Urgent Message from ACC Leadership Regarding MOC

All of us continue to be troubled by the complex situation presented by the changes in re-certification by the American Board of Internal Medicine (ABIM) over the past year. We have heard clearly that our members are unhappy, and many are dissatisfied with ACC actions to date. Our approach to the issue has been careful and deliberate, perhaps leading to the assumption that the ACC is not adequately addressing the problem.

The current ACC approach is as follows:

  • We respect the intelligence of our members in analyzing the best path for continuing education/certification individually and realize that it may not be the same for each of us; we are not wedded to one solution for all.
  • An ACC Task Force led by ACC Immediate Past President Patrick T. O’Gara, MD, MACC, is focused on continuing to provide input to ABIM to see if proposed temporary changes become permanent and to see if their processes can further improve to the extent that they are helpful and acceptable to members.
  • A second ACC Task Force led by ACC President-Elect Richard Chazal, MD, FACC, is aggressively exploring whether an alternative board should/could be developed by ACC for our members. Potential possibilities could include: new board(s); working with already established alternate boards and/or other organizations; working within or without ABMS framework; and other solutions. While working as rapidly as possible, we want to be cautious, realizing the great complexity of the situation.

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Unexpected Hurdles in my ACHD Fellowship: Providing End-of-Life Care

Keri Shafer HeadshotThis post was authored by Keri Shafer, MD, Boston Children’s Hospital and Brigham and Women’s Hospital.

The care of adults with congenital heart disease (ACHD) is a rich and rewarding experience filled with unique challenges, some unexpected. I began ACHD fellowship enthusiastically determined to improve my understanding of complex cardiac physiology with questions swirling through my mind such as “What is anatomic malposition?” and “How is a Kawashima performed?” I soon learned that ACHD care is much more than that. Quality care requires a comprehensive understanding of the function of every organ system as years of congenital heart disease can take a toll on the lungs, kidneys, liver, etc.  Growing up with congenital heart disease can also affect patients’ approach to nearly every aspect of their lives. Therefore, the most successful ACHD physicians continually demonstrate compassion, patience and excellent communication skills when caring for their patients and families. Paramount among these skills is the ability to help patients and families through what can be the most difficult part of care: end of life. Continue reading

ACC President Celebrates SGR Repeal Victory at White House

Yesterday, ACC President Kim Allan Williams, Sr., MD, FACC, represented the College at the White House where President Barack Obama hosted a reception to celebrate passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Williams attended the Rose Garden ceremony along with Democrat and Republican Committee staff, House Speaker John Boehner, Democratic Leader Nancy Pelosi, House Majority Whip Kevin McCarthy and House Minority Whip Steny Hoyer, and Health and Human Services Secretary Sylvia Matthew Burwell.

The recently passed legislation, which permanently repeals the Sustainable Growth Rate (SGR), establishes a framework for rewarding clinicians for value over volume, streamlines quality reporting programs into one system, and reauthorizes two years of funding for the Children’s Health Insurance Program, is a tremendous victory for the house of medicine and ends nearly two decades of uncertainty for providers, practices and patients. Continue reading

Ambulatory Cardiology For the FIT

Akhil Narang headshotThis post was authored by Akhil Narang, MD, a fellow-in-training at the University of Chicago.

Most cardiology fellows spend the majority of their rotations in the inpatient or laboratory setting. Whether it’s the catheterization lab, electrophysiology lab, stress lab, imaging lab, consult services, or the coronary care unit, fellows-in-training become well versed in these key domains. The Accreditation Council for Graduate Medical Education mandates fellows also spend one half-day per week caring for patients in the ambulatory cardiology setting. In addition to weekly continuity clinic, fellows often get varying degrees of outpatient training in preventative cardiology, lipidology, hypertension clinic and vascular clinic. Are these outpatient experiences sufficient to enable fellows to confidently care for patients in the ambulatory setting?

After completing fellowship, regardless if one pursues subspecialty training, much of the practice of cardiology takes place in the ambulatory domain. There is no doubt that the busy inpatient services and laboratory experiences better equip fellows to take care of the most complex patients. While it’s likely that many of the inpatient skills translate into the outpatient realm, outpatient cardiology is fundamentally distinct from inpatient cardiology. What are your strategies for ensuring you’re well equipped to efficiently see patients while providing high quality care? Continue reading

EHR Checkup: Insight From HIMSS15

1_Tcheng_photo1This post was authored by James E. Tcheng, MD, FACC, chair of the ACC’s Informatics and Health Information Technology Task Force.

Last week, tens of thousands of health care providers and health information technology (IT) experts, vendors and stakeholders gathered in Chicago for HIMSS15, a conference dedicated to the transformation of health IT. All week, Chicago was abuzz about how technology is improving health outcomes for millions of patients around the world. Hot topics ranged from wearables to telehealth and mHealth, but electronic health records (EHRs) took center stage. A robust lineup of sessions featured representatives from the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator (ONC) for Health IT, medical associations, hospitals, EHR vendors and more who provided a diverse array of perspectives regarding the current EHR landscape and where the industry is headed. Continue reading

MOC Update: Greater Flexibility Available for Part II; New ACC Task Forces Formed

Patrick_OGara_130x130 richard_a_chazal_130x130_12_31_2014This post was authored by Patrick T. O’Gara, MD, MACC, immediate past president of the ACC, and Richard Chazal, MD, FACC, president-elect of the ACC.

