1. ACC Board of Governors Meeting September 2010 Jim Fasules, MD FACC SVP Advocacy The American College of Cardiology Health Reform et al: Where we are now

2. Healthcare Reform: Hollywood on the Potomac

3. Reform Started with ARRA $1.1B for CER (PCOR) $36B for HIT Meaningful use $44,000 - $66,000 for MDs Misinformation – “death panels”

4. ACC Principles for Reform 1.Provides universal coverage; +++ 2.Provides coverage through an expansion of both public and private (pluralistic) programs; +++ 3. Focuses on patient value — transparent, high quality, cost-effective, continuous care; + 4. Emphasizes professionalism, the foundation of an effective partnership with empowered patients; 5. Ensures coordination across sources and sites of care; + 6. Includes payment reforms that reward quality and ensure value. ?

5. Healthcare Reform: Role of Cardiology Avoid spin and disinformation “Lies, damn lies, statistics” Disraeli “Lies, damn lies, and extreme partisan rhetoric” Fasules “Don’t trust, verify” after Reagan

6. Other BIG issues we face…

7. “Reform 2010”: the Rule and the RUC SPECT MPI cut 36% after ECHO cuts and lower PE

8. The “Rule” – Where are we now?

10. Cliff Happened!!!!

11. RBM Onslaught on “self-referral”

12. Critical Issues Lie Ahead ACOs and Payment Reform Public Reporting Maintenance of Certification Primary Care - PCMH? Physician Employment

13. ACC Advocacy: Creating Change “We in America do not have government by the majority. We have government by the majority who participate” Thomas Jefferson, 1787

15. ACC Board of Governors Meeting September 2010 Jack Lewin, M.D., CEO The American College of Cardiology Health Reform: What Lies Ahead

16. A crack in the crystal ball

17. Controlling the future?

18. The Bullish Forces

19. PPACA The beginning or result of health reform?

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

21. The pressure for integration and consolidation Physicians, hospitals and insurers ACOs Vertical vs. horizontal integration

22. The pressure for physician employment AMA estimates ACC estimates Impacts on professional societies Vertical vs. horizontal integration

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

24. The pressure for delivery system reform EHRs and Meaningful Use Care coordination Prevention and chronic disease management H2H, etc.

25. 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 CPIP/CPR

26. The pressure to improve population health

27. Risks and Opportunities

28. Causes for Cautious Optimism

29. PINNACLE and NCDR FOCUS and AUC CPIP/CPR ACC Science, Education, LLL, POC Innovation

30. Uniting a fragmented profession