudhir Malik, A Professional Medical Corporation

N

SUNIL RAYAN, M.D., INC.

N

Surgical Associates Of La Jolla Medical Group, Inc.

N

Suzanne P Handler Md Inc

N

Szmidt A Professional Medical Corp

N

Thomas Diggs

N

Tram Le

N

Vg Cardiac Associates, A Medical Corporation

N

Vitali Aizin Md Inc

N

Wayne Whitwam

N

Wun-Ling Chang, M.D., Inc.

N

ACO governing body

Last name

First name

TItle/Position

Voting power

Membership type

ACO participant TIN legal business name

Hirsch

Kevin

MD, Chair

12.5%

ACO Participant Representative

Scripps Health

Dworsky

Dan

MD

12.5%

ACO Participant Representative

Scripps Health

Eisman

Scott

MD

12.5%

ACO Participant Representative

Acute Care Associates, Inc. and Scott A Eisman MD Inc.

King

Andrew

MD

12.5%

ACO Participant Representative

Scripps Health

Polak

Clara

MD

12.5%

ACO Participant Representative

Clara Lucy Polak, MD

Tjosvold

Robert

12.5%

Medicare Beneficiary Representative

N/A

Van Gorder

Chris


12.5%

ACO Participant Representative

N/A

Worsey

Michael

MD

12.5%

ACO Participant Representative

Dana P. Launer, MD, and M. Jonathan Worsey, MD, A Professional Corp.

Key ACO clinical and administrative leadership

Tracy Chu

ACO Executive

Anil Keswani, MD

Medical Director

Taunya Juliano

Compliance Officer 

Karen Patel

Quality Assurance/Improvement Officer

Associated committees and committee leadership

Committee name

Committee leader name and position

Network Alignment

Michael Worsey, MD, Network Alignment Committee Chair

Utilization Management

Anil Keswani, MD, ACO Medical Director

Credentialing

Dan Dworsky, MD, Committee Chair

Communications

Cindy Gipson, ACO Senior Director

Clinical Care Line Council

Anil Keswani, MD, ACO Medical Director

Quality Committee

Dan Dworsky, MD, Committee Chair

Types of ACO participants, or combinations of participants, that formed the ACO:

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

Shared savings and losses

Amount of shared savings/losses

Second agreement period

  • Performance Year 2020, $7,758,213.65


First agreement period

  • Performance year 2019, -$8,726,114.79
  • Performance year 2018, $0
  • Performance year 2017, $0


Shared savings distribution

Second agreement period

Performance year 2020

  • Proportion invested in infrastructure: 44% 
  • Proportion invested in redesigned care processes/resources: 29%
  • Proportion of distribution to ACO participants: 27%


First agreement period

Performance Year 2019

  • 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 2018

  • 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 2017

  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

2020 Quality Performance Results

ACO#

Measure name

Rate

ACO Mean

ACO-43

Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality 

0.83

0.95

ACO-13

Falls: Screening for Future Fall Risk

58.68

84.97

ACO-14

Preventive Care and Screening: Influenza Immunization

50.82

76.03

ACO-17

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

62.50

81.67

ACO-18

Preventive Care and Screening: Screening for Clinical Depression and Follow Up Plan 

46.49

71.46

ACO-19

Colorectal Cancer Screening 

48.36

72.59

ACO-20

Breast Cancer Screening 

70.10

74.05

ACO-42

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

77.97

83.37

ACO-27

Diabetes: Hemoglobin A1c Poor Control (>9)

15.61

14.70

ACO-28

Controlling High Blood Pressure

74.52

72.87

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.


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.