Following on the heels of its Internal Medicine Summit in Philadelphia, PA, last week, the American Board of Internal Medicine (ABIM) has released an updated “Application for ABIM MOC Recognition” that provides more opportunities for physicians to earn Maintenance of Certification (MOC) Part II points for activities with a self-assessment component that have traditionally been designated as CME credits only.

In its February 2015 announcement regarding changes to the MOC process, which resulted from sustained, constructive input from organizations like the ACC, ABIM indicated it would develop ways to recognize most forms of ACCME-approved Continuing Medical Education, thus “allowing new and more flexible ways” for physicians to demonstrate self-assessment of medical knowledge. The updated ABIM MOC application, if managed correctly, provides an opportunity for physicians to apply earned CME credits towards meeting their five-year MOC requirements. Continue reading

An Important Message From the ACC President on ABIM MOC and SGR Legislation

Dear ACC Members,

As you know, we are on the brink of a historic Senate vote that would permanently repeal the Sustainable Growth Rate (SGR) that has created well over a decade of instability for our patients and our practices. The bill to be considered, H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, is a well-vetted piece of legislation that was developed in a bipartisan, bicameral manner and enjoys the support of ACC and virtually all of organized medicine. This consensus legislation passed the House two weeks ago with an overwhelming level of support- 392 members from across the political spectrum. We now must push the Senate to act.

We have issued multiple calls to action for you to contact your legislators. With over 6,000 messages to the Hill from members of the ACC alone, the response has been unprecedented and impressive. In recent days, we have seen speculation and misinformation that is a potentially damaging distraction from this critical effort.

The facts are clear. H.R. 2, supported by the ACC, does not require participation in maintenance of certification (MOC), nor does it establish ABMS, ABIM, or any specific entity to administer MOC. No one would be forced to participate in MOC. Continue reading

An Early Career’s Perspective of the ACC.15 Sports and Exercise Intensive

Salazar_Christina 9112This post was authored by Christina Salazar, MD, FACC, member of the ACC’s Sports and Exercise Cardiology Section Leadership Council.

Preparation and performance come to mind as I reflect on my experience as a first time faculty at ACC.15 in San Diego. I had the pleasure of co-chairing one of the four parts of the Sports and Exercise Intensive during ACC.15. It was not a difficult position, but exciting and I was able to meet and interact with several of the leading cardiologists in the field of sports cardiology.

This year’s Annual Scientific Session brought much excitement due to the focus on interactive education. For those of you who attended ACC.15, you were able to experience first-hand the many beneficial educational changes that were visible throughout the conference. In particular, the Sports and Exercise Intensive was a 4.25-hour block of time dedicated specifically to the growing field of sports cardiology. We were fortunate to have many leading cardiologists present during this intensive and in the end there were several take away points. Continue reading

Pharmacists Involvement in MI Care: Completing the Team

Craig BeaversThis post was authored by Craig J. Beavers, PharmD, AACC, BCPS-AQ Cardiology, CACP, co-chair of the ACC’s Clinical Pharmacist Workgroup.

Myocardial infarction (MI) is a common occurrence, with an approximate annual incidence rate of 525,000 new events and 200,000 recurrent events, and an estimated 30-day mortality rate of 7.8 percent. Therefore, it is no surprise much focus and attention has been devoted to MI management. Great strides have been made in terms of improving morality and reducing morbidity via interventional techniques and advanced pharmacotherapy. However, variation exists amongst hospitals regarding MI mortality rates despite solid evidence for treatment. While geographic locations, number of beds and MI volumes have correlations with mortality rates and may explain some variability; there still remains a substantial proportion of unaccounted variation. In order to address these unknowns, investigators preformed an analysis of hospitals with the lowest 30-day risk standardized mortality rates. They found seven strategies that impacted their morality outcomes with one of the domains including pharmacist care. This analysis has blossomed into the concept of the ACC’s Surviving MI Initiative. Continue reading

The Economic Impact of AUC Implementation at a Large Community Hospital

Pranav Puri headshotThis post was authored by Pranav Puri, a first year undergraduate student at The University of Chicago.

Approximately 600,000 percutaneous coronary interventions (PCIs) are performed in the U.S. each year at a cost that exceeds $12 billion. In recent years, the emphasis of the national health care system has shifted towards providing higher quality care at lower costs, and payment models are shifting away from fee-for-service towards population-based health management and bundled payments. In an effort to assist both physicians and patients in choosing the best procedure for patient outcomes, the ACC developed appropriate use criteria (AUC) for coronary revascularization in 2009 and released a focused update in January 2012.

In February 2012, UnityPoint Trinity in Rock Island, IL initiated a process involving the education and participation of physicians and nurses towards the implementation of the ACC’s AUC. Since the economic impact of AUC has been of interest to me for quite some time (read my previous blog on my poster presentation at ACC.13 here), my colleagues and I put together a study to assess the long-term effects of implementation of AUC on volumes of both interventions and diagnostics. We also studied the distribution of acute vs. elective interventions, and aimed to quantify the economic impact of implementation of the AUC. Continue reading