Health IT Innovation Showcased at HIMSS16

Photo for Publication or Presentation Purposes 2015This post was authored by Tyler J. Gluckman, MD, FACC, a presenter at HIMSS16.

Just weeks after the ACC was in Las Vegas for the 2016 Cardiovascular Summit, thousands of health information technology (IT) experts came together in the same city for the 2016 Healthcare Information and Management Systems Society Conference (HIMSS16). The conference focused on how technology is being used to improve health and was a stage for the U.S. Department of Health and Human Services (HHS) and other government agencies to announce policies that will shape the future of health IT.

At HIMSS16, the ACC took part in the HIMSS Interoperability Showcase, an area dedicated to innovations in interoperability. The ACC has been a longtime advocate for interoperability, which describes how effectively clinical data can move between different participants, both human and technological, in the care delivery chain. The College was able to highlight its work in this space – from Integrating the Healthcare Enterprise efforts to using NCDR registries to enable interoperability – during presentations by ACC members and staff in the Interoperability Showcase. Continue reading

The Journey to Value-Based Payment Continues

Dr Paul CasaleThis post was authored by Paul Casale, MD, MPH, FACC, a member of ACC’s Board of Trustees and chair of the Partners in Quality Subcommittee.

Health care is undergoing a transformation in regard to how we, as physicians, are paid for our services. Over the last decade, the Medicare Prescription Drug, Improvement and Modernization Act, the Deficit Reduction Act of 2005, the Tax Relief and Health Care Act of 2006, the Patient Protection and Affordable Care Act of 2008, and the American Recovery and Reinvestment Act of 2009 have gradually moved the needle on quality reporting. While we’ve been on the journey from fee-for-service to pay-for-value for years, 2015 was a pivotal year for the transition to value-based payment.

Last year introduced the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation that permanently repeals the Sustainable Growth Rate, establishes a framework for rewarding clinicians for value over volume and streamlines quality reporting programs into one system. MACRA also established two new payment pathways for clinicians that will start in 2019: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Continue reading

Advocating for Cardiology in the Nation’s Capital

The ACC’s 2015 Legislative Conference is in full swing in Washington, DC. The conference kicked off on Sunday night with a special ACC Political Action Committee-sponsored reception and dinner featuring remarks from Pulitzer Prize-winning syndicated columnist, political commentator and psychiatrist Charles Krauthammer, MD. In the midst of a unique congressional climate, Krauthammer shared an insider’s perspective into the state of politics in Washington and the 2016 presidential election.

Today, a full lineup of sessions armed more than 400 attendees with the information needed to effect change in their states and on Capitol Hill. While it’s important for attendees to understand the health policy landscape every year, it’s more important than ever in 2015. Recent developments, including repeal of the Sustainable Growth Rate (SGR) by enactment of the Medicare Access and CHIP Authorization Act of 2015, release of new Meaningful Use regulations and ICD-10 implementation, have significantly shifted how health care is delivered, resulting in novel challenges and opportunities. Continue reading

Population Health and Primary Prevention in the Spotlight

MartinThis post was authored by Gerard R. Martin, MD, FACC, chair of the ACC’s Population Health Policy and Health Promotion Committee.

We’re currently at a crossroads of health care delivery and health promotion. Up until now, we, as cardiovascular professionals, have been laser focused on secondary prevention, only scraping the surface of primary prevention. While technological and educational advances over the last few decades have resulted in a significant reduction of cardiovascular disease (CVD) in the U.S., the burden of CVD is set to increase 57 percent by 2020 worldwide.

To adjust to this new landscape, we must shift the paradigm from treatment to prevention and begin moving towards population health if we want to kick CVD off the list as the world’s #1 killer. This is no easy task. Population health – which is at a complex intersection between an increasingly diverse population, an evolving health care system, traditional public health and elaborate social policies – is not easy to define. I can guarantee that each and every one of us has a different perspective on the topic, making it difficult to come to a consensus on how best to move forward. Continue reading

A Closer Look at CMS’ Updated NCD for VAD

This post was authored by Lee Goldberg, MD, MPH, FACC, heart failure and transplant section chair.

The Centers for Medicare & Medicaid Services (CMS) made a number of important changes to the national coverage determination (NCD) for ventricular assist devices (VAD) in October 2013. DNV Healthcare Inc. requested review of the NCD to consider the position held by the Joint Commission as the only entity approved to accredit VAD programs. In response to this request, CMS will create standards any entity must meet in order to accredit VAD programs.

