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Report from the Chair of the Board of Governors: ACC Board of Trustees Retreat, Colorado Springs
Fellow Governors:
The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.
William Arthur Ward
I was honored to participate in the ACC Board of Trustees (BOT) meeting which concluded last weekend at the Broadmoor Hotel in Colorado Springs. ACC leadership, trustees, and guest participants including ACC Colorado Governor Dr. Eugene Sherman and Governor-Elect, Dr. Thomas Haffey convened for the annual retreat. The Board reviewed the College’s policy positions in the rapidly changing face of health system reform and how we can positively influence the final proposals.
Dr. James Rohack, President of the American Medical Association, shared his vision of the future of the medical profession, AMA, Specialty societies and cardiology. We heard detailed updates on the status of the proposed CMS Fee schedule and Health System Reform efforts on Capitol Hill from Dr. Jack Lewin and Dr. Jim Fasules. The BOT examined different perspectives on patients, physician accountability, and payment reform provided by two nationally known discussants: David Lansky, Ph.D., President, Pacific Business Group on Health and James Heywood, “Patients Like Me” on Patient Empowerment and Potential for Improvement in the Patient-Physician Relationship. Both speakers focused on patient centered care and transparent information sharing, as well as promoting shared decision making as an essential part of improving quality and reducing unnecessary spending.
The BOT revisited the ACC Strategic Plan and reviewed the Environmental Scan in the context of the rapidly changing health care environment as we “set course and speed” for the future. We discussed the impact of the “great recession” on the tripartite mission of the College: Advocacy, Education and Quality. The previously defined six strategic priority areas for the College were discussed:
- Quality First and IC3
- Learning linked to performance
- New products strategy
- Patient centered care transformation and patient empowerment
- Professionalism and self-regulation
- Value based payment reform
We discussed several “big hairy audacious goals” (BHAG’S). The BHAG concept was first proposed by James Collins and Jerry Porras in their 1996 article entitled ‘Building Your Company’s Vision’ where they encouraged companies to define visionary goals that are more strategic. In the article, Collins and Porras define a BHAG as a form of vision statement “an audacious 10-to-30 year goal to progress towards an envisioned future.”
BHAG #1: ACC being the “Operating System” for Cardiology.
BHAG #2: Dramatically reduce the incidence, severity, and complications of cardiovascular disease in the United States, and as possible, internationally.
The Board envisioned the future of the College and cardiology. Professionalism, competence, patient centeredness, continuous quality improvement, life long learning, social accountability and value creation were discussed in the context of tuning up our strategic plan. Discussion areas included:
• Translating science into practical usability at the front lines to achieve optimal patient outcomes.
• The College will be the premier source of cardiovascular knowledge and optimal care delivery— through science, education, guidelines, appropriate use criteria, and their implementation tools.
• The ACC will align training, education, and clinical science to systematically reduce cardiovascular risk and disease, improve prevention, and personalize care.
• Develop leadership and better means over time to systematically improve population-based societal cardiovascular health.
•Strong focus on patient-centered care, patient empowerment, and shared decision making combine to improve quality of care and satisfaction, and to improve the CV patient-clinician relationship.
Issues surrounding practice viability in the current environment of healthcare reform was discussed. There will be increasing pressure to replace fee-for-service reimbursement with hybrid compensation models that reward quality, outcomes, patient satisfaction, and efficiency. Some of these will involve bundling or episodes of care, and members will need assistance in preparing to participate if or when significant upsides are proposed. New compensation models for improved coordination and transitions of care will be created, as in the medical home concept. Pressure for integration and consolidation of practices will increase and will be tied to new payment opportunities. Smaller practices will find it hard to compete and the College must prepare to help practices survive and thrive in this new healthcare environment. Pressure for physician employment in larger groups, IPAs, PHOs, or directly by hospitals is likely to increase significantly related to the above trends. ACC needs to help members assess their best options and to support physician led groups. The concept of individual physician autonomy is transitioning to physician accountability, and will be coupled with professional responsibility for societal health needs as well. The pressure for integration and consolidation of practices will increase. Reduction in the number and geographic distribution of cardiology practices may decrease access to cardiovascular care, particularly for the economically deprived.
The Board also reviewed and approved a new set of evolving principles around appropriate relationships with industry (RWI) following a debate on that topic between Dr. Steve Nissen and Dr. Robert Harrington. The Board approved a landmark beginning of a member reporting program based on NCDR and IC3 data. This program is not public reporting, but it will motivate practices and members to better understand how their practices compare with similar ones in a way that we know will stimulate quality improvement. The College is also willing to work with consumer groups about regional (de-identified) quality reporting and tracking. Consumer group contacts feel this is a significant positive step.
