Science to Practice: The ACC Tapestry The Quality Colloquium August 21, 2006 Janet S Wright MD FACC

ACC Mission To advocate for quality cardiovascular care — through education, research promotion, development and application of standards and guidelines — and to influence health care policy. To advocate for quality cardiovascular care — through education, research promotion, development and application of standards and guidelines — and to influence health care policy.

ACC Goals ACC Goals  Recognized leader in cardiovascular science, knowledge & best practices  Accelerate application of science, knowledge & measurement into practice  Build partnerships to improve the delivery of high quality cardiovascular care

The Venn of ACC Quality AdvocacyEducation Science

Start with the Science Practice Guidelines (1984) Practice Guidelines (1984) Expert Consensus Documents Expert Consensus Documents Competence and Training Statements Competence and Training Statements Clinical Data Standards Clinical Data Standards Clinical Performance Measures Clinical Performance Measures Appropriateness Criteria Appropriateness Criteria

Accelerate Application  Guideline tools-PDA, EHR  Self Assessment Programs  Focus on outcomes: ACC-NCDR® GAP Medical Directors’ Institute Appropriateness Criteria

ACC-NCDR Comprehensive CV data repository Diagnostic Caths/Coronary InterventionsDiagnostic Caths/Coronary Interventions > 700 labs and > 2.5 million patient records > 700 labs and > 2.5 million patient records Implantable Cardioverter DefibrillatorsImplantable Cardioverter Defibrillators Official database for CMS Official database for CMS Carotid InterventionsCarotid Interventions Meets CMS requirements for data collection Meets CMS requirements for data collection

Leading provider of services to improve the quality of CV care through Data collection Data collection Analysis and reporting and by Analysis and reporting and by Providing educational & research activities Providing educational & research activities National CV Data Registry

Participation Growth

ACC-NCDR Services Quarterly and Annual Reports Quarterly and Annual Reports Annual User group Meeting Annual User group Meeting Participant Support Line staffed by Clinical/Technical experts Participant Support Line staffed by Clinical/Technical experts

Science and Quality Meet Guidelines Applied in Practice or GAP Guidelines Applied in Practice or GAP Acute MI in Michigan: 1=> 5=> 33 hospitalsAcute MI in Michigan: 1=> 5=> 33 hospitals Heart Failure in OregonHeart Failure in Oregon Stable Angina in AlabamaStable Angina in Alabama National Door to Balloon (D2B) InitiativeNational Door to Balloon (D2B) Initiative Highlight team-care, care coordination, data collection and utilization to improve outcomesHighlight team-care, care coordination, data collection and utilization to improve outcomes

MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess

MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork

MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork Health plans & cardiologists at odds Health plans & cardiologists at odds

MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork Health plans & cardiologists at odds Health plans & cardiologists at odds “Let’s put on a show!” “Let’s put on a show!”

The MDI is a national, action- oriented community committed to solving mutual problems on a local level.

MDI Objectives Build relationships among cardiovascular specialists, payers, and purchasers Build relationships among cardiovascular specialists, payers, and purchasers Identify opportunities for collaborative solutions Identify opportunities for collaborative solutions Execute plans of action on national and local levels to improve healthcare. Execute plans of action on national and local levels to improve healthcare.

MDI-The Early Years 2002: forum to identify mutual problems 2002: forum to identify mutual problems 2003: 2003: Utilization of ImagingUtilization of Imaging Disease ManagementDisease Management Measuring & Paying for QualityMeasuring & Paying for Quality

MDI 2004 Information Technology and EMRs Information Technology and EMRs Who pays? Who benefits? What works?Who pays? Who benefits? What works? Employers & Purchasers are KEY partners Employers & Purchasers are KEY partners Crisis in Imaging Use and Cost Crisis in Imaging Use and Cost Advise us now or live with our remedies!Advise us now or live with our remedies! Go NuclearGo Nuclear

MDI 2005 Principles for Pay for Performance Principles for Pay for Performance Ambulatory Performance Measures Ambulatory Performance Measures Collaborative effort with PCPI; NQF endorsedCollaborative effort with PCPI; NQF endorsed Staged implementationStaged implementation Appropriateness Criteria (AC) for Nuclear Imaging Appropriateness Criteria (AC) for Nuclear Imaging

What are Appropriateness Criteria? Evidence-based, clinical judgment- informed guidance to help physicians select Right test or procedure Right test or procedure Right Patient Right Patient Right Time Right Time

Why Appropriateness Now ? Explosive growth of CV imaging Explosive growth of CV imaging Substantial regional variation Substantial regional variation True nature of utilization unknown True nature of utilization unknown New technology on the horizon New technology on the horizon Clinicians, patients, payers, purchasers all seeking guidance Clinicians, patients, payers, purchasers all seeking guidance

MDI 2005 Directives CMS is key partner CMS is key partner Formalize MDI Governance Formalize MDI Governance Provide input into design of CV COEs Provide input into design of CV COEs Participate in AQA work Participate in AQA work AC for CT/MR, Echo AC for CT/MR, Echo Ambulatory Registry for CV Disease Ambulatory Registry for CV Disease

MDI Pilots in Progress Clinical vs Administrative Data Clinical vs Administrative Data Physician Recognition Program Physician Recognition Program Ambulatory Discharge Contract in EMR Ambulatory Discharge Contract in EMR Medicare Health Support Programs Medicare Health Support Programs Aetna in Chicago metropolitan areaAetna in Chicago metropolitan area American Healthways in Maryland/DCAmerican Healthways in Maryland/DC Health Dialog in PennsylvaniaHealth Dialog in Pennsylvania

MDI 2006 Systematic Appropriateness Coordinate care with primary physicians Coordinate care with primary physicians Design a coverage policy to drive AC Design a coverage policy to drive AC Identify the tools and systems to capture, measure, and report adherence Identify the tools and systems to capture, measure, and report adherence Establish the benefits of AC adherence Establish the benefits of AC adherence Educate consumers about AC-driven care Educate consumers about AC-driven care

Implementing Appropriateness Criteria ACC Payers How can practices use AC to improve care? What resources do practices need to apply AC? How can HPs use AC? What impact can AC have on cost and quality? All patients receive EBM Physicians deliver EBM efficiently Payers buy quality Here are the data! 45% of patients are receiving EBM Physicians want to provide EBM Payers want to buy quality Show me the data!

Key Lessons Learned Science => practice takes > a village Science => practice takes > a village Focus on quality Focus on quality OVER-communicate OVER-communicate Build on successes, learn from failures Build on successes, learn from failures Data + incentive => change Data + incentive => change