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In 2015, the Northwell Health ACO chose to participate in the Medicare Shared Savings Program, with an effective start date of January 1, 2016. The Northwell Health ACO is governed by independent physicians, Northwell Health employed physicians, and a Medicare FFS beneficiary.

Northwell Health’s participation in the Medicare Shared Savings Program presents an opportunity to develop innovative approaches to health care delivery, streamline existing value-based programs, and promote wellness that will improve the health of our communities.

What is a Medicare Shared Savings Program ACO?

A Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) is a new, national approach to health care delivery for Medicare fee-for-service (FFS) beneficiaries. Created under the 2010 Patient Protection and Affordable Care Act, a MSSP ACO works to improve quality and reduce unnecessary costs.

MSSP ACOs are not managed care organizations, do not use closed networks of providers, and do not limit a Medicare beneficiary’s ability to seek care from participating Medicare providers outside an ACO.

There is no financial downside risk or disruption to underlying Medicare fee-for-service billing. When an MSSP ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.

Our mission

The Northwell Health ACO’s mission is to improve the health and wellness of the community through the collaborative efforts of physicians and other healthcare providers who:
  • Share a commitment to the provision of excellent healthcare services; and
  • Seek to enhance delivery of quality, coordinated and efficient care.
The Northwell Health ACO provides an opportunity to collaboratively improve patient outcomes by:

 

Northwell Health ACO annual compliance training (for participants only)

MSSP public reporting ACO Name and Location:

North Shore-LIJ MSSP ACO, LLC d/b/a Northwell Health ACO
2000 Marcus Avenue
New Hyde Park, New York 11042

ACO Primary Contact:

Mr. Terry Lynam
Chief Public Relations Officer, Northwell Health
(516) 321-6702
tlynam@northwell.edu

Organizational Information: ACO Participants:

Advanced Allergy And Asthma Pllc
Advanced Internal Medicine Pc
Alan E Uliss MD PC
Allay Medical Care Pc
Anat Benjamin Md Pc
Andrew Zaager MD
Angela Azar MD PC
Anita-Kay Martin Md Pc
Atlantic Dermatologic Associates, Llp
Ausubel, Ausubel, Bienstock Physicians LLP
Bernardini, Vomero, Anselmi & Anwar MD PC
Bobby Chandok MD PLLC
Bruce Lowell
Carol A Livoti M.D.P.C
Central Suffolk Hospital
Charles Timson
City Medical Associates PC
Comprehensive Island Medical Care
Corcoran Medical Rehabilitation, PC
Country Doctors Family Medicine Hauppauge Pc
Cross County Medical Care Pc
David Arbesfeld
David B Samadi MD PC
Digestive Diseases Nutrition LLC
Doctors Medical Office Pllc
Dodis Kohan, Md Pc
Dr. Karen Schwartz MD PC
Dr. Marc Allen Medical PC
East Merrick Medical PC
East Side Primary Medical Care PC
Edward Condon Medical PC
Eye Care Ophthalmology, PC*
Family Medical Practice Of Long
Fink Family Medical, PC
Floral Park Medical PC
Florante Melchor MD FACP PLLC
George Tung MD, PC*
Glen Cove Hospital
Global Rehabilitation Medical PC
Great Neck Obstetrics & Gynecology Pc
Hamilton Podiatry P C
Harold Satz M D Pc
Helen S Flamenbaum Md Pc
Hillside Medical & Pain Management, Pc
Hillside Polymedic Diagnostic & Treatment Center Inc
Hudson Medical Professional Services, PC
Huntington Hospital Association
Huntington Hospital Dolan Family Health Center
Ilene Gewirtz MD
Inga Zilberstein, MD, PLLC
Ira J. Salzman, MD PLLC
Island Medicine, PLLC
Island Musculoskeletal Care MD PC
Jamaica Family Practice & Osteopathic Medicine
Jeff D Kopelman MD, FACS, PLLC
Jeffrey Krupen MD
Joseph Devito
Joseph Loiodice M.D.
Josh Werber
Kaumudi Somnay
Kaumudi Somnay, MD
Kew Gardens Podiatry Pc
Kip L Bodi Physician FACS PLLC
Klein Geier Lipp MD LLP*
Krishana K. Jajoo Physician PC
Lawrence Korn MD LLC
Lawrence Lippert
Lawrnece J Robinson Md Pc
Lenox Hill Hospital
Lenox Hill Hospital Medical, PC
Lenox Hill Pathology, PC
Lenox Otolaryngology Head And Neck Surgery, P.C.
Long Island Eye Surgeons, PC*
Long Island Infectious Disease Associates, LLP
Long Island Jewish Medical Center
Long Island Kidney Physicians, PLLC
Long Island Medical PC
Long Island Vitreo Retinal Consultants*
Luz del Carmen Cespedes MD, PLLC
Medical Help Pc
Michael B. Gold MD PC*
Michael Benhuri Md PC
Michael Oliverio, DO, PC
Michael Polcino Md Pc
Mid Island Eye Physicians & Surgeons, P.C.*
Millennium Medical Professionals, PLLC
Mudgil Dermatology, P.C.
Nassau Pulmonary & Critical Care Medicine, PC
New Life Medical Services Pc
North Island Ophthalmology Associates Pc
North Shore – Lij Radiology Services, Pc
North Shore Lij Internal Medicine At New Hyde Park Pc
North Shore Lij Physicians Group Pc
North Shore Long Island Jewish Healthcare Inc.
North Shore University Hospital
North Shore University Hospital At Plainview
North Shore-LIJ Cardiology at Deer Park, PC
North Shore-LIJ Heart Surgery, PC
North Shore-LIJ Internal Medicine at Lynbrook, PC
North Shore-LIJ Medical Group at North Nassau, PC
North Shore-LIJ Medical Group at Syosset, PC
North Shore-LIJ Medical PC
North Shore-LIJ Ob/GYN at Garden City, PC
North Shore-LIJ Ob/GYN, PC
North Shore-LIJ OB-GYN at New Hyde Park, PC
North Shore-LIJ Pediatrics of Suffolk County, PC
Ophthalmology Associates of Glen Cove PC
Orthopaedic Associates of Manhasset PC
Parmeshwar Mahabir
Paul B Lang, MD, PC
Paulette Stewart
Phelps Medical Services, PC
Phelps Memorial Hospital Association
Pulmonary Critical Care & Sleep Medicine of Nassau P
Queens Professional Medical Care,P.C.
Queens Vitreo Retinal Consultants
Raber Medical PC
Rego Park Medical Associate PC
Richard C Maleski MD PC
Richard P Boughal MD PC
Robert Appel
Robert Maccabee
Roshan Kothandaram MD
Salil P Marfatia Md Pc
Scott Gross
South Shore Eye Care LLP*
Southside Hospital
Steven Blumenthal
Steven Mandel MD PC

