Health Care Today Health Care today might be symbolized by this picture. We are in the midst of a storm and surrounded by sharks, but if you look carefully there’s hope in the form of a ship in the background.

Weaknesses of Current System Problematic hand-offs Poor adherence Unsystematic chronic disease management Significant variation and inefficiency Persistent disparities Poor population-based progress

Spending on health care makes up huge portion of GDP and only increasing. Source: Congressional Budget Office

Physician Reimbursement Losing Ground to Inflation, Costs Meanwhile, physician payment continues to decline making it difficult to support a practice and staff, let alone provide patients with access to the right care at the right time.

This is what we all might feel like doing these days. But …

“We in America do not have government by the majority “We in America do not have government by the majority. We have government by the majority who participate” Thomas Jefferson, 1787

The ACC’s Goal: To stop arbitrary payment cuts and proactively pursue a new standard for health care reform that is centered on patient value and access to quality care.

ACC Action Plans for Reform Test payment models that reward quality; stop arbitrary payment cuts Reduce disparities and geographic variations in care Reduce CV hospital re-admission rates (H2H Initiative) Facilitate appropriate imaging (AUC/decision support at point of care) Seek opportunities to promote tort reform

Quality First in Action Share best practices Learn and teach Deploy QI initiatives based on practice needs Implement Appropriate Use Criteria Use interoperable electronic systems to: exchange data deliver decision support reduce errors

We have the tools now!

ACC/AHA Clinical Guidelines Performance Measures Appropriate Use Criteria SPECT MPI (Updated in 2009) CCT and CMR Stress Echocardiography TTE/TEE Coronary Revascularization

NCDR: Number of sites and patient records Imaging Registry ICD Long EP Registry IMPACT Registry IC3-Office 600, >15K PAD Registry ACTION-GWTG Registry 445, >120K Registries can drive quality and define targets for quality improvement. HF Registry CathPCI Registry 1132, 8.6M CARE Registry 166, >9K ICD Registry 1445, >120K 1998….. 2004 2005 2006 2007 2008 beyond 13

Challenges to Reform Crowded arena Short timeline and no “real” meat on reform bills Tendency to focus solely on cutting costs CMS proposal to cut Medicare payments for CV services by as much as 40%

Physician Payment: Fixing the SGR Congress intervened since 2003 to stop SGR cuts; action necessary again to stop latest cuts and replace flawed formula Bipartisan consensus that formula needs to be replaced Long-term reform held up by increasing cost and lack of consensus

Physician Payment Proposed Medicare 2010 Physician Fee Schedule Overall 11% decrease in Medicare payments for cardiology services. Reimbursement for almost all cardiovascular services would see cuts ranging from 10% - 40%. Practice expense survey data used by CMS to determine cuts were not reviewed or validated. CMS used responses from only 55 practices This rule underscores the need for payment reform. Without it, practices will not be able to improve quality of care or incorporate delivery system reforms! We are hearing that many practices will be forced to lay off staff, limit Medicare patients or close down all together.

Physician Payment: Message to Congress Stop proposed CMS cuts! Replace flawed formula with more sustainable system that reflects increases in practice costs and accounts for appropriate growth in services Test models that seek to reduce variations in spending and ensure patients receive evidence-based care

Now is the Time to Fight! If there was ever a time to get involved this is it! All ACC members must get involved. Protect yourself, your practice, your staff and your patients.

Ways to Get Involved With Congress Grassroots: www.acc.org/can (Includes ACC’s toll-free grassroots hotline, patient materials, sample letters, and more) ACC PAC: www.accpacweb.org ACC 2009 Legislative Conference: Sept. 13-15, Washington, DC Grassroots: Congress needs to hear from the entire cardiovascular community on the impacts of the proposed cuts on their practices. Lawmakers also need to hear about the impacts of these cuts on reform efforts. PAC: If you’ve never contributed to the PAC, now is the time to do so. The PAC opens doors to key members of Congress and their staff and helps us make sure the cardiovascular voice is heard.

Member Resources Patient Materials: www.acc.org/Chapters Health IT Resources: www.acc.org/healthit Lewin Report Online Forum lewinreport.acc.org Patient Materials: Patient materials on payment reform are available for download at the Chapters Web site and on the Chapter Affairs Extranet. They include a sample letter for patients, talking points and posters or fliers for your office.

American College of Cardiology http://qualityfirst.acc.org