Public Reporting

ACO Name and Location

Prisma Health Midlands Network, LLC

Previous Names: Palmetto Health Quality Collaborative, LLC

1301 Taylor Street
STE 9A
Columbia, South Carolina 29201

ACO Primary Contact

Sarah Perry Orsinger,

803-296-2352
Sarah.Orsinger@prismahealth.org

Organizational Information

ACO Participants and Participation in ACO Joint Venture, Yes (Y) or No (N)

  • Professional Pathology Services PC – N
  • Plastic Surgery Consultants, LLC – N
  • Wellspring Family Medicine, PA – N
  • Donen Davis Plastic Surgery, LLC – N
  • South Carolina ENT Allergy & Sleep Medicine PA – N
  • Kraemer Womens Care, LLC – N
  • Elgin Podiatry Institute, LLC – N
  • University Specialty Clinics – Neurology – N
  • Sandhills OBGYN Associates, P.A. – N
  • Cardiology Associates of Sumter LLC – N
  • Palmetto Health-University of South Carolina Medical Group – N
  • Prisma Health Tuomey – N
  • Centa Medical Group PA – N
  • Carolina Anesthesiology Associates, PA – N
  • Midland Ear Nose and Throat – N
  • University Specialty Clinics – Surgery – N
  • University Specialty Clinics – Neuropsychiatry and Behavioral Science – N
  • CAROLINA KIDNEY SPECIALISTS, LLC – N
  • Pinner Clinic PA – N
  • PIERRE JAFFE – N
  • Sumter Family Medicine Associates, P.A. – N
  • University Pediatrics – N
  • Department of Internal Medicine – N
  • South Carolina Oncology Assoc Pa – N
  • MCCAIN ORTHOPAEDIC CLINIC – N
  • South Carolina Neurological Clinic PA – N
  • University Specialty Clinics – Obstetrics/Gynecology – N
  • Palmetto Retina Center LLC – N
  • University Specialty Clinics – Orthopaedics – N
  • University Specialty Clinic, Dept. Family & Preventive Medicine – N
  • Carolina Anesthesia Inc – N
  • Carolina Allergy & Asthma Consultants – N
  • TANDEM HEALTH SC – N
  • Palmetto Family Practice, LLC – N
  • The Dermatology Group LLC – N
  • Prisma Health – N
  • Caryn M West & Assoc PC – N

ACO Governing Body

Board of Managers

  • William (Bill) Gerard, MD—Chair, Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health
  • Albert Odom, Jr., MD—Vice Chair, Voting Member Power – 1, ACO Participant Representative, Palmetto Health-University of South Carolina Medical Group
  • Michael Bundy—Secretary, Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health
  • James Best—Treasurer, Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health
  • Gary Bell, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Palmetto Health-University of South Carolina Medical Group
  • Davis Donen, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Donen Davis Plastic Surgery, LLC
  • Jeff Haladay, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Carolina Anesthesiology Associates, PA
  • Leslie Hall, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Palmetto Health-University of South Carolina Medical Group
  • Fred Kudrik, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, South Carolina Oncology Assoc Pa
  • E.J. Mayeaux, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Palmetto Health-University of South Carolina Medical Group
  • Bradley Presnal, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Palmetto Health-University of South Carolina Medical Group
  • Tom Brown, DrPH—Voting Member, Voting Member Power – 1, Medicare Beneficiary Representative, NA
  • William Giles, MD—Voting Member, Voting Member Power – 1, ACO Participant Representative, Centa Medical Group PA
  • Joseph Brannigan, MD—Voting Member, Voting Member Power – 1, Other Entity Representative (Non-MSSP Participant, but Clinically Integrated Network Participant), Columbia Nephrology Associates, PA
  • J. Mark Mitchiner, MD—Voting Member, Voting Member Power – 1, Other Entity Representative (Non-MSSP Participant, but Clinically Integrated Network Participant), Sumter Pediatrics
  • Kevin Wessinger, MD—Voting Member, Voting Member Power – 1, Other Entity Representative (Non-MSSP Participant, but Clinically Integrated Network Participant), South Carolina Pediatric Alliance

