Health Care Today

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Health Care Today
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Weaknesses of Current System

• Problematic hand-offs
• Poor adherence
• Unsystematic chronic disease management
• Significant variation and inefficiency
• Persistent disparities
• Poor population-based progress

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Source Congressional Budget Office
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Physician Reimbursement Losing Ground to
Inflation, Costs
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• We in America do not have government by the
  majority. We have government by the majority who
  participate
• Thomas Jefferson, 1787

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The ACCs 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.

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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

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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

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• We have the tools now!

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

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NCDR
Number of sites and patient records
Imaging Registry
ICD Long
EP Registry
IMPACT Registry
PAD Registry
IC3-Office 600, gt15K
ACTION-GWTG Registry 445, gt120K
HF Registry
CathPCI Registry 1132, 8.6M
CARE Registry 166, gt9K
ICD Registry 1445, gt120K
1998.. 2004 2005 2006 2007 2008 beyond
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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

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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

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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

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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

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Now is the Time to Fight!
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Ways to Get Involved With Congress

• Grassroots www.acc.org/can
• (Includes ACCs toll-free grassroots hotline,
  patient materials, sample letters, and more)
• ACC PAC www.accpacweb.org
• ACC 2009 Legislative Conference Sept. 13-15,
  Washington, DC

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Member Resources

• Patient Materials www.acc.org/Chapters
• Health IT Resources www.acc.org/healthit
• Lewin Report Online Forum lewinreport.acc.org

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American College of Cardiologyhttp//qualityfirst
.acc.org