Grassroots Advocate in the Spotlight: Anita Arnold, DO, FACC

arnold#2 jpeg copyThis post was authored by Anita Arnold, DO, FACC, a member of ACC’s Health Affairs Committee and a grassroots advocate.

I had never thought about meeting with a member of Congress on behalf of the ACC, but when I moved to Florida, Allen Seals, MD, FACC, was the advocacy chair, and he quickly recruited me to the cause. I was under the mistaken impression that congressional members were very much aware of the issues, and would not want to talk with me about them. But as it turns out, if health care is not a priority of theirs, they know very little and are interested in dialoguing with a representative of an important group such as the ACC. Continue reading

The Time is Ripe For a New Dialogue on Capitol Hill

As part of ACC’s 2015 Legislative Conference, more than 400 cardiovascular professionals were on Capitol Hill yesterday meeting with their congressional leaders. For the first time in many years, cardiology had a fresh message to take to Washington. Now that the Sustainable Growth Rate (SGR) is history, it’s time to focus on other issues that threaten the tremendous progress that has been made over the last several decades to reduce cardiovascular disease. Continue reading

BOG and Chapters 101: How to Make the Most of Your ACC Membership

ShorThis post was authored by Robert A. Shor, MD, FACC, chair of ACC’s Board of Governors.

What is the ACC’s Board of Governors (BOG) and why should I care?

It is a privilege to serve as chair of the BOG this year. It is my mission to highlight and emphasize the integral value that ACC Chapters and their leaders provide to cardiovascular professionals across the U.S. and to ensure the goals of ACC’s state chapters also align with the College’s strategic plan. To begin, we must start at the very beginning – what are ACC Chapters? Who leads them? What do these leaders do? Continue reading

ACC Board of Governors Come Together to Move College’s Strategic Vision Forward

I have often said the men and women who make up ACC’s Board of Governors (BOG) are the College’s feet on the ground – meeting the needs of cardiovascular professionals where they live and work. As such, the BOG plays a critical role in the success of ACC programs and tools. This weekend’s BOG meeting underscored the importance of this role as member leaders engaged in discussions around how best to move the College’s strategic vision forward. In particular, leaders addressed shared decision making tools, educational programs and products, involvement in hospital and outpatient-based clinical data registries, increasing member value, top cardiovascular advocacy issues, potential partnerships and more. Continue reading

Prenatal Congenital Defect Diagnosis on the Rise

This post was authored by Gerard R. Martin, MD, FACC, a past chair of the ACC’s Adult Congenital and Pediatric Cardiology Council and senior vice president, Center for Heart, Lung and Kidney Disease, Children’s National Health System.

In the last several years, cardiologists working with obstetricians have made great strides towards increased prenatal diagnosis of critical heart defects, with the proportion of defects diagnosed before birth increasing from 44.9 percent in 2004 to 63.8 percent in 2009, in a Massachusetts statewide population study. This is good news for the nearly 40,000 babies who are born with congenital heart disease every year – but we still have a long ways to go, as diagnosis rates continue to vary greatly between hospital centers and regions of the country. Continue reading

Tackling Imaging Legislation in the Golden State

This post is authored by Norman E. Lepor, MD, FACC, governor-elect of the ACC’s California Chapter.

Legislation that was introduced recently in California has grave implications for how cardiovascular services are delivered not only in the Golden State, but also nationwide if similar sweeping prohibitions are copied by other states. Senate Bill 1215 (S.B. 1215) threatens in-office ancillary exceptions (IOASE) across the House of Medicine, including exceptions for advanced modality  (including PET, CT and MRI) and many other services performed outside cardiology. Continue reading

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.

A “Win” for Cardiology in Kentucky

I have said before that ACC’s Board of Governors (BOG) are the foot soldiers of the College, and with a teamwork-focused BOG, previously insurmountable changes can be more easily attainable. The power of the BOG recently came into play when Kentucky Chapter Governor-Elect Jesse Adams III, MD, FACC, reached out to his BOG colleagues to get their feedback and recommendations about a situation he was encountering at his hospital.

Dr. Adams noted that at one of the large local hospitals, administration decided to implement a policy that only intensivists would be able to write orders in the ICU. Dr. Adams approached the BOG to get their thoughts to see if type of model could be found anywhere else, and if specialist were prohibited to write orders in the ICU, how it would impact the hospital’s adherence with guidelines.

He received feedback and guidance from BOG leaders ranging from concerns about order writing, intensivists as the only primary team in this situation, and concerns about the patient. As Dr. Zoghbi noted, “to deny a cardiologist (and all other specialists in this situation) management of their patients, particularly in most acute medical conditions where they provide the expertise needed is completely unacceptable.”  With this powerful feedback from ACC’s leaders, Dr. Adams then took the conversations to the administration and they rapidly clarified and modified the policy which now allows for optimal collaborative involvement of intensivists and cardiovascular specialists consistent with ACC/AHA guidelines.

