ACC Advocacy seeks to advance the College’s mission through interactions with Congress, federal government agencies, state legislative and regulatory bodies, private insurers and other policy making groups.   

The ACC is actively working with Congress and other key stakeholders to develop a health care system that: A Puts patients first Rewards cardiovascular professionals for their commitment to quality, evidence-based care B

Through its Advocacy efforts, is… the The ACC is… Developing a Quality Driven Health Care System Ensuring Provider Stability Securing the Future of CV Medicine Addressing Population Health

2015 Advocacy Priorities The ACC is… Developing a Quality Driven Health Care System Ensuring Provider Stability Securing the Future of CV Medicine Addressing Population Health

Creating a Value-Driven Health Care System Key 2015 Priorities Ongoing implementation of Medicare quality incentive programs Educate ACC members on value-based payment environment Facilitate chapter involvement in state/local payment model activity Implement ACC-preferred cost and quality measures for CV care Develop specialty payment models Improve the U.S. health care system by improving the experience of care, enhancing the health of populations, and reducing the costs of health care. Advocate for cardiovascular care interests in development of alternative payment models.

Ensuring Access to Care and CV Practice Stability Key 2015 Priorities Permanent SGR repeal Site of service payment differential GME funding and CV workforce support Protection of IOASE at state and federal level Appropriate payer policies for use of CV services Medical liability reform Narrow networks Advocate for patient access to a comprehensive array of services at the hospital or in the office, adequate resources for practices to support patient care, and reduced administrative burdens.

Promoting Use of Clinical Data to Improve Care Key 2015 Priorities Implementation of AUC mandate Federal legislative initiatives to support use of registries Ongoing implementation of QCDR program EHR Incentive Program Stage 3; EHR standards and certification Access to claims data Advocate for the use of clinical data registries for quality improvement and research, recognition of clinical practice guidelines and appropriate use criteria, and improvements in health information technology.

Fostering Research and Innovation in CV Care Key 2015 Priorities Drug safety Drug and device approval 21st Century Cures Initiative Informed consent Post-market surveillance Advocate for the adoption and tracking of new drugs and medical devices, funding for clinical research, improvements to the clinical research infrastructure, and access to new technology.

Improving Population Health and Preventing CVD Key 2015 Priorities Appropriations for public health and prevention activities Initiatives to reduce and regulate tobacco use and products Chronic disease management and prevention Support for CHD; Implementation of pulse ox screening for CCHD State initiatives for prevention of sudden cardiac death Advocate for policies that address risk factors for cardiovascular disease, reduce the global burden of cardiovascular disease, decrease disparities in care and outcomes, improve access to care for special need populations, and support ACC members in their increased accountability for the health of populations.

Connect With Congress ACCPAC Legislative Conference (Oct. 18 – 20, 2015) Legislator Practice Visits Grassroots Network ACCPAC Increases political power and reach of the College Supports federal candidates who back CV-friendly legislation/policies Legislative Conference Annual conference to educate CV professionals about issues facing cardiovascular providers and ensure the voice of Cardiology is heard on the Hill. Legislator Practice Visits Opportunity for federal and state government officials to witness first-hand how the cardiac care team provides patients with quality, cost-efficient care by employing state of the art technology, health care data and professional training through a team approach. ACC staff can help you every step of the way. To set up a practice visit, contact Elizabeth Shaw at eshaw@acc.org Grassroots Network: ACC Advocacy Action Mobile App This tool allows ACC members to engage with lawmakers and influence health policy during Legislative Conference and throughout the year. The app is available on iTunes (iPhone, iPad) and Google Play (Android devices). Grassroots Alert System Ensure your voice is heard by using the ACC's Grassroots Alert System to contact your lawmakers.

Connect With State Lawmakers Chapter advocacy activities Legislator practice visits Lobby days at the state house Grassroots network

Fuels ACC’s Advocacy Efforts Increases Political Power and College Reach Supports Federal Candidates Who Back CV-Friendly Legislation/Policies Ranks Among Top 10 Medical Specialty PACs Through the generous support of its members, ACC Political Action Committee (ACCPAC) has established itself as the leading voice of the cardiovascular community on Capitol Hill and has built the relationships necessary to deliver cardiology’s message directly to lawmakers.

Shaping Health Policy to Meet the ACC Advocacy in Action Shaping Health Policy to Meet the Triple Aim Better Health Better Outcomes Lower Cost

