An International Perspective of Legislative Conference 2012

This post was authored by Jorge Acuña Valerio, MD, member of the ACC Mexico Chapter and fellow-in-training at the Instituto Nacional de Cardiologia Ignacio Chavez.

This year I was fortunate to be invited by leaders of the ACC Mexico Chapter to attend the ACC’s Legislative Conference. What was most interesting to me was seeing how the ACC is present in other areas, not just the science and medicine. It is important for cardiologists, and any specialty, to move forward as a group and advocate before other people or organizations. I believe that often times the medical community doesn’t do enough to come together as a group, so it was satisfying to see how in a more developed social model, physicians indeed can come together to advocate before organizations, even government.

Physicians have always been leaders in society, and the weigh cardiologists have over any other specialist has always been quite particular. It is because of this responsibility why I think it’s very important for cardiologists to be involved in social activities besides their medical education and clinical formation. The principle of democracy lies when our representatives act in our favor, and to achieve this we need to have our issues exposed to them. If we, as physicians, have the support of such a powerful organization such as the ACC, it’s easier to execute.

The Congress in Mexico is comprised of Deputies and Senators. There are 500 Deputies total, and represent the citizens from each region called a “district.” The Senate members are elected by state, and we have 128 members. Even though they’re both Congress members, deputies have more power over the fiscal legislation and the senate has more power over the ins and outs of Mexican politics. Both are elected for three or six year terms, almost every one of them by voting. Although the US and Mexico differ greatly in government structure, there is still much to learn from one another.

In Mexico we have a saying: “God can’t hear the one who doesn’t speak.” I think this saying can be applied to the ACC’s Legislative Conference. If we want to move one step closer towards getting our work conditions improved, it’s necessary for us to expose these issues to our political leaders so that they can decide what contribution they can make, which will ultimately benefit patients. After seeing your model, I think in many cases this can be applied to every profession.

Visit the ACC’s International Center on CardioSource.org for more news and information about ACC’s International activities.

A FIT Perspective of Legislative Conference 2012

This post was authored by Scott Lilly, MD, PhD, chair of the FIT Committee and an Interventional Cardiology fellow at the University of Pennsylvania.

This year over 70 fellows-in training (FITs) from across the nation attended the 2012 Legislative Conference in Washington, DC where they met with ACC and congressional leaders to discuss current issues affecting practice of cardiology in both academic and private practice settings. Although it may be difficult to remain apprised of proposed and impending legislation during fellowship years – the conference format addresses this.  On Monday, there was an array of speakers that discussed specific issues for collaborative lobbying. These short (and often entertaining) presentations were interactive and reliably followed by practical questions from the nearly 500 physicians, cardiac care associates or FITs in attendance. In between the discussions, there were a number of breaks that allowed FITs to interact and introduce each other, have smaller group conversations regarding a particular issue, or meet with ACC leadership. Fully debriefed, we received our congressional visit schedules and prepared to “storm the hill” with our fellow state ACC members.

Among the issues we addressed this year was a proposed cut to ACGME spending – something that could directly affect on our training.  Whether these cuts would have a direct affect on the number of fellowship positions, or result in variations in educational infrastructure or national meeting subsidies is unclear. Regardless, these changes are clearly occurring at a time when there is a greater need for cardiovascular physicians – driven both by the aging population and the availability of new and effective therapies that mandate specialized training. The ACC has responded to this and other proposed cuts proactively by requesting a partnership with respect to health care reform. Through addressing overutilization via appropriate use criteria, and improving quality of care by advocating national registries, the hope is that we will be able to more effectively deliver care in a less costly manner.

While we as FITs may spend most of our professional time at the bedside or in the latest scientific journal, I was reminded this weekend of the world outside of the clinic. We have cardiologist advocacy leaders – individuals that, despite busy practices devote a significant amount of time to preserving our ability to learn, care for our patients and help to secure our future. When FITs participate now, it strengthens the delivery of these messages to congress, broadens our perspective, and will hopefully cultivate the next generation of these cardiologist advocacy leaders.