CMS made other important changes to the NCD that impact VAD programs. First, CMS decided to keep the bridge to transplant and destination therapy coverage categories. This decision rejected the suggestion made by the ACC and a number of other stakeholders that these categories reflect neither the way programs select patients nor the medical uncertainty that is often present when a VAD is implanted.  Continue reading

Health Care Reform Headed for a Perfect Storm

A Perfect Storm: A critical or disastrous situation created by a powerful concurrence of factors.

As cardiovascular professionals, our top priority is, and always will be, delivering the best possible care to our patients. Throughout our careers, we continuously strengthen our knowledge and skills through various education opportunities in order to ensure we are the best providers we can be. While our dedication to medicine is unwavering, the health care system is failing us, and has been for some time. Continue reading

What You Need to Know for Health Policy in 2013

This post was authored by Jim Fasules, MD, FACC, senior vice president of Advocacy for the ACC.

Despite a rather recalcitrant Congress, last year saw very significant changes for health care and cardiology. After the swirling uncertainty surrounding the Affordable Care Act (ACA), the U.S. Supreme Court ruled the ACA, including its individual mandate, was constitutional. With the federal debate laid to rest, the action shifts to the states where for political and policy reasons a patchwork quilt of variability still leaves physicians, hospitals and patients perplexed on how to adapt to Medicaid expansion, the Exchanges and other insurance changes. Yet hidden in the rancor over the ACA were many challenges and changes effecting cardiology that the ACC tackled with a large degree of success.

For more than a decade, the sustainable growth rate (SGR) and the nearly 30 percent cuts associated with the flawed formula have threatened to impede improvements to the health care system and weaken the sustainability of practices nationwide. While a fight for permanent repeal of the SGR was unsuccessful, the last-minute “fiscal cliff” legislation delayed “the cliff” and its 27 percent cuts until 2014, at least restore a degree of financial security to physicians and ensure patients have continued access to quality care for 2013.

Besides helping achieve the SGR patch in the American Taxpayer Relief Act of 2012 (ATRA), the ACC team succeeded in helping cardiology in two other important ways.  First, last year saw an aggressive campaign waged to close the in-office ancillary services exception (IOASE), also known as the Stark exception that allows us to perform tests and imaging in our offices, mounted by radiology and others. Its inclusion in the ATRA was successfully prevented. In addition, the team’s work with the Senate Finance, Ways and Means and Energy and Commerce Committees, following the stellar testimony of ACC Past President Douglas Weaver, MD, MACC in July, resulted in the law providing that participation in qualified clinical data registries, such as the NCDR®, will count as PQRS participation in 2014. While many details still need to be worked out, this will allow greater ease of avoiding the cuts that now occur for non-participation in PQRS.

Despite our successes, 2013 has many risks. The 2 percent across-the-board sequestration cut to Medicare and the even greater cuts to public health remain a threat when the two month delay in the ATRA expires on March 1. The ACC adamantly opposes the 2 percent Medicare sequester and the approximately 8 percent sequester cut to NIH, CDC, AHRQ and other crucial agencies, and the College will continue to urge Congress to prevent the cuts from going into effect. While successfully prevented in 2012, the forces working to close the IOASE have already marshaled an even stronger campaign this year. In response, we are working with a broad coalition to demonstrate to Congress and the Administration that closure of the exception would cause great disruption to patient care and would effectively end the viability of private practice and actually result in greater expenses for Medicare and insurers. Similarly, the College remains opposed to enactment of prior authorization for imaging services under Medicare.

On the medical liability reform front for this year, the U.S. House of Representatives is expected to take action on the HEALTH Act once again, which includes MICRA-type liability reforms. The College will continue to work with other stakeholders to support this act and advance supplemental medical liability reforms. Often missed in the College’s activities is its work for public health and science.  Again this year, the College will work to support federal funding for NIH; AHRQ; the NHLBI; the Health Resources and Services Administration’s AED program; the Prevention and Public Health Fund; the Million Hearts™ initiative; CDC’s Heart Disease and Stroke Prevention Program; and congenital heart disease research and surveillance.  As Congress struggles to find spending cuts, Graduate Medical Education (GME) finds itself targeted.  Advocacy with the help of the Academic Council is working with the AAMC to prevent any disruption to fellowship training.

