2. 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.

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

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

5. 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.

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

7. “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

8. 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.

9. 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

10. 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

11. We have the tools now!

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

13. 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… beyond 13

14. 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%

15. 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

16. 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.

17. 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

18. 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.

19. Ways to Get Involved With Congress
Grassroots:
(Includes ACC’s toll-free grassroots hotline, patient materials, sample letters, and more)
ACC PAC:
ACC 2009 Legislative Conference: Sept , 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.

20. Member Resources Patient Materials: www.acc.org/Chapters
Health IT Resources:
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.

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