For the many FITs that visited the Capitol last week, I hope you arrived home safely; to the rest, I hope to see you next year.

A Glimpse at Future Leaders of the ACC and Cardiology

Over the past few weeks I’ve gotten a glimpse into the not-so-distant future of the ACC and Cardiology. Last week’s 21st Annual Legislative Conference was a huge success thanks to the efforts of 400 attendees, many of whom traveled to our nation’s capital and participated in the Hill visits. This was a record attendance! We were very pleased to have over 70 fellows-in-training (FITs) and over 60 Cardiac Care Associates (CCAs) in attendance during the briefings and Hill visits. I was inspired to see this growing support from the physicians and associates who are the future of cardiology. Their involvement was indeed palpable and inspiring. You can read about the perspective of different member types including an FIT, CCA, Cardiovascular Administrator and International member here on the blog in coming days.

After the conference, I had a chance to attend the “Teaching Skills Workshop for Emerging Faculty” at Heart House conducted by Drs. Pat O’Gara and Rick Nishimura and generously supported since its inception in 2005 by ACC Past President Dr. Michael Wolk. I also had dinner with these bright young cardiologists and CV surgeons, some of whom came all the way from Israel. The workshop promotes the development of skills (effective individual presentations, teaching, and communication) for those emerging faculty who are committed to contributing to the College’s mission of education and to facilitate this transfer of knowledge into their professional environment. It is invigorating to see such stellar and engaged professionals, a glimpse of our future educational and thought leaders.  I had a chance also to address them formally and tell them about the College and how they can get involved.  I even showed them an impromptu taped testimonial (that I did in my office on my iPhone!) of the effect of this intense workshop on a previous graduate who is among our faculty—Dr. Steve Little, who is now a young star.

This program has been phenomenal. Since 2005, we’ve had a total of 82 participants in 4 courses (given every other year); the skills and relationships developed at the workshop have led to their involvement in close to 600 activities or appointments at ACC to date. During my presentation I reiterated the fact that the ACC is always looking for involvement at every career stage. The College is accepting nominations and applications for committee and council membership through Oct. 31. All ACC Fellows (FACC/MACCs), FITs, CCAs, and Cardiovascular Administrators are invited to nominate a colleague or apply for membership online at https://services.acc.org/CommitteeNominations.

Looking ahead, the College is now accepting applications for the Chief Executive Officer of the ACC. As I mentioned in a previous blog post, the College selected Korn/Ferry International, a leading global executive recruitment and talent management firm, to work with the search committee tasked with hiring our new CEO. Our hope is to have the CEO named by next year’s Annual Scientific Sessions held March 9 – 11, 2013 in San Francisco, CA. You can read the job description, apply or refer someone for the position here.

The College’s future leaders and CEO will help guide the College in its continued pursuit of the singular mission to transform cardiovascular care and improve heart health. From what I can see, the future is very promising and exciting indeed!

(pictured above: Over 70 FITs attended Legislative Conference, view more photos here)

A Practice Administrator Perspective of Legislative Conference 2012

This post is authored by Cathie Biga, RN, MSN, president and chief executive officer of Cardiovascular Management of Illinois.

I just finished a remarkable two days at ACC’s Legislative Conference in our nation’s capital.  While I have been privileged to attend in the past, this was the first time I had the honor of being on the Hill with the ENTIRE cardiac team representing Illinois! Led by our current Governor Marc Shelton, MD, FACC, Past Governor Jerome Hines, MD, PhD, FACC, integrated and independent physicians, FITs, CCAs, and practice administrators, we were 11 strong and hit nine offices.

Sharing our message from the “trenches” was important to all of us, and explaining the vast landscape of cardiology care in Illinois was a challenge we tried to hit head on.  From patient access (explaining why imaging cannot be reduced any more or reductions for same day of service is problematic) to the administrative burdens and cost of running a practice, we relayed our message and asked for their help.