As you can see 2013 holds many risks to cardiovascular care.  There are many opportunities for U.S. members to get involved in ACC’s advocacy efforts, including learning more about ACCPAC, and participating in legislator practice visits and Legislative Conference.

Stay tuned to CardioSource.org/Advocacy throughout the year for health policy updates. To get involved in ACCPAC, visit accpacweb.org.

Fiscal Cliff Crisis Averted and “Doc Fix” Patched for Another Year

Earlier this week the nation waited in anticipation as the American Taxpayer Relief Act of 2012 was passed through the Senate, and eventually through the House late New Year’s Day, therefore averting the so-called “fiscal cliff” from taking effect. The bipartisan deal included a one-year patch of the flawed Sustainable Growth Rate (SGR) formula, preventing Medicare payment cuts of 26.5 percent that were set to kick-in on Jan. 1. Across-the-board sequester cuts of 2 percent were also delayed, keeping Medicare reimbursement safe for another two months.

Throughout the past year, ACC leadership and staff helped lay the groundwork for several quality-related provisions in the new law through ongoing dialogue with congressional committees about ACC’s quality improvement tools, including registries. Included in the legislation, was an extension of the Geographic Work Adjustment through 2013 and reauthorization of funding for measure endorsement for another year. The ACC worked with the Stand for Quality coalition, including the National Quality Forum and the American Medical Association, to advocate for extension of this funding.

Also thanks to the incredible efforts of ACC’s Advocacy team, a provision to qualify registry programs to meet Physician Quality Reporting System (PQRS) reporting requirements was included. Professional society clinical data registries, such as the ACC’s National Cardiovascular Data Registry, collect robust data that are used to provide feedback to physicians and enhance performance. This focus on quality, evidence-based care by itself is an effective way to reduce overall costs while enhancing quality of care. Registry participation is a more robust performance improvement method than the current PQRS, and now that more physicians can meet PQRS requirements, physicians can avoid future penalties under the program. This provision was the result of discussions between ACC, the American Society of Clinical Oncology, the Society of Thoracic Surgeons, and a few other organizations with bipartisan staff for the Senate Finance Committee and House Ways and Means Committee in the summer and fall.

The College also played a key role in a provision to enhance the quality of data needed for new delivery and payment models. The law now requires the Secretary of HHS to develop a strategy to provide data for performance improvement to physicians in a timely manner. This provision is the direct result of testimony by physicians, including ACC Past President Doug Weaver, MD, MACC, before the Senate Finance Committee this summer as well, as a roundtable discussion between committee staff, ACC and several other specialties this fall.

While the offsets used to pay for the $25 billion SGR patch do result in an increase in the equipment utilization rate for advanced imaging modalities that is limited to CT/MR/PET, which will mean reduced payments, but fortunately ACC staff were able to keep prior authorization and changes to the in-office ancillary services exception kept out of the agreement.

Moving forward, ACC’s Senior Vice President Jim Fasules, MD, FACC, said it best when he told the ACC presidential team earlier this week  that while “the work now shifts to the spending cuts debate with a big spotlight on entitlements … right now we get to stop holding our breath.” It is now more important than ever that the cardiovascular community and the rest of the house of medicine build on the momentum from these efforts and continue to push for a permanent repeal of the SGR. As I mentioned in my blog post last week, 90 percent of ACC PAC-supported candidates (104) won their respective elections in November 2012, strengthening the College’s allies on Capitol Hill. These relationships and grassroots efforts have and will continue to be increasingly important as we work towards a permanent repeal over the next year. The ACC stands ready to work with Congress as it confronts the challenges and opportunities within Medicare.

Stay tuned to the ACC Advocate and CardioSource.org for additional details in the coming months.

Banding Together to Fix the Flawed Payment System

This post is authored by Stephen R. Ramee, MD, FACC, chair-elect of the Interventional Scientific Council.

The 2013 Medicare Physician Fee Schedule continues the Centers for Medicare and Medicaid Services’ (CMS) campaign to reduce payments for complex procedures and diagnostic tests in order to redirect resources to other services. An agenda that began with crippling cuts to echocardiography and SPECT and continued with implementation of faulty practice expense data that cut cardiology services across the board has now targeted EP procedures and PCI.  Although the cuts result in large measure from decreases in the amount of time needed to perform the typical EP study and ablation or PCI (note that the system for determining RVUs is heavily driven by procedure time), CMS payment policy decisions have made things worse. By unilaterally rejecting recommendations from the physician community that would provide opportunities for cardiologists to accurately report more complex procedures, CMS is preventing physicians who care for the most challenging patients from being fairly compensated. ACC will be vigorously opposing CMS’s decisions and working with the Society for Cardiovascular Angiography and Interventions (SCAI) and the Heart Rhythm Society (HRS) to rectify these decisions. Unfortunately, no changes to the fee schedule can happen before 2014.

