1. Physician Accountabilities in Health System Reform:
A View from the ACC
Jack Lewin, M.D., CEO The American College of Cardiology

2. Jack Lewin MD
I have no disclosures to note.

4. "It's tough to make predictions, especially about the future.“
~Yogi Berra

5. “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” ~ Charles Darwin

8. “You can lead a man to Congress, but you can’t make him think!”
~ Milton Berle

9. ACC Health Reform Priorities
Universal Access
Public and private system
Quality (value) definition, measurement
Coordination of care systems
Payment reform evolution
Professionalism

10. The Bullish Forces

11. ACA The beginning or result of health reform?

13. Percent of median family income required to purchase family health insurance
Source: Author’s calculations, using KFF and AHRQ premium data, CPS income data, plus projections from Carpenter and Axeen, The Cost of
Doing Nothing, 2008. 13

14. Medicare is unsustainable now (percent of GDP, projected)
Source: Medicare Trustees Report:, 2009. 14

15. The pressure for cost containment and fair competition in a global economy

16. The pressure for integration and consolidation
Physicians, hospitals and insurers
ACOs
Employer and consumer groups
Vertical vs. horizontal integration

17. The pressure for physician employment
AMA, ACC estimates
Lifestyle preferences of young physicians
Vertical vs. horizontal integration

18. Changing Cardiology Practice Landscape
14%
The majority of private CV practices (excluding solo practitioners) – 60% – have engaged in integration/merger activity. CV practices are more likely to integrate into a hospital setting than merge with another practice (38% vs. 14%).
The ACC’s 2010 Practice Census was conducted from May 5 through August 9 by and telephone. A total of 2,413 unique practices from 49 states and Puerto Rico participated in the study. The response rate was 31 percent.

19. The pressure to move away from fee-for-service reimbursement
Payment reforms
PCMH (patient centered medical home)
HOPPS
Government strategy

20. The pressure for delivery system reform
EHRs and Meaningful Use
Team care
PCMH vs. minute clinics
Specialty hospitals
Prevention and disease management
Care coordination, H2H, etc.

21. The pressure to measure and report on quality improvement
Public reporting expectations
Who measures Q in payment reform?
Claims vs. clinical data
The importance of registries
Measurement at the point of care

22. The pressure to create patient financial incentives related to health care costs
Employer actions
Government actions
Co-pay incentives
Preferred networks, Centers of Excellence and CV Practice Improvement Program (CPIP)

23. The pressure to improve population health

24. ACC 2011 Top Advocacy Priorities
Feedback from CCO, Leadership Forum and BOG

25. Likely 2011 Top Priorities ACA and HSR issues Payment reform issues
Private practice protections
State advocacy issues
Innovation and science
Meaningful use and HIT
Public reporting

26. The Most Important? Payment reform Tort reform
The ongoing nuts and bolts: SGR, RUC, CMS regulations, insurers, state legislatures

27. Other Key Issues Reducing disparities (and expanding access)
Public reporting (& clinical data vs.claims data)
Medicaid reform issues (especially peds cardiology)
Workforce and changing demographics and generational influences
Team practice and delivery system models
Public health and prevention
Technology and ability to share social tools
Monitoring self referral protections under Stark, including CV hospital employed contract issues

28. ACA Clean Up Priorities
Payment Reform and ACOs
Anti-trust relief
Value-based reimbursement
Level playing field?
Physician regulation and the IPAC (HR 452)
Major risk for physicians – hospitals, too?
Tort reform (Gingrey)
Medicare/Medicaid reimbursement issues
HOPPS assault?

29. ACA Opportunities CMS innovation center grants -- $10 billion
Workforce transitions
Graduate medical education issues
PCORI

30. Accountable Care Organizations
ACOs
What are they?
Who governs them?
Will payment incentives be real?
A unified policy position for medicine?
Hospital and physician alignment

31. Risks and Opportunities

32. Accountabilities

33. Uniting a fragmented profession

34. Train wreck at Montparnasse Station, Paris, 1895. Studio Lévy & fils.

36. Who will save us?