While speaking with our Legislative aides, chiefs of staff, and a few members of Congress, we relayed that while payment reform will inevitably happen (and it really must), we MUST ensure accurate quality data is used to drive this process – which the College has. In addition, physicians and their team MUST be at the table when these decisions are made.

Change is inevitable and hopefully our trek to the Hill will remind us all how important this health care message is for cardiology and why EVERY member of the team needs to be involved.

P.S., You don’t have to fly all the way to Washington to get involved — our Senate and Congressional representatives live in your neighborhood! Get to know them, call them, invite them to your practice and support them!

Hope to see you all next year!

For additional coverage of the 2012 Legislative Conference, visit CardioSource.org and check out the photos on ACC’s Facebook page.

What Happens When 350 Cardiologists Tackle the Hill?

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

This week more than 350 ACC members were in our nation’s capital for the College’s 21st Annual Legislative Conference. ACC’s leaders, FACCs, FITs, CCAs, Practice Administrators and even international members were all on hand to participate in briefings on the critical health policy issues facing medicine today.

The conference kicked-off on Sunday with a special reception and dinner celebrating the 10th Anniversary of ACC’s Political Action Committee. During the keynote speech, Pulitzer Prize winner and syndicated Washington Post columnist George Will shared his insider’s perspective of the current political climate and the impending presidential election. Filled with facts and baseball references, Will was able to engage a packed room full of attendees from both sides of the aisle.

On Monday members heard from ACC President William Zoghbi, MD, FACC, who presented results from the 2012 Practice Census, (read more about the results on CardioSource.org), as well as from a range of politicos including an election outlook from Ronald Brownstein.

Earlier today Rep. Michael Burgess, MD (R-TX) was presented with the President’s Award for his distinguished public service and support of the College’s health policies that promote high-quality patient-centered care.  Soon after, conference participants headed to Capitol Hill for a day full of pre-arranged meetings with their members of Congress. Given the current health care landscape, members stressed the importance of Congress avoiding further harmful spending cuts and reforming the Medicare payment system. With 295 separate legislator meetings scheduled, the ACC’s commitment to quality and patient-centered care was heard loud and clear on the Hill.

Our actions and advocacy efforts this week are important for many reasons. We are dependent on Congressional action to prevent upcoming cuts from the sustainable growth rate (SGR). In addition, the Centers for Medicare and Medicaid Services (CMS) has already proposed an array of new policies for the 2013 Medicare Physician Fee Schedule (read ACC’s comments on the proposed rule here) that include both threats and opportunities for cardiology. These proposed policies include:

  • The final year of transition to new PE RVUs causes small reductions to most cardiology services.
  • A proposed multiple procedure payment reduction for a wide range of diagnostic cardiology services (e.g., echocardiography, stress tests, vascular ultrasound) would reduce the technical component payment for the second and any subsequent service by 25 percent if performed on the same day.  ACC has vigorously opposed this proposal.
  • Medicare has proposed for the first time to pay for transitional care services for patients discharged from hospitals or skilled nursing facilities. Physicians providing care coordination services within the first 30 days of discharge would have the opportunity to bill Medicare for these services. The ACC sees this as an important step forward for Medicare, but expressed some concerns about the specifics of the proposal. We’re hopeful that CMS will make some changes to ensure that patients with cardiovascular disease benefit from the new policy.
  • If CMS goes forward with its proposed rules, physicians in groups with 25 or more practitioners will be the first to be subject to the value-based payment modifier established in the Affordable Care Act. Also, beginning in 2015, groups of 25 or more will be subject to a 1 percent penalty or may be eligible for bonus payments based on PQRS participation and performance on quality and cost measures in 2013, and practices with 25 or more physicians and other practitioners will need to take action in the first quarter of 2013 to avoid the penalty and ensure potential eligibility for bonus payments.

Not included in the proposed rule, but of great significance to cardiology, we also expect 2013 coding and valuation changes to result in cuts of 20 percent or more for EP/ablation services and some PCI services, but exact impacts will not be available until Medicare releases payment information on Nov. 1.