The Board Retreat generated significant discussions on the importance of practice viability and the shared exposure of all physicians in cardiovascular practice be it academic, salaried or voluntary private practice to the proposed CMS fee cuts. This potential shared destiny will drive many of the College’s advocacy activities going forward. Advocacy will be restructured to allow for focused task forces on reform aspects of patient care and cardiology practices.
These issues will be furthers discussed during the September Board of Governors meeting and Legislative Conference. We look forward to continued discussion and debate on these critically important topics in cardiovascular medicine and the future strategic direction of the American College of Cardiology.
“Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be waiting for, it is a thing to be achieved. - Williams Jennings Bryan
JOHN GORDON HAROLD, MD, FACC
2009-2010 Board of Governors Steering Committee Membership:
John Gordon Harold, MD, FACC (Chair), California: john.harold@cshs.org
Jane E. Schauer, MD, PhD, FACC (Past Chair), New Mexico: janeschauer1@msn.com
Richard J. Kovacs, MD, FACC (Chair-Elect), Indiana: rikovacs@iupui.edu
José Rivera Del Río, MD, FACC, Puerto Rico: joseriveradelrio@gmail.com
J. Chris Higgins, MD, FACC, Vermont: jch6@mac.com
Oscar R. Jenkins, Jr, MD, FACC, North Carolina: oscarj@avlcard.com
Margo Minissian, ACNP-BC, MSN, CNS, California: Margo.Minissian@cshs.org
Thad F. Waites, MD, FACC, Mississippi: twaites@netdoor.com
Michael Widmer, MD, FACC, Oregon: michael@heartdoctorsnw.com
Chapter Affairs Changes
Helen Smith has transferred to the Quality Division of ACC, and is the new Associate Director for Appropriateness Criteria. She looks forward to working with the Chapters and BOG on quality improvement programs this fall and into the future.
Please direct Chapter Affairs questions to Jayne Jordan (jjordan@acc.org) or Taryn Gold (tgold@acc.org.)
News You Can Use
Please find Chapter newsletter information here: http://chapteraffairs.acc.org/chapters/tools/Pages/NewsYouCanUse.aspx
Comment Period Deadline for Proposed Fee Schedule Approaching; Take Action Now
The deadline for public comments on the Centers for Medicare and Medicaid Services’ (CMS) proposed 2010 Medicare Physician Fee Schedule is August 31. With that in mind, it is critical that ACC members across the country contact their respective members of Congress and urge them to stop the drastic cuts from being implemented. Congress needs to hear about the impacts of these proposed cuts as they relate to practice viability and patient care. ACT NOW! In the House, Reps. Charles Gonzalez (D-TX) and Mike Rogers (R-MI) are circulating a letter to HHS Secretary Kathleen Sebelius, expressing concerns regarding the proposed rule and the data used to justify the practice expense cuts. For help with scheduling in-district meetings while members of Congress are home on recess contact Molly Nichelson at mnichels@acc.org. Patient materials are available for download at www.acc.org/can.
Registration Closes Today! ACC’s 2009 Legislative Conference
Today is the registration deadline for ACC’s 2009 Legislative Conference, to be held Sept. 13 – 15 at the Fairmont Hotel in Washington, D.C. Given the drastic payment cuts proposed by CMS, as well as efforts to pass overarching health reform legislation, don’t miss this opportunity to help educate Congress about the important work the ACC is doing in the areas of quality improvement and medical imaging. Even more importantly, you can help advocate for fair reimbursement and sound, unobtrusive policies that will ensure that cardiovascular professionals can continue to practice medicine in a manner that provides the greatest benefit for their patients. Click here to register now!
Member Opinion Piece: Effects of the Proposed Payment Cuts
President of ACC’s Oregon Chapter Michael Widmer, M.D., F.A.C.C., was featured in an opinion piece in the Oregonian on August 9. He describes the payment cuts under the proposed physician fee schedule and writes that they will “lead to reduced access and quality care for patients with cardiovascular disease,” as well as reduce the free care provided to the uninsured and indigent and forgo participation in quality improvement activities. He concludes: “The goal for health reform should be to move physicians, patients and the nation as a whole closer to ensuring the right care, to the right patient, at the right time.” |