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Advocacy Update
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• Current environment is not sustainable– 47 million uninsured– Millions underinsured– More than 16% of economy spent on
health care– Varied health care quality and outcomes
Health Care Reform
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Health Care Reform
• Delivery System Reform buzz words: – Accountable care organizations– Medical home– Bundling– Hospital readmissions– Value based purchasing– Gainsharing or shared savings
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Health Care Reform
• There is no silver bullet to fix the problems with the U.S. health care system
• The cardiovascular community needs to be at the table, not on the menu
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ACC Quality First
• Health Reform Summit 2008 and 2009
• “Blueprint for Reform”
• Principles
• Action Plans
• Website: qualityfirst.acc.org
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ACC Principles for Reform
1. Provides universal coverage2. Provides coverage through an expansion
of public and private programs3. Focuses on patient value (transparent,
high quality, cost-effective, continuous care)
4. Emphasizes professionalism5. Ensures coordination across sources
and sites of care6. Includes payment reforms that reward
quality and ensure value
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ACC Action Plans for Reform
1. Reduce CV hospital readmission rates
2. Increase appropriate imaging
decision support at point of care
3. Reduce geographic variations in care
4. Test payment models that reward quality
5. Increase adherence to guidelines
6. Make quality operational
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ACC Action Plans for Reform
7. Partner on patient-centered medical home models
8. Increase primary and secondary prevention through medication adherence and lifestyle
9. Ensure transparency
10. Empower patients
11. Ensure professional competence
12. Seek opportunities to promote tort reform
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• 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 and waste
Quality First Network
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Hospital to Home
• ACC and Institute for Healthcare Improvement (IHI) quality improvement initiative
• Goal: “excellence in transitions”
• Reduce 30-day hospital readmission rates for HF or AMI by 20%
• For more info: www.acc.org/h2h/enrollment
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Physician Payment
• MIPPA provided 1.1% payment increase for 2009 in place of cuts; no long term solution to flawed SGR formula
• Physicians face 21.5% Medicare pay cut on Jan. 1, 2010; 40% in cuts in next decade
• Congressional action necessary to stop cuts and replace flawed formula
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Physician Payment
•Congress intervened since 2003
•Bipartisan consensus that formula needs to be replaced
•Long term reform held up by increasing cost and lack of consensus
•Action expected as part of health reform bills in June/July
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Physician Payment
• 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
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Imaging
•MIPPA requires accreditation of providers for MRI, CT, and nuclear medicine/PET by Jan. 1, 2012
•MIPPA establishes 2-year, demonstration program to test appropriate use criteria by Jan. 1, 2010
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Imaging
• HHS to designate accrediting bodies by end of 2009; IAC, ACR should be named
• CMS will announce appropriateness pilot in next few months
• Stay tuned for more information from ACC
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Imaging
• Imaging under attack again– GAO Report– CBO Report– Baucus White Paper– Obama budget blueprint
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Imaging
• RBM Threat:– Obama budget and CBO report include use
of RBMs to ensure “appropriate imaging payments” for advanced imaging
– Budget savings estimate: $300 million
– CBO savings estimate: $1.9 billion
– Under discussion on Capitol Hill
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Imaging
• Self Referral Scrutiny:– Baucus White Paper– MedPAC discussing whether physician
ownership of imaging equipment influences use of imaging
– Found that physicians who owned equipment had 5-104% higher spending on imaging than those that did not
– June report will include self referral chapter
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Imaging
• New data– Since 2005, rate of imaging growth slowing– 2006-2007, imaging spending dropped 13%
• UHC/ACC pilot– Results of SPECT-MPI appropriateness
criteria pilot released at ACC.09– One practice reduced inappropriate tests from
22% to 13% through feedback and education
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Imaging
• ACC advocates for responsible approach to imaging, continued emphasis on improving quality with health plans and state and federal policymakers
• Development and implementation of appropriate use criteria offers alternative to prior authorization/pre-certification
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PQRI
• MIPPA increased PQRI incentive to 2% for 2009 and 2010
• Problems with 2007 feedback reports and payment
• ACC/CMS Mar 18 Open Door Forum for cardiovascular professionals
• Resources: http://www.acc.org or http://www.cms.hhs.gov/PQRI
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HIT
• MIPPA e-Rx incentives: 2009-2011
• ARRA HIT incentives: 2011-2015
• ACC Resources: www.acc.org/healthIT
• E-Rx Initiative: CMS e-Rx program info, minimum functional criteria
• EHR Toolkit: ARRA FAQs, helpful hints, contract negotiation advice, selection tools, educational resources
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Specialty Hospitals
• ACC continues to be active on physician ownership issues
• Fought several attempts to attach specialty hospital language to legislation in 2008 and 2009
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Physician Resource Reports
• MIPPA authorized Medicare confidential physician resource use reports
• CMS sent test reports to some physicians in early 2009
• Contact ACC with feedback if your practice is involved in the test
• Nationwide distribution in late 2009
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ACE Demo
• Medicare Acute Care Episode (ACE) Demo
started this year
• Bundled payments for select cardiovascular
inpatient procedures
• Goals: improve quality; produce savings for
providers, beneficiaries, and Medicare; improve
price and quality transparency; and increase
collaboration among providers
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Get Involved
• Get involved in ACC Advocacy
• Grassroots: www.acc.org/can
• PAC: www.accpacweb.org
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Contact ACC
• ACC Website: www.acc.org
• ACC Phone Number: 800-253-4636