Author + information
- W.Bruce Fye, MD, MA, FACC, President, American College of Cardiology*
- ↵*Reprint requests and correspondence:
W. Bruce Fye, MD, MA, FACC, Mayo Clinic, Division of Cardiovascular Diseases, 200 First Street, SW, West 16A, Rochester, MN 55905-0001, USA.
The American College of Cardiology (ACC) has a rich tradition of innovation, and for domestic members the creation of chapters is one of the most important developments in our history. Because our chapters are now such a vital part of the organization, it is hard to believe the first ones (Florida and Arizona) were created just 16 years ago. Today, we have 38 chapters that serve ACC members in 42 states and Puerto Rico. In many states, more than 90% of ACC members have chosen to join their chapters—a clear signal that they see value in this model.
Initially, the main incentive to create chapters was to help cardiovascular specialists respond in a coordinated way to a growing number of local and regional challenges they faced in the areas of legislation, regulation, and reimbursement. As our chapters have grown and gained momentum, their agendas have expanded to other important areas such as education and quality of care.
Many ACC chapters have developed advocacy committees to help their members respond to local regulatory initiatives and payer policies. New policies are often designed to reduce reimbursement, to increase required documentation, or to regulate who can perform a procedure and where. The goal is often to cut costs or control the flow of patients rather than to encourage high-quality care or improve patient satisfaction. When inappropriate or unfair policies are implemented, the local ACC chapter can collect, collate, and process information that can be used to develop a coordinated and compelling response. In the current era of market-driven medicine, changes occur quickly and unpredictably. This means that all too often we must react to the unexpected. Ideally, chapters should be asked for input when local or regional policies that will affect cardiovascular specialists are being developed.
Since the College created a new 501(c)(6) entity last year, our expert advocacy staff in Bethesda is now better able to help chapters address advocacy issues. The national advocacy division is an efficient clearinghouse for information that can help members throughout the nation to anticipate challenges they may face and to develop effective responses to them. Meanwhile, our chapters are a vital part of the ACC’s advocacy early warning system. Some of the more problematic policies proposed by major third-party payers such as Blue Cross & Blue Shield have been invented and tested in one or more local or regional markets before being introduced in other areas.
Chapter advocacy efforts can make a big difference. For example, last year, the Pennsylvania Chapter of the ACC (working with the state’s medical society) helped achieve passage of the “Medical Care Availability and Reduction of Error Act.” This law will allocate $40 million per year in state funds to help doctors pay for liability insurance, will require lawsuits to be filed within seven years of an alleged error, and will allow jury awards to be paid in installments (and, in some cases, to be reduced by a judge). The law also addresses issues related to patient safety.
Legislative and regulatory victories are often difficult to achieve, but they are more likely if the effort is well coordinated and the message is clear and compelling. Increasingly, our chapter leaders recognize the value of working together to engage elected officials and influence policy. In the last few weeks, 11 chapters (Illinois, Indiana, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, and Virginia) have agreed to pilot a grassroots network for state advocacy. This innovative program will be launched before the 2003 legislative sessions begin. It will help ACC members work together and with other groups (such as state medical societies and other specialty societies) to craft messages that address the concerns of cardiovascular specialists and the patients we serve.
Education and the quality of care
Local educational programs sponsored by our chapters complement national programs offered by the ACC Foundation. At the national level, the ACC has thrived because it regularly brings together educators and learners who have a shared interest in advancing medical practice through the transmission of new, clinically relevant information on diagnosis and treatment. Chapter meetings are an ideal opportunity for academic and practitioner cardiologists to meet to share their knowledge, experience, and perspectives. For this reason, several chapters—especially the larger ones—frame their annual meetings around a first-rate educational program. Sometimes the speakers are from local academic medical centers. Often, a local faculty is supplemented by speakers from other regions of the country. The College is also exploring new opportunities for the national ACC Foundation to jointly sponsor educational meetings with our chapters to expand the potential audience for these informative programs.
Reflecting the interests of our members, the ACC is devoting increased attention to programs and projects that help to enhance the quality of cardiovascular care. One major quality initiative, the Guidelines Applied in Practice (GAP) program, approved by the ACC Board of Trustees in 1998, depends on cooperation with individual chapters. This innovative approach provides a structure for guidelines implementation and quality improvement that can be adapted to the local context. The first GAP project, focused on acute myocardial infarction (AMI), was launched in Michigan in 1999 with strong support from the state chapter. Meanwhile, the first GAP project devoted to heart failure is under way in Oregon. The Alabama Chapter recently launched a GAP project focused on stable angina pectoris.