 

*Participants involved in a joint venture are identified by a * next to their names on the participant list.

 

ACO Participants in Joint Ventures Between ACO Professionals and Hospitals:

N/A

governing-body

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
Burns, MD Patrick Voting Member 1 ACO Participant Representative Island Medicine, PLLC
Carney, MD Maria Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Cohen, MD Barry Co-Chair 1 ACO Participant Representative North Shore University Hospital
Corcoran, MD Patrick Voting Member 1 ACO Participant Representative Corcoran Medical Rehabilitation, PC
Balwan, MD Sandy Voting Member 1 ACO Participant Representative Lenox Hill Hospital
Geier, MD Steven Co-Chair 1 ACO Participant Representative Klein, Geier, Lipp, MD, LLP
Gottridge, MD JoAnne Voting Member 1 ACO Participant Representative North Shore University Hospital
Jacobs, MD Mitchel Voting Member 1 ACO Participant Representative Nassau Pulmonary & Critical Care Medicine, P.C.
Kadam, MD Jaydeep Voting Member 1 ACO Participant Representative Long Island Medical PC
Kirtane, MD Yashodhara Voting Member 1 ACO Participant Representative Long Island Jewish Medical Center
Korpacz-Fink, MD Mary Voting Member 1 ACO Participant Representative Fink Family Medical, PC
Krupen, MD Jeffrey Voting Member 1 ACO Participant Representative Jeffrey Krupen MD
Hoey, MD Cynthia Voting Member 1 ACO Participant Representative Long Island Infectious Disease Assoc.
Jonisch, MD John Voting Member 1 ACO Participant Representative Queens Vitreo Retinal Consultants
 Laxer, MD Joel Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Paulus, MD Santhosh Voting Member 1 ACO Participant Representative Glen Cove Hospital
Potters, MD Louis Voting Member 1 ACO Participant Representative Long Island Jewish Medical Center
Siegelheim, MD Mark Voting Member 1 ACO Participant Representative South Side Hospital
Stein, MD Mark Voting Member 1 ACO Participant Representative South Shore Eye Care LLP
Wright, MD Paul Voting Member 1 ACO Participant Representative North Shore University Hospital At Plainview
Stenzler Leonard Voting Member 1 Medicare Beneficiary N/A

