Collom & Carney Clinic ACO, LLC

CMS Shared Savings Program ACO Reporting

	ACO Name and Location:
	Collom & Carney Clinic ACO, LLC
	5002 Cowhorn Creek Rd.
	Texarkana, TX 75503-9766

	ACO Primary Contact:
	Priscilla A. Newton
	pnewton@collom-carney.com 903-614-3395

	Organization Information:
	∙ ACO Participants:
	1. Collom & Carney Clinic Association
	∙ ACO Governing Body:
	1. Joseph Womack, MD, Chairman‐Voting Member/Physician, ACO Participant, Collom & Carney Clinic Association
	2. PuiSum Wong, MD, Secretary‐ Voting Member/Physician, ACO Participant, Collom & Carney Clinic Association
	3. Malcolm Smith, MD, Voting Member/ Physician, ACO Participant, Collom & Carney Clinic Association
	4. Jon Tarpley, MD, Voting Member/ Physician, ACO Participant, Collom & Carney Clinic Association
	5. Roger A. Hall, Voting Member/ COO, ACO Participant, Collom & Carney Clinic Association
	6. Mary E. Dwight, Voting Member/ Manager, ACO Participant, Collom & Carney Clinic Association
	7. Fay Durrant, Voting Member, Medicare Beneficiary Representative
	∙ Key ACO Clinical and Administrative Leadership:
	1. ACO Executive: Mr. Roger A. Hall
	2. Medical Director: Joseph S. Womack, MD
	3. Utilization Review Committee – Joseph S. Womack, MD – Chair
	∙ Associated Committees and Committee Leadership:
	1. Quality and Clinical Informatics Committee: Malcolm A Smith, MD – Chair
	2. Finance Committee: Gregory A. Richter, MD – Chair
	3. Utilization Review Committee – Joseph S. Womack, MD – Chair
	∙ Types of ACO participants or combinations of participants that formed the ACO:
	1. ACO Professionals in a group practice arrangement

	Shared Savings and Losses:
	Amount of Shared Savings/Losses
	∙ Agreement period beginning 2017, Performance Year(s):
	∙ To be completed after the conclusion of the performance year

	Shared Savings and Distribution:
	∙ Agreement period beginning 2017, Performance Year(s):
	∙ Proportion invested in infrastructure
	∙ Proportion invested in redesigned care processes/resources
	∙ Proportion of distribution to ACO participants

	Payment Rule Waivers
	∙ "No, Our ACO does not use the SNF 3-Day Rule Waiver"

	Quality Performance Results
	∙ "To be completed after the conclusion of the performance year"