BJC Accountable Care Organization

We are required to make available certain waivers of specific fraud and abuse laws (the “ACO Participation Waivers”) in connection with the operation of an Accountable Care Organization (“ACO”) participating in the Medicare Shared Savings Program (“MSSP”). 

The Centers for Medicare and Medicaid Services (“CMS”) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available certain waivers of specific fraud and abuse laws (the “ACO Participation Waivers”) in connection with the operation of an Accountable Care Organization (“ACO”) participating in the Medicare Shared Savings Program (“MSSP”).  In order to receive the benefit of an ACO Participation Waiver, the BJC HealthCare ACO (“BJC-ACO”) is required to publicly disclose arrangements for which waiver protection has been sought.  Presently, waiver protection has been sought for the following arrangements: 

1). Waiver protection has been sought for a compensation model developed for use with hospitalist physicians employed by Physician Groups, L.C. d/b/a BJC Medical Group of Missouri and Fairview Heights Medical Group, S.C. d/b/a BJC Medical Group of Illinois (collectively, “BJCMG”) related to services provided by BJCMG-employed hospitalists at those BJC hospitals participating in the BJC-ACO at which the hospitalists practice. The effective date of the compensation model is July 1, 2018.  The purpose of this model is to better align hospitalist physician incentives with hospital, BJC-ACO and MSSP goals. 
 

2). Waiver protection has been sought for certain written contractual arrangements by and among BJC HealthCare and BJC-ACO-participating physician practices, beginning January 1, 2014, under which BJC has made donations of certain electronic health record (EHR) technology used to facilitate the exchange of electronic health data between and among providers. The purpose of the arrangements described above is to continue and enhance the ability of BJC-ACO-participating health care providers to receive and exchange health data in the interest of: (1) reducing medical errors, improving care decision-making and reducing costs; and (2) providing a more efficient and effective means of collecting and reporting quality, cost and performance information, as required by the MSSP or as needed to further the ACO’s efforts to succeed in the MSSP. 
 

3). Waiver protection has been sought for a program under which BJC HealthCare will make available telehealth technology for use by ACO providers including ACO-participating or affiliated physicians and other providers for purposes of facilitating telehealth encounters between such providers and patients located in remote locations. The parties to the arrangements under this program would include BJC HealthCare, ACO providers and the remote facility(ies) or location(s) at which the patient would be present for the encounters. The effective dates of the arrangements under this program would be after September 30, 2020. The purpose of the program is to expand the use of the telehealth technology by ACO providers for the benefit of their patients, including, but not limited to, their ACO-attributed Medicare beneficiaries, in furtherance of  improving care coordination for these patients by expanding the availability and convenience of needed specialist care, reducing costs by avoiding unnecessary or otherwise avoidable hospital admissions and readmissions, and improving the quality and efficacy of care provided. 
 

4). Waiver protection has been sought to implement a new compensation model developed for Physician Groups, L.C. d/b/a BJC Medical Group of Missouri; Fairview Heights Medical Group, S.C. d/b/a BJC Medical Group of Illinois and Missouri Baptist Sullivan Hospital d/b/a BJC Medical Group of Sullivan (collectively, “BJCMG”) employed primary care physicians (“PCPs”) as well as the physician assistants and nurse practitioners (“collectively Advanced Practice Providers or APPs”) that work with those PCPs. The effective date of the compensation model is November 21, 2021.  The purpose of this model is to better align financial incentives for PCPs and APPs with the BJC-ACO and MSSP goals of better management of overall health care for the patient population through greater access to, and coordination of, primary care services. This model is designed to increase BJCMG’s capacity to see and examine more patients for primary care medicine which will result in patients receiving a treatment plan, consultations, and medications more quickly and efficiently. Increased patient access will also enable these PCPs and APPs to help manage and monitor their patients’ condition and/or treatments throughout the continuum of care.