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, MD Inc

N

BRETT J. BERMAN, MD, PROFESSIONAL CORPORATION

N

Bruce Kimura

N

Cardiac Arrhythmia Associates A Medical Corporation

N

Catharine Marshall MD

N

Cesar Pena

N

Chia-Lin Charles Liu,DO,Inc

N

Chula Vista Heart Clinic, Inc.

N

Clara Lucy Polak, MD 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, MD and M.Jonathan Worsey, MD, A Professional Corp.

N

Daniel Michaels, MD, INC 

N

Danielle Weiss

N

Dennis Costello

N

Edward Kocharian MD APC

N

Elahe Toulouie, Md, Inc

N

Enlightened Healthcare Alliance Medical Corporation

N

Francisco S. Pardo MD PC

N

Frank E. Mayer, MD, A Professional Corporation

N

Frederick J De La Vega Md

N

Gregory P Ranches MD ACP

N

Gregory Ranches

N

Hanh M Bui Md Apmc

N

HOUMAN DAHI MD, APC

N

INTERNAL MEDICINE ASSOCIATES MEDICAL GROUP OF SAN DIEGO, INC.

N

James Santiago Grisolia, MD Inc

N

Jay Berenter

N

Jeffry A Mullvain Md Inc

N

Jerrold Glassman, MD, 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 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, MD, Inc.

N

Michael Torrente

N

Naira Kocharian MD APC

N

Ngocbich Nguyen, MD, 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

Pamela Resnikoff

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

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 MD, Apc

N

Stewart L Frank, MD, Inc.

N

Sudhir Malik, A Professional Medical Corporation

N

SUNIL RAYAN, MD, 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, MD, Inc.

N

ACO governing body

First name

Last name

TItle/Position

Voting power

Membership type

ACO participant TIN legal business name

Kevin

Hirsch

MD, Chair

12.5%

ACO Participant Representative

Scripps Health

Dan

Dworsky

MD

12.5%

ACO Participant Representative

Scripps Health

Scott

Eisman

MD

12.5%

ACO Participant Representative

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

Andrew

King

MD

12.5%

ACO Participant Representative

Scripps Health

Clara

Polak

MD

12.5%

ACO Participant Representative

Clara Lucy Polak, MD

Robert

Tjosvold

12.5%

Medicare Beneficiary Representative

N/A

Chris

Van Gorder


12.5%

ACO Participant Representative

Scripps Health

Michael

Worsey

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, Growth and Accountable Care Assistant Vice President

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 2021, $0
  • 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 2021

  • 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 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

2021 Quality Performance Results

Quality performance results are based on CMS Web Interface.

Measure#

Measure name

Rate

ACO Mean

001

Diabetes: Hemoglobin A1c (HbA1c) Poor Control

9.26

12.46

134

Preventative Care and Screening: Screening for Depression and Follow-up Plan

59.44

74.38

236

Controlling High Blood Pressure

72.00

74.87

318

Falls: Screening for Future Fall Risk 

63.27

87.03

110

Preventative Care and Screening: Influenza Immunization

82.23

80.52

226

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

40.00

80.97

113

Colorectal Cancer Screening

74.04

73.63

112

Breast Cancer Screening

82.86

75.11

438

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

82.45

84.24

479

Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups

0.1444

0.1540

MCC1

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)

31.88

33.94

CAHPS-1

Getting Timely Care, Appointments, and Information

82.84

84.67

CAHPS-2

How Well Providers Communicate

94.27

93.56

CAHPS-3

Patient’s Rating of Provider

93.82

92.19

CAHPS-4

Access to Specialists

79.14

78.80

CAHPS-5

Health Promotion and Education

54.45

61.61

CAHPS-6

Shared Decision Making

56.80

60.89

CAHPS-7

Health Status and Functional Status

73.01

71.78

CAHPS-8

Care Coordination

87.56

85.66

CAHPS-9

Courteous and Helpful Office Staff

93.62

91.88

CAHPS-11

Stewardship of Patient Resources

23.34

24.71

Please note, the Quality ID #: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.


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.

Fraud and Abuse Waivers

ACO Pre-Participation Waiver:

The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.


Arrangement #1


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: December 8, 2017
  • Items, services, goods, or facility provided: Scripps Health EpicCare EHR
  • Date and nature of any amendments to the arrangement, if applicable: N/A


Arrangement #2


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: May 30, 2018
  • Items, services, goods, or facility provided: Chronic Disease Care Management services
  • Date and nature of any amendments to the arrangement, if applicable: N/A


Arrangement #3


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: September 26, 2018
  • Items, services, goods, or facility provided: Clinical and hospital facilities for coordinated oncology services
  • Date and nature of any amendments to the arrangement, if applicable: N/A


Arrangement #4


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: January 23, 2020
  • Items, services, goods, or facility provided: Home-based care management services
  • Date and nature of any amendments to the arrangement, if applicable: N/A


Arrangement #5


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: January 23, 2020
  • Items, services, goods, or facility provided: Advance care planning services
  • Date and nature of any amendments to the arrangement, if applicable: N/A


Arrangement #6


  • Parties to the arrangement: Scripps ACO and ACO Participants
  • Date of arrangement: February 24, 2021
  • Items, services, goods, or facility provided: Remote monitoring devices to assist in management and care of chronic and/or acute conditions
  • Date and nature of any amendments to the arrangement, if applicable: N/A