Key ACO Clinical and Administrative Leadership

  • ACO Executive: Anna Kay
  • Medical Director: Bill Gerard, MD
  • Compliance Officer: Anna Kay
  • Quality Assurance Improvement Officer: Anna Kay

Committees

  • Finance Committee: Jeff Haladay, MD Chair
  • Quality and Care Delivery Committee: Greta Harper, MD, Chair
  • Network Participation Committee: William Giles, MD, Chair
  • Sumter Steering Committee: J. Mark Mitchiner, MD Chair

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

  • ACO professionals in a group practice arrangement
  • Federally Qualified Health Centers (FQHCs)
  • Hospital Employing ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2016: $0
    • Performance Year 2017: $0
    • Performance Year 2018: $0

Shared Savings Distribution

  • First Agreement Period
    • First Agreement Period
      • Performance Year 2018
        • Portion invested in infrastructure: N/A
        • Portion invested in redesigned care processes/resources: N/A
        • Portion of distribution to ACO participants: N/A
    • Performance Year 2017
      • Portion invested in infrastructure: N/A
      • Portion invested in redesigned care processes/resources: N/A
      • Portion of distribution to ACO participants: N/A
    • Performance Year 2016
      • Portion invested in infrastructure: N/A
      • Portion invested in redesigned care processes/resources: N/A
      • Portion of distribution to ACO participants: N/A

Quality Performance Results

2018 Quality Performance Results

ACO # Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 87.19 86.14
ACO-2 CAHPS: How Well Your Providers Communicate 96.26 93.93
ACO-3 CAHPS: Patients’ Rating of Provider 94.66 92.45
ACO-4 CAHPS: Access to Specialists 82.96 81.5
ACO-5 CAHPS: Health Promotion and Education 62.75 59.26
ACO-6 CAHPS: Shared Decision Making 69.51 61.94
ACO-7 CAHPS: Health Status/Functional Status 73.4 73.35
ACO-34 CAHPS: Stewardship of Patient Resources 27.4 26.26
ACO-8 Risk Standardized, All Condition Readmission 14.278 14.98
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission measure (SNFRM) 18.428 18.59
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 34.307 37.01
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 70.704 76.75
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 56.261 59
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.7408 1.98
ACO-11 Use of Certified EHR Technology 99.86% 97.66%
ACO-12 Medication Reconciliation Post-Discharge 50.13% 85.91%
ACO-13 Falls: Screening for Future Fall Risk 91.22% 79.73%
ACO-44 Use of Imaging Studies for Low Back Pain 57.58% 64.36%
ACO-14 Preventive Care and Screening: Influenza Immunization 73.26% 72.71%
ACO-15 Pneumonia Vaccination Status for Older Adults 75.85% 75.97%
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 88.19% 76.83%
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 64.29% 72.81%
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 72.08% 66.74%
ACO-19 Colorectal Cancer Screening 63.76% 68.27%
ACO-20 Breast Cancer Screening 78.45% 71.96%
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 82.16% 81.47%
ACO-40 Depression Remission at Twelve Months 2.13% 8.76%
Diabetes Composite Diabetes Composite (All or Nothing Scoring) 32.16% 46.80%
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 14.49% 15.51%
ACO-41 Diabetes: Eye Exam 34.98% 52.42%
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 70.89% 73.10%
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 92.34% 88.92%

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

Note: In data.cms.gov, search for “Palmetto Health Quality Collaborative, LLC” to view the previous years’ quality performance results. This ACO can also be found by using the ACO ID A99911 in the public use files on data.cms.gov.

Payment Rule Waivers

  • Skilled Nursing Facility (SNF) 3-day Rule Waiver:
    • No, our ACO does not use the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612
  • Waiver for Payment for Telehealth Services:
    • No, our ACO clinicians do not provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.