Our practices that have already experienced precipitous cuts in payment for core services now face payment reductions on the order of 27 percent for EP studies/ablations and 20 percent for PCI. Many of us, myself included, are astonished that the reward for a relentless focus on quality that has brought about a 27-percent reduction in mortality from heart disease is a payment cut.

While the cardiovascular field is justifiably angry about the latest round of payment cuts, it’s important to recognize that this is the byproduct of a broken system for physician payment. Congress’s inability to fix the Sustainable Growth Rate (SGR) has meant a decline in real terms in the resources our nation devotes to paying for the physician services Medicare patients need and deserve. Rest assured that ACC will be doing everything possible to reverse CMS’s bad decisions and to stop the SGR cut from going into effect. But we will also be redoubling our efforts to make sure policymakers understand the value of the lifesaving work cardiologists do every day and to move toward a payment system that supports and rewards our specialty’s dedication to improving care and outcomes for patients with heart disease.

For full coverage of the 2013 fee schedule and coding changes, visit CardioSource.org/PhysicianPayment. Stay tuned to The ACC Advocate for updates on ACC’s action. Be sure to follow @Cardiology on Twitter for the latest advocacy and health policy news.

The Election is Over but Now What?

This post was authored by Douglas Weaver, MD, MACC, past president of the ACC.

This year has been a painful one for healthcare providers due to the continued atmosphere of uncertainty.  Many of us began this year working on initiatives that deal with some of the changes attendant with the Affordable Care Act – e.g. reduce unnecessary admissions and change them to observation status, decrease readmissions for patients with a recent MI or for heart failure, and putting together means to provide better continuity of care.  Before the election, it was impossible to fully engage given the polarizing rhetoric between parties.  At the present time our payment policies don’t reward either physicians or hospitals for reducing readmissions, and rather we take a hit.

However, even after the election, it still isn’t better. We are in an environment with continued partisan bickering about the legislation, lack of agreement on a common approach to sequestration, the tax cuts, unemployment benefit extension, reducing the deficit, how to pay for the SGR (and possibly with further Medicaid cuts, reduced NIH funding, loss of facility based E and M dollars, IME reductions).

After studying the issues and listening to the pundits, I have come to the following conclusions: first, our national debt is a major problem and one that needs to be fixed.  If you include the “promised entitlements” of Medicare and Social Security, it is close to 86 trillion dollars — and this number would require collecting 8 trillion dollars a year in taxes to just keep it from going higher. Congress can’t agree on ways to get a few hundred billion to balance the budget for the coming year. The total earnings of all of us filing tax returns is a little over 5 trillion dollars a year — and that is earnings not the taxes you and I currently pay.  Conclusion: we have to curb entitlements no matter what happens to taxes.

Second, people are spending less on healthcare. Visits are down, admissions are down—the cost curve has been bent already. If you count up the 50 million people in our country with no insurance, add 40 million who do, but who can’t pay their deductibles or co-pays, and the almost 55 million on Medicaid—this says that half the people in our country can’t afford our healthcare.  Conclusion: it is not about healthcare inflationary costs (these are now fixed), it is about the absolute cost.  Cost of healthcare in the U.S. is 1.5 to 2 times more expensive than elsewhere.  With peoples’ individual contributions increasing for care, they are voting with their feet and avoiding, when possible, doctor visits and procedures.

Lastly, there are some basic problems with the way we are approaching enacting “change.”  If all of our patients are going to pay more now for coverage and we are going to move to pay for quality, our patients should be getting something for this right up front—not years down the road.  Second, don’t harness the providers to the plain vanilla PQRS quality reporting measures and 18 month old administrative data to track performance. Instead, let specialty societies like the ACC, who can focus initiatives in areas where its members determine deserve improvement, and support these organizations to provide feedback and tools for improvement to their constituencies, instead of funding a larger, but less relevant reporting now done by the insurers.

We are adaptable—we can move more quickly and deliver more, but not at our own expense. We can however do so with a promised reduction in the overall cost of care and with equal or higher satisfaction from our patients.