Author + information
- Michael J Wolk, MD, FACC, President, American College of Cardiology*,
- Christine McEntee, Chief Executive Officer, American College of Cardiology* and
- Penny Mills, Division Vice President, Strategy and External Relations, American College of Cardiology*
- ↵*Send correspondence to:
Dr. Michael J. Wolk, 520 East 72nd Street, New York, New York 10021, USA.
Perhaps the greatest challenge cardiovascular (CV) specialists face today is keeping up with the mountainous escalation of knowledge that emerges from the field on a regular and frequent basis: scientific journals publish articles about clinical trials; the latest developments in procedures, devices, and drug therapy appear in media reports, medical websites, online newsletters, and other print publications. With all of the intellectual property engulfing our profession, Fellows and non-members alike frequently seek counsel from the College's deep informational reserves. When they do, they expect to find expert resources, and in general, they have their needs for knowledge and information satisfied.
It is the ACC member's unique and perpetual quest for answers and increased knowledge that, in large part, fuels the College's planning and decision-making processes. On any given day, Fellows, other professional members, and non-members query the staff or their chapter peers, asking: “What is the College's position on driving down cholesterol low-density lipoprotein levels?” “Does the College have recommendations on percutaneous heart valve intervention?” “What is the College doing to improve the Medicare reimbursement system?” “Can the College start providing me with ready access to informational resources as I deliver bedside care to my patients?”
How can the College be certain that these questions reflect the concerns of 30,295 people—the full complement of its membership? How do we decide which concerns to address, prioritize, and develop? Just as importantly, how do we respond to the ever-changing environment in which health care and the practice of CV medicine are delivered? How can the College make the “right” choices?
The College uses a variety of informational vehicles to take the pulse of the environment in which its members practice, conduct research, and teach. A full range of primary informational sources is tapped to get sample opinions and current ideas from portions of the membership and, sometimes, from the entire membership. Each year, the College runs focus groups with selected members at the Annual Scientific Session. It also conducts a member survey. This year, a census was mailed to individuals in all of the ACC membership categories. And of course, the Board of Governors helps identify trends at state and local levels. Their listserv is a kind of audited dialog on ongoing issues.
Secondary informational sources indicate emerging trends in science, business, technology, reimbursement, education, and economic areas. Current practice guidelines and emerging CV news contribute to this body of information. The College uses environmental scanning as an important tool to anticipate what our membership will need and want in their continuously changing professional environment. A Board of Trustees (BOT) work group, chaired by Peter Alagona, MD, brings this type of information to the Board each year at its summer meeting to help place context around ACC initiatives and to prioritize them. Scanning results will be incorporated in the revised Strategic Framework to be approved at the Board's December 2004 meeting. Future Board meetings will continue updating and revising, as needed, on a consensus basis.
Through astute information-gathering and goal-crunching, the College determines how aggressive it must be in allocating resources and funds to support member needs and the management of a vastly growing body of CV science. The continuing shortage of CV physicians in the work force, for instance, has placed a dramatic emphasis on quality patient care and on patient access to it. As a result, the College has opened its doors to cardiac care associate members as a means of providing training and educational opportunities to non-physician CV specialists. The ACC also highlights the important roles of non-physician cardiac care team members in an effort to increase awareness among Fellows of this strategic team initiative which can improve practice management, physician efficiency, and overall patient care.
In recognition of the increasingly globalized CV health community, the College also has expanded its international role, recruiting international associates and increasing its educational presence around the world. Examples include the ACC support for programs like Heartbeat International and more sophisticated and frequent virtual education programs, such as the recently presented live Cardiovascular Disease and Depression series that took place on the World Wide Web this past spring.
In response to a domestic climate wrought with tension stemming from the medical liability crisis, the ACC has asserted itself as a leader in protecting and improving physician reimbursement and fighting for medical liability reform. Of course, the latter crisis has exacerbated the work force shortage, forcing some CV specialists out of practice. Subsequently, the College has heightened its emphasis on, and increased its resources for, strengthening guidelines for quality care—another way of gaining accountability among CV physicians and, actually, among all points of CV care.
There have been calls for creative clinical knowledge delivery, and truly innovative knowledge management systems have become more sought after, with the advent of the successful Guidelines Applied in Practice (GAP) project, in which sometimes simple clinical tools, such as standardized discharge documents, helped improve outcomes and make care procedures more uniformly consistent across the specialty.
Increased concern from Fellows about variations in practice and outcomes has led the College to consider new ways of making the ACC/AHA guidelines recommendations more accessible to physicians as they deliver patient care. Currently in the staff-planning stage, having gained momentum from Board consideration and prioritization, is an information management initiative that will enable physicians to virtually embed guideline recommendations into every step of a patient's care.
Other key issues that came to the forefront at last summer's BOT meeting included a noticeable trend toward women entering into medical training programs, but not necessarily into cardiology; the impact of the practice/care team's composition; and reports that Medicare fees had fallen dramatically on a per-procedure basis for cardiologists. Validating the ACC's agenda to continue working on these issues—all of which impact the delivery of quality CV care—member surveys directed the ACC to focus on declining reimbursements, the quality of patient care, the high cost of medical liability coverage and prescriptions, practice management, and the ability to stay current in the field, among other concerns.
As the College identifies and implements programs based on information assimilated from all of its sources, performance measurements are also put in place. Benchmarks exist for all programs in operation: programs are not initiated and then allowed to passively exist. Each program must meet goals and objectives to ensure that membership participation in them is vital and effective—that programs provide answers and close the loop where knowledge gaps previously existed.
Cardiosource may best exemplify the success of the College's planning methodology. Five or six years ago, environmental scanning indicated that online usage was growing among physicians. That information was monitored and projected forward until the College launched the premier online knowledge site for CV specialists nearly two years ago. The site still regularly renews itself under the sure direction of Editor-in-Chief Alfred Bove, MD, responding to subscribers' usage patterns and offering new features such as clinical collections on selected topics, expert opinion, clinical trials, practice guidelines, self-assessment programs, a library of journals, and much, much more. In fact, subscription rates are solid.
We urge you to review the Strategic Framework, online at www.acc.org/about/overview/overview.htm#ACCgoals, to see where the College's pulse is. The current framework reflects the clear vision of the College and renews its mission to advocate for quality CV care through education, research promotion, and the development and application of standards and guidelines. It recommits to education, not just for physicians, but for patients, policy makers, and members of the entire cardiac care team. It also identifies the core values important to all of us—professionalism, knowledge, the value of the CV specialist, integrity, and inclusiveness—and ties them to activities that enable the College to reach ambitious goals. The Strategic Framework provides the College with an offensive game, but with each new fiscal season, it will be revised as current issues, thinking, and concerns emerge and are blended into it.
The formation of the Strategic Framework means, ultimately, that when you need guidance or an answer to a question, the College will be ready to respond in the most timely, efficient, and effective way possible. We aim always to stay a step ahead of our members' needs and to lead the way in all matters that relate to the delivery of quality CV care.
↵* Throughout his Presidential year, Dr. Wolk will present ideas important to College members, in collaboration with key ACC leaders and staff.
- American College of Cardiology Foundation