 

Key ACO Clinical and Administrative Leadership:

ACO Executive Director

William Lynch, JD

Medical Director

Sandy Balwan, MD, FACP

Compliance Officer

Aaron Lund, JD, LL.M

Quality Assurance/Improvement Officer

Lisa Sokoloff, RN, MS

Associated Committees and Committee Leadership:

Performance and Distribution Committee

Chairperson:

Mark Siegelheim, MD

Members:

Patrick Corcoran, MD
Steven Geier, MD
Mitchel Jacobs, MD
Joel Laxer, MD
Louis Potters, MD

Clinical Performance and Quality Committee

Chairperson:

Yashodhara Kirtane, MD

Members:

Patrick Burns, MD
Barry Cohen, MD
Sandy Balwan, MD
Mary Korpacz-Fink, MD
Cynthia Hoey, MD
Paul Wright, MD

Network Composition and Credentialing Committee

Chairperson:

Patrick Corcoran, MD

Members:

Barry Cohen, MD
Steven Geier, MD
Jaydeep Kadam, MD
Yashodhara Kirtane, MD
Mark Siegelheim, MD

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

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Hospitals employing 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 2016, $0

 

Shared Savings Distribution

  • First Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
Payment Rule Waivers
  • No, our ACO does not utilize the SNF 3-Day Rule Waiver.

2016 Quality Performance Results

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 80.42 79.9
ACO-2 CAHPS: How Well Your Providers Communicate 94.22 92.63
ACO-3 CAHPS: Patients’ Rating of Provider 94.16 91.93
ACO-4 CAHPS: Access to Specialists 86.81 83.52
ACO-5 CAHPS: Health Promotion and Education 58.37 60
ACO-6 CAHPS: Shared Decision Making 75.11 75.28
ACO-7 CAHPS: Health Status/Functional Status 71.71 71.82
ACO-34 CAHPS: Stewardship of Patient Resources 20.61 27.52
ACO-8 Risk-Standardized, All Condition Readmission 15.93 14.7
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 19.8 18.17
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 52.34 53.2
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 74.96 75.23
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 58.93 59.81
ACO-9 Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 8.72 9.27
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 ) 14.18 14.53
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 94.3 82.72
ACO-39 Documentation of Current Medications in the Medical Record 96.81 87.54
ACO-13 Falls: Screening for Future Fall Risk 41.24 64.04
ACO-14 Preventive Care and Screening: Influenza Immunization 71.58 68.32
ACO-15 Pneumonia Vaccination Status for Older Adults 59.11 69.21
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 82.7 74.45
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 96.84 90.98
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 19 53.63
ACO-19 Colorectal Cancer Screening 53.91 61.52
ACO-20 Breast Cancer Screening 53.99 67.61
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented 79.17 76.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 76.17 77.72
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 16.67 18.24
ACO-41 Diabetes: Eye Exam 30.25 44.94
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 73.69 70.52
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 80.81 85.05
ACO-31 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 93.42 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%) 81.55 79.67

Participation waiver disclosure

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limited innovation by ACOs participating in the Medicare Shared Savings Program (“MSSP”). See Final Waivers in Connection With the Shared Savings Program, 79 Fed. Reg. 62356 (Oct. 17, 2014) (“Interim Final Rule”). Pursuant to the Interim Final Rule, North Shore-LIJ MSSP ACO, Inc. (the “ACO”) seeks waiver protection for the arrangement described below:

The ACO has entered into an agreement with Northwell Health to provide a broad range of necessary management services and operational personnel to support the ACO’s operations as an ACO in the MSSP. Under the arrangement, the ACO shall compensate Northwell Health from any shared savings payments for its provision of management services, including but not limited general day-to-day operational personnel and services, financial management and accounting services, and credentialing.

The ACO’s governing body, consistent with its obligations under 42 C.F.R. § 425.106(b)(3), has made and duly authorized a bona fide determination on August 23, 2016 that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program, including, specifically, promoting accountability for the quality, cost, and overall care for a Medicare population and aiding the ACO in managing and coordinating care for Medicare fee-for-service beneficiaries.

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