Health Care Today

Weaknesses of Current System

• Problematic hand-offs• Poor adherence• Unsystematic chronic disease

management• Significant variation and inefficiency• Persistent disparities• Poor population-based progress

Source: Congressional Budget Office

Physician Reimbursement Losing Ground to Inflation, Costs

“We in America do not have government by the majority. We have government by the majority who participate”

Thomas Jefferson, 1787

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.

The ACC’s Goal:

ACC Action Plans for Reform

1. Test payment models that reward quality; stop arbitrary payment cuts

2. Reduce disparities and geographic variations in care

3. Reduce CV hospital re-admission rates (H2H Initiative)

4. Facilitate appropriate imaging (AUC/decision support at point of care)

5. Seek opportunities to promote tort reform

• 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

Quality First in Action

We have the tools now!

• ACC/AHA Clinical Guidelines• Performance Measures• Appropriate Use Criteria

– SPECT MPI (Updated in 2009)– CCT and CMR– Stress Echocardiography– TTE/TEE– Coronary Revascularization

Number of sites and patient records

1998….. 2004 2005 2006 2007 2008 beyond

CathPCICathPCIRegistryRegistry

1132, 8.6M1132, 8.6M

ICDICDRegistryRegistry

1445, >120K1445, >120K

CARECARERegistryRegistry166, >9K166, >9K

ACTION-GWTGACTION-GWTGRegistryRegistry

445, >120K445, >120K

IC3-OfficeIC3-Office600, >15K600, >15K

ImagingRegistry

HFRegistry

PADRegistry

EPRegistry

IMPACTRegistry

ICD LongICD Long

NCDR:

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%

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

• 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

Physician Payment

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

Now is the Time to Fight!

Ways to Get Involved With Congress

• Grassroots: www.acc.org/can(Includes ACC’s toll-free grassroots hotline, patient materials, sample letters, and more)

• ACC PAC: www.accpacweb.org• ACC 2009 Legislative Conference:

Sept. 13-15, Washington, DC

Member Resources

• Patient Materials: www.acc.org/Chapters

• Health IT Resources: www.acc.org/healthit

• Lewin Report Online Forum lewinreport.acc.org

American College of Cardiologyhttp://qualityfirst.acc.org