A Collaborative Venture
The HHC ACO Participants are:
- NYC Health + Hospitals
- Community Healthcare Network, Inc.
- Coney Island Medical Practice Plan, P.C.
- Downtown Bronx Medical Associates, P.C.
- Harlem Medical Associates, P.C.
- Metropolitan Medical Practice Plan, P.C.
- Mt Sinai Elmhurst Faculty Practice
The HHC ACO is a collaborative venture that also includes the following physician affiliate organizations that provide professional staff of physicians and other healthcare professionals serving patients at NYC Health + Hospitals’ 11 acute care hospitals and related outpatient and nursing facilities, as well as required teaching, administration, quality assurance and supervisory services: Icahn School of Medicine at Mount Sinai (“MSSM”), New York University Grossman School of Medicine (“NYU”), and Physician Affiliate Group of New York, P.C. (“PAGNY”).
Arrangements Covered by Medicare ACO Pre-Participation and Participation Waivers
Contract payments are made by NYC Health + Hospitals to reimburse its affiliates for services provided by their providers, and may include compensation earned through satisfaction of certain performance indicators, which are intended to improve quality of care, eliminate inefficiencies and reduce costs – goals that the NYC Health + Hospitals and HHC ACO Boards of Directors have determined further the purpose of the Medicare Shared Savings Program. Whereas some aspects of such arrangements could implicate certain fraud and abuse statutes, including federal laws prohibiting “gainsharing” payments to physicians for reducing services (e.g., by reducing lengths of stay or avoidable admissions), such arrangements qualify for Medicare ACO Pre-participation and Participation Waivers (from certain fraud and abuse statutes including federal laws prohibiting “gainsharing” payments to physicians) that CMS and the HHS OIG have made available in the ACO context, as set forth in 76 Fed. Reg. 67992 (Nov. 2, 2011).
In order to qualify for such waivers, the NYC Health + Hospitals Board of Directors (prior to establishment of the HHC ACO Board of Directors), and the HHC ACO, Inc., Board of Directors, thereafter, passed respective resolutions dated June 12, 2012 and July 25, 2012 that: (i) duly authorized such arrangements and made a bona fide determination that each such arrangement is reasonably related to the purposes and goals of the MSSP – i.e., improving quality of care, eliminating inefficiencies, and reducing cost with respect to services furnished to Medicare fee-for-service beneficiaries (as required in both the Medicare ACO Pre-participation and Participation Waiver contexts); and (ii) ratified and adopted such arrangements as being start-up arrangements necessary for the organization to achieve its purposes as an ACO, which arrangements qualify for the Medicare ACO Pre-Participation Waiver (from certain fraud and abuse statutes including federal laws prohibiting “gainsharing” payments to physicians).
Attachments A to those resolutions identify the types of services involved in the particular arrangements at issue, which have been incorporated in multi-year Affiliation Agreements between: (i) NYC Health + Hospitals and NYU for contract terms beginning with NYC Health + Hospitals’ Fiscal Year 2012, for services at Bellevue Hospital Center, Gouverneur Healthcare Services, Woodhull Medical and Mental Health Center, and Cumberland Diagnostic and Treatment Center, and (ii) NYC Health + Hospitals and each of MSSM, NYU, and PAGNY beginning with NYC Health + Hospitals’ Fiscal Year 2013, for services at the other respective facilities identified below. The facilities at which each respective Affiliate provides services pursuant to such Affiliation Agreements are as follows:
Mount Sinai School of Medicine (subsequently, Icahn School of Medicine at Mount Sinai)
Elmhurst Hospital Center
Queens Hospital Center
New York University Grossman School of Medicine
Bellevue Hospital Center
Woodhull Medical and Mental Health Center
Cumberland Diagnostic and Treatment Center
Gouverneur Healthcare Services (subsequently, Gouverneur Health)
Coler-Goldwater Specialty Hospital and Nursing Facility (subsequently, Coler Rehabilitation and Nursing Care Center, and Henry J. Carter Specialty Hospital and Nursing Facility, respectively)
Physician Affiliate Group of New York, P.C.
Coney Island Hospital
Harlem Hospital Center
Jacobi Medical Center
Lincoln Medical and Mental Health Center
Metropolitan Health Center
North Central Bronx Hospital
Morrisania Diagnostic and Treatment Center
Renaissance Health Care Network Diagnostic and Treatment Center
Segundo Ruiz Belvis Diagnostic and Treatment Center
Composition of ACO: Joint venture arrangement between hospitals and ACO professionals