Although CMS will review comments and release final decisions on these proposals soon, our efforts on the Hill this week will inevitably help raise awareness of the issues facing cardiology today. Stay tuned to the ACC Advocate and CardioSource.org for updates this fall. Also stay tuned for individual perspectives from Legislative Conference here on the blog in the coming days.

What do Cardiologists and Football Have in Common?

One might not initially think that cardiologists and football players have a lot in common. However, coming out of the standing-room-only Board of Governors (BOG) meeting this past weekend, I can tell you that the team spirit and tireless work ethic of ACC’s cardiovascular “team” rivals that of the best players on the football field.

The September BOG Meeting is always one of my favorites. We’re moved beyond saying “here’s what we’re going to do” to “here’s what we’re doing.” It’s a time to look back on early accomplishments, reassess priorities if needed, and celebrate where we’re going.

Among the early accomplishments this year:

  • A formal recommendation regarding Appropriate Use Criteria terminology. The BOG has been an integral part of these discussions over the last several months and   we believe that the recommended changes will address many of the concerns raised by members at the grassroots level, particularly regarding the use of the term “Inappropriate.”
  • The development of a Digital Strategy. No, the BOG is not responsible for developing the Digital Strategy, but many governors have been involved in some manner in its development, whether it’s sharing feedback from Chapter members, actively taking part in usability testing or simply using the College’s online and mobile resources.
  • Participation in the Million Hearts initiative. We heard from Janet Wright, MD, FACC, executive director of Million Hearts, that the College and its Chapters are among the biggest contributors to Million Heart activities. As the initiative enters its second year, even more opportunities for involvement are expected.

Looking ahead, the College’s new Lifelong Learning Portfolio offers unprecedented new learning opportunities for ACC members. There are also incredible new quality improvement tools in development or newly launched that are intended to help cardiovascular professionals not only adhere to guidelines and best practices, but also involve patients in their care. Among these resources: Clinical Toolkits for atrial fibrillation and heart failure, and growing opportunities to use Imaging in FOCUS tools in practice. New CardioSmart initiatives like CardioSmartTV, which puts patient-themed content on waiting room televisions, offer up unique new ways to reach patients. As Dr. Wright also mentioned, we still have four more years to reach the Million Hearts goal of preventing one million heart attacks and strokes.

Of course, I’d be remiss not to mention some of the health policy issues ahead. There is no doubt that health reform implementation will continue to have impacts on the current practice environment, as will continued cuts to Medicare physician payment. There is a need for the entire cardiac care team to come together as one voice to make sure that policies moving forward are in the best interest of our patients. Issues like public reporting, the Physician Payment Sunshine Act and other policies being discussed will have profound impacts on how we practice and it’s important that the College and its members be heard.

This weekend reinforced that the ACC’s BOG is comprised of an amazing team of men and women who selflessly volunteer their time in many different ways, with the ultimate end goal of ensuring patients living with, or at risk of, heart disease are receiving the best, most appropriate care possible. Like the football teams who took to the field this weekend, we will take some hits and might even lose a few yards, but at the end of the day there’s a sense of accomplishment for all the yards run and the touchdowns that were made. As the old saying goes, we “come together, share together, work together and succeed together.”

Another Love Affair is Over

This post was authored by Kathy Blake, MD, FACC, member of the ACC’s Advocacy Steering Committee.

A recent article in the Wall Street Journal, “Same Doctor Visit, Double the Cost” (subscription required) detailed the shift we have seen across the country of hospital systems acquiring private practices, often leading to higher prices of services.
The article notes that “as physicians are subsumed into hospital systems, they can get paid for services at the systems’ rates, which are typically more generous than what insurers pay independent doctors. What’s more, some services that physicians previously performed at independent facilities, such as imaging scans, may start to be billed as hospital outpatient procedures, sometimes more than doubling the cost. The result is that the same service, even sometimes provided in the same location, can cost more once a practice signs on with a hospital.”