Current Advocacy Successes 1 SGR Reform Bill Includes AUC Mandate Record Number of ACC Members Connect With Congress ACCPAC Leads CV Political Action Committees 2 SGR Reform Bill Includes AUC Mandate In conjunction with most of organized medicine, the ACC pushed for permanent Sustainable Growth Rate (SGR) repeal, working with key congressional committees to produce a bipartisan, bicameral SGR repeal bill. While Congress failed to agree on budget offsets for final passage of the bill, a one year patch was passed to avert a 24 percent cut to Medicare payments without any onerous provisions. The patch will expire on March 31, 2015, and the ACC continues to advocate for permanent payment reforms that will provide stability and facilitate the delivery of high quality, cost-efficient care. The Protecting Access to Medicare Act of 2014, which delayed payment cuts associated with the SGR, also requires consultation with appropriate use criteria (AUC) and clinical decision support for advanced diagnostic imaging, beginning in 2017. The ACC is working with the Centers for Medicare and Medicaid Services (CMS) on a regulatory framework and will be engaged every step of the way to ensure that the use of AUC in Medicare works to improve patient care and creates the minimum possible burden for physicians. Record Number of ACC Members Connect With Congress Nearly 400 cardiovascular professionals gathered in Washington, DC, for ACC's 2014 Legislative Conference, which centered on the many ways the ACC is leading the transformation of care. During nearly 300 congressional meetings, ACC members urged Congress to work with the ACC to develop a quality driven health care system, ensure practice stability and secure the future of cardiovascular care. For the first time, conference attendees were able to connect with Congress on the go using the new ACC Advocacy Action mobile app. ACC members can now use their smartphones and tablets to communicate with lawmakers throughout the year using ACC's grassroots alert system. This will empower ACC members to engage in advocacy and strengthen ACC’s burgeoning grassroots efforts, which have already facilitated 56 practice visits by members of Congress to date. On the state level, ACC chapter members in four states teamed with patients to meet with lawmakers and before legislative committees, and four state Lobby Days were instrumental in advancing legislation. The ACC has helped craft policy for Certificate of Need/percutaneous coronary intervention oversight in seven states, critical congenital heart defects (CCHD) screening in three states and cardiopulmonary resuscitation in four states. ACCPAC Leads CV Political Action Committees ACC’s Advocacy efforts are fueled by the ACC Political Action Committee (ACCPAC), which increases the political power and reach of the College by engaging ACC members in support of federal candidates who back legislation and policies that facilitate the delivery of the highest quality cardiovascular care. ACCPAC, which is pushing hard to surpass $1 million in contributions for the 2013-2014 cycle, is the number one cardiovascular PAC and ranks among the top 10 medical specialty PACs in the U.S. 3

Current Advocacy Successes 4 Patient Access to Imaging Protected Coding and Coverage Wins SMARTCare Lands CMMI Grant 5 Patient Access to Imaging Protected A California Senate bill which sought to remove the in-office ancillary exception for advanced modality imaging and many other services performed outside cardiology was successfully defeated, thanks in part to grassroots efforts by the ACC’s California Chapter. California’s defeat of the bill means that other states do not have the legislative precedent or political momentum to justify similar proposals. Coding and Coverage Wins In collaboration with other societies, the ACC successfully requested that CMS create national coverage for transcatheter mitral valve repair (TMVR). The ACC was pleased that CMS responded positively to comments recommending deletion of its proposal to require joint intraoperative participation by both an interventional cardiologist and cardiac surgeon. The ACC also worked with other stakeholders to request an expansion of national Medicare coverage of cardiac rehabilitation. Those services are now covered for chronic heart failure patients. To report TMVR and other services, the ACC Coding Task Force successfully presented proposals, along with several societies, to create codes for TMVR, subcutaneous implantable cardioverter defibrillators, extracorporeal membrane oxygenation, and a new code to report transesophageal echocardiography guidance during transcatheter interventions like TMVR. SMARTCare Lands CMMI Grant  The Center for Medicare and Medicaid Innovation awarded a $15.8 million grant to support SMARTCare pilot projects designed by the ACC’s Florida and Wisconsin Chapters. The innovative pilots aim to reduce health care costs by providing tools to help doctors and patients communicate about options for their care while helping physicians apply the latest guidelines to the decision-making process.   6

Current Advocacy Successes 7 ACC President Provides Expertise to Congressional Committee Tobacco Tackled at the Federal and State Level Pulse ox Legislation Advances in the States 8 ACC President Provides Expertise to Congressional Committee   ACC President Patrick T. O'Gara, MD, FACC, shared his perspective on personalized medicine with the House Energy and Commerce Committee as part of the 21st Century Cures initiative, a series of hearings and stakeholder roundtables intended to promote the discovery, development and delivery of new cures and therapies. The 21st Century Cures initiative is expected to culminate in a legislative package in early 2015.   Tobacco Tackled at the Federal and State Level   The ACC, a number of ACC Chapters and partners such as the Campaign for Tobacco Free Kids submitted letters calling for the Food and Drug Administration to extend its regulatory authority to cover electronic cigarettes and additional tobacco products. Additionally, the ACC and its chapters are actively advocating for smoke-free policies in the states. Pulse ox Legislation Advances in the States Significant strides have been made on the state level for advancing legislation for CCHD screening. To date, 41 states have CCHD screening regulations in place and two others are working on regulations. 9

Current Advocacy Successes 10 Greater Flexibility for EHR Incentive Program Reporting Facilitating Alternative Payment Model Participation Cost and Resource Use Measures for Cardiovascular Conditions 11 Greater Flexibility for EHR Incentive Program Reporting In response to comments from the ACC and other health care organizations, CMS issued a final rule allowing health care providers more flexibility in how they use certified electronic health record technology to meet meaningful use requirements under the Electronic Health Record Incentive Program reporting period for 2014. The rule also extended Meaningful Use Stage 2 through 2016 for certain providers and announced the Stage 3 timeline. Facilitating Alternative Payment Model Participation The ACC is conducting ongoing surveillance of alternative payment model activity and outcomes as well as ACC member understanding of and involvement in alternative payment models. In a quest to facilitate member participation in alternative payment models, ACC members are able to seamlessly take part in federal quality reporting programs, including the Physician Quality Reporting System, by participating in the PINNACLE Registry. For the 2013 Program Year, the PINNACLE Registry submitted data on behalf of 1,236 providers across 96 practices. Cost and Resource Use Measures for Cardiovascular Conditions The ACC opposed the National Quality Forum’s (NQF) recommendations on Cost and Resource Use Measures for Cardiovascular Conditions for use in federal payment programs due to risk adjustment and attribution concerns. The NQF Consensus Standards and Approval Committee is considering approval of the measures despite the lack of NQF member consensus. The ACC will develop a response to any decision made to endorse any of the measures. 12

Thank you so much for your time today.   Please let me know if you have any questions about the ACC!