Chapters have played a critical role in these GAP pilot projects by providing local physician leadership and support. This approach—designed and managed by ACC members—will help cardiovascular specialists and the health care teams they direct provide optimal care that reflects state-of-the-art practice. Like other College quality-of-care initiatives, the GAP program includes a commitment to creating tools that individual physicians can adapt to fit the needs of their patients and practices. For example, the AMI-GAP “tool kit” includes a critical pathway for nurses, suggested standard orders, and educational materials for patients and their families to use after discharge. The College’s GAP program reflects our conviction that our mission areas of education and quality are complementary.
Networking and growing our chapters
The ACC chapters provide domestic members with a variety of opportunities to meet their colleagues from communities or hospitals in their state or region. These pleasant and useful professional and social interactions take place in a variety of contexts. Many chapters have experimented with various approaches for their annual meetings in an attempt to identify what venue and type of program appeals most to their members. These annual chapter meetings cover the spectrum from traditional continuing medical education programs to presentations devoted exclusively to state advocacy issues. Often, these topics are blended in an attempt to provide a diverse group of attendees with a combination of information they can use in both the clinical and business aspects of their practices. Several chapters also sponsor special sessions (for example, coding seminars) for their members’ administrative and business personnel. Annual chapter receptions are another common model for bringing members together. On Monday night during the ACC Annual Scientific Session, most chapters sponsor receptions either independently or jointly with neighboring states.
Chapters have a special opportunity to introduce fellows-in-training (known as Affiliates-in-Training, or AITs, at the College) in their states or regions to the unique value of the ACC as an organization that can help them address many professional needs throughout their careers. Some chapters have made a special attempt to engage this important constituency by incorporating AIT poster competitions and/or job fairs into their annual meetings. Today, many ACC members are seeking colleagues to help them cope with growing clinical demands driven by an expanding population of heart patients and an impressive array of new treatment modalities. Chapter meetings and receptions can be a pleasant and effective venue for linking members seeking colleagues and trainees exploring job opportunities in academic medicine or private practice. At its annual meeting, the California Chapter has combined this opportunity for networking with formal presentations that describe careers in different contexts. This has proved to be very popular.
Many ingredients contribute to a successful chapter—one that provides its members with information and services they value. Although there is no single formula for success, two individuals play a critical role in energizing a chapter. The chapter president and the administrator must be committed to building and maintaining a chapter that serves its members and communicates effectively with them and the national ACC. The College staff in Bethesda continue to work closely with chapter leaders and administrators to help them strengthen their chapters. Dr. Robert Jones, current chair of the Board of Governors, has launched a new initiative to extend the efforts of his predecessors and other College leaders and staff who have worked hard over the years to increase the effectiveness of the chapters. Fortunately, the number of dedicated volunteers who have been attracted to many of the chapters has reached a critical mass, contributing to the success of those chapters.
A chapter’s size is an important factor in terms of its ability to develop and maintain a comprehensive agenda that reflects the diverse needs of its members. Reflecting the population and the distribution of cardiovascular specialists, some chapters are very large, and others are small. Obviously, the largest chapters have a bigger pool of volunteers to draw from to launch and sustain chapter programs and projects. Nevertheless, medium-size chapters have created very ambitious and successful programs that address education, advocacy, and quality. Even small chapters have developed a broad range of activities that serve their members.
Most chapters have established several committees and working groups to help them achieve their local missions. The Board of Governors Steering Committee and its Chapter Relations Subcommittee are actively collaborating with senior ACC staff and chapter administrators to identify models that have worked especially well in one or more locations. These initiatives and approaches can then be disseminated to other chapters for consideration and possible implementation. The ACC in Bethesda recently launched a Web-based set of tools to help chapter leaders and administrators achieve their goals. This novel program is called OSCAR, which stands for the “Online System for Chapters to Access Resources.”
If our chapters are to meet their full potential, the number of members who are willing to devote their time and energy to local programs and projects must be sufficient to achieve a critical mass. For those who are interested in serving the national ACC, the chapters are a great way to get involved in the College. Many national leaders of the ACC got their start by working at the chapter level. Chapter presidents are asked annually to recommend local members for consideration for appointment to national committees, task forces, and working groups. I urge each domestic College member to consider his or her chapter as a partner that can help them to practice high-quality medicine in a very dynamic and challenging era. Support your chapter so it, in turn, can serve you better.
- American College of Cardiology Foundation