As we have seen the landscape of cardiology change drastically over the past few years, situations like these are sure to occur in different forms. It is up to the leaders of the College to stand up and bring our expertise and guidance when something is wrong. By banning together to support one another, this advocacy becomes possible. Kudos to Dr. Adams, Dr. Juan Villafane, and the entire Kentucky Chapter, who not only had a successful chapter meeting last weekend, but also had a minor “win” for cardiology with this example. Job well done!

Racing to Improve Treatment Times

Do our patients know the signs of a heart attack and what to do if someone goes into cardiac arrest? When every minute counts, are we meeting the standards for door to balloon (D2B) times? These are the questions the ACC’s North Carolina Chapter has focused on over the past decade in collaboration with hospital systems throughout the state.

The Regional Approach to Cardiovascular Emergencies (RACE) project was developed in 2003 as a statewide system for providing rapid artery reperfusion for patients with ST-elevation myocardial infarction (STEMI). The RACE system is the largest state-wide STEMI system in the U.S. and incorporates the quality improvement efforts of over 100 hospitals, 700 emergency systems, and thousands of health care professionals working in a coordinated effort in order to improve timely reperfusion.

A recent study published in Circulation authored by NC Chapter Governor James Jollis, MD, FACC, who has been a champion on this issue, and colleagues looked at expanding regional coordination to the entire state of North Carolina. In doing so, rapid diagnosis and treatment of STEMI has become an established standard of care independent of health care setting or geographic location, and has resulted in improvements in timely coronary artery reperfusion.

Without a doubt, teamwork and grassroots efforts were needed to accomplish this streamlined effort. However, patient education and involvement is also a big component of helping to save lives.

The ACC, the NC Chapter and CardioSmart recently headed to Charlotte, NC, home of the NASCAR Hall of Fame, to participate in the Coca-Cola 600. As recently updated CPR guidelines recommend compression-only CPR, representatives from the RACE program were on-site to give CPR demos teaching race car fans about the 5 C’s (check, call, compress, continue, connect) and how to save a life. Cardiac arrest is a prominent issue in North Carolina and will affect an estimated 8,000 North Carolinians this year, of which only 1 in 4 will receive bystander CPR and only 1 percent will have an AED used on them.

In addition to the CPR demos, blood pressure screenings and fact sheets on CPR and heart health were given to thousands of race car fans. Dr. Jollis and Philip Iuliano, MD, FACC, also took the stage during the track walk alongside NASCAR racers and discussed tips for avoiding heart disease, keeping active and living a healthy lifestyle. CardioSmart’s partnership with Coca-Cola has given the College numerous opportunities to increase awareness of heart health and get out into the community.

I am encouraged by state-wide efforts such as the North Carolina RACE program that focus on coordinating and improving treatment times. It goes to show that by working together through quality improvement programs and initiatives we really can make a difference.

Back to the Basics: FOCUS in Delaware

This post was authored by John Shuck, MD, FACC, governor of the Delaware Chapter of the ACC.

Over the past few years the issue of appropriate use and radiology benefit managers (RBMs) has been a “hot topic,” particularly in Delaware. Recently, the misuse of RBM’s in denying cardiac stress imaging within the state came to national attention.  A Delaware patient was denied a cardiac stress test by an RBM used by a major health plan in Delaware. The patient was ultimately admitted to the hospital emergently for a catheterization and a lifesaving CABG was performed.  This patient’s plight became well-publicized and sparked investigations by the U.S. Senate Commerce Committee and Delaware Insurance Commissioner as to why the test was denied.

Thanks to the efforts of many at the ACC national and state level, this past fall the Delaware Insurance Commissioner announced that the health plan will support use of the ACC’s FOCUS: Cardiovascular Imaging Strategies tool by Delaware cardiologists to make decisions about certain diagnostic imaging tests, as an alternative to RBMs. Unlike RBMs, the FOCUS tool engages providers in ongoing feedback reports and quality improvement activities. At the same time it reduces third-party costs to physicians and health plans (read more about FOCUS in a blog post here).

In January 2012 the FOCUS health plan product went live incorporating many of the same elements present in the FOCUS performance improvement module. Under the agreement, the health plan will pay for cardiologists in the state to use the online tool, which allows for consistent application of appropriate use criteria to determine when cardiovascular imaging tests are needed. Importantly, the program also provides feedback reports on the patterns of appropriate use to physician practices and health plans. FOCUS participants then use the reports to complete action plans and share best practices.

This model for managing medical costs by focusing on patient-centered decision making and quality care will hopefully be implemented by other insurers and within other states when it comes to ensuring appropriate use of medical imaging. I’m happy to see our efforts to implement this program in Delaware have not gone unnoticed as several other ACC chapters are currently in talks with health plans to implement this program at the state level.

For more information about Imaging in FOCUS, visit CardioSource.org/FOCUS. This post is from a special AUC series on the blog focusing on the “basics” of what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available. Click here to read more.