The article lays the groundwork for much of what the College has been advocating for over the past few years: the need for payment reform. The payers have noticed. The patients have noticed. The Centers for Medicare & Medicaid Services (CMS), as the article suggests, may have its hands (somewhat) tied by statute. The love affair with independent practice ended a long time ago. The infatuation of business with private payers and HMOs died awhile back. The current love affair, with integrated systems, is looking a bit tattered. The reality suggests that a variety of offerings across the full spectrum probably leads to a healthier delivery ecosystem, especially if there is transparency about cost and quality, and real competition based on accurate determination of value.

The article is timely as the 2012 Legislative Conference is right around the corner and will be touching on issues such as the College’s ongoing payment reform efforts, including advocating for the repeal of the sustainable growth rate (SGR) and instead focusing on quality-based delivery and payment models. Also at Legislative Conference Dr. Zoghbi will give an update on the “State of Cardiology” with results from this year’s Practice Census (we remember the results from two years ago that started documenting this shift in private practice).

The current fee-for-service system in integrated models is not sustainable, and it is up to us to steer the payment reform decisions in the right direction.

A “Supreme” Opportunity to Transform the Health Care System

The long-awaited U.S. Supreme Court ruling regarding provisions in the Affordable Care Act (ACA) was released yesterday. In a majority decision, the Court ruled that the ACA, including its individual mandate that virtually all Americans buy health insurance, is constitutional.

The ACA is the largest expansion of health care coverage since Medicare and Medicaid were initiated in the sixties. Having this decision behind us means that we can continue to move forward with supporting policies and provisions within the law that are in line with our overarching health care reform principles – particularly those that expand health care coverage, encourage preventive care, and foster innovative payment and delivery system models that reward quality and ensure value.

At the same time, the College will also continue to work with Congress and the Centers for Medicare and Medicaid Services (CMS) on provisions that affect cardiovascular care. Among those:

  • Implementation of the controversial Independent Payment Advisory Board, a 15-member Board tasked with developing and presenting proposals to the president and Congress, starting in 2014, to extend the solvency of Medicare, slow cost growth, improve quality of care, and reduce national health expenditures. The College remains concerned by the authority granted to an independent body to determine payment cuts for only physicians, particularly in light of ongoing payment reductions as a result of the Medicare physician payment formula.
  • Implementation of the Physician Payments Sunshine Act requiring that industry disclose payments to physicians and teaching hospitals, both direct and indirect. While the ACC supports the overarching objectives of the Act, the College has raised concerns regarding CMS’s interpretation and proposed implementation of the Act. Final regulations are expected in the coming months so stay tuned!

Outside of the ACA, there remains a lot of hard work before we can arrive at a sustainable health care system that emphasizes value and a strong patient-doctor relationship. In the coming months the College will actively be advocating for overarching payment and medical liability reforms that are critical for comprehensive health reform to be truly effective. In addition, our Advocacy team is focused on several regulatory proposals and legislative efforts that will have major impacts on cardiology. Among them:

  • The 2013 Medicare Physician Fee Schedule (the proposed rule is expected any day);
  • Additional cardiovascular coding changes as a result of continued bundling efforts;
  • The annual battle to repeal/stop the flawed sustainable growth rate (SGR) formula used to calculate Medicare physician payment.

These topics, as well as life after the Supreme Court decision and the 2012 elections, will be the focus of the College’s annual Legislative Conference in Washington, DC, this September. (Registration is now open to all ACC members.)  Additionally, the ACC continues to be engaged with CMS, industry and other stakeholders as appropriate on all of these issues. It’s definitely a time of change for health care in the U.S. However, it’s this change that provides the most prospects for action. I’m excited by the opportunities not only for the College, but for the cardiovascular profession as a whole. Now is the time to leverage our successes over the last six decades in improving cardiovascular care and ensure that future policies and programs further these results. Let us work all together for this ultimate goal.