Author + information
- Shalom Jacobovitz, Chief Executive Officer, American College of Cardiology∗
- ↵∗Address correspondence to:
Shalom Jacobovitz, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
The American College of Cardiology (ACC) and its members are facing significant and rapid changes in the healthcare environment. These changes run the gamut from new payment and care delivery models, to increased certification requirements, and to the rapid dissemination of digital and mobile technologies that cross into the worlds of both the professionals and patients.
Given these changes, last year the College embarked upon an effort to develop a strategic plan that re-envisions specialty care with the goal of optimizing the role of cardiovascular professionals to meet the triple aim of high-quality, appropriate, and cost-effective care. The strategic plan was approved by College leaders in January 2014, and over the last several months our focus has been on taking the plan from concept to reality.
These implementation efforts have involved careful and thoughtful looks at the products we build and the programs and activities we undertake in order to ensure that they are: providing the greatest member value; supporting purposeful education; moving us toward transformation of care; positioning us as effective advocates; contributing to improvements in population health; and maximizing data to inform research and opportunities to improve outcomes.
This strategic plan is not an easy task, but it is critical in continuing the ACC's legacy as the professional home for cardiology. It is also important for building a high-impact learning organization that is efficient, effective, and positioned to thrive in the increasingly competitive and constantly changing healthcare environment.
The good news is that the College already has many programs and products that are either already moving us toward meeting our strategic objectives, are poised to deliver on our goals, or are in exciting new concept phases. A great example of an existing program that truly demonstrates all of the tenets of the strategic plan and showcases where the College is heading is the PINNACLE Registry, the largest cardiovascular outpatient Registry in the United States.
The overarching goal of the PINNACLE Registry is to facilitate the practice of evidence-based cardiovascular medicine and help clinicians adhere to guidelines and metrics for coronary artery disease, atrial fibrillation (AF), hypertension, and heart failure. However, in addition to providing powerful clinical insights to clinicians, PINNACLE data also provide benefits to researchers and patients involved in the management and preventions of these conditions.
For clinicians, PINNACLE provides many opportunities for practices to be on the front lines of care transformation at national, state, local, and facility levels. Participation in the registry allows practices to track progress over time and identify areas for practice-level improvement like hypertension management and anticoagulant use for stroke prevention in patients with AF. For example, PINNACLE Registry data indicate that only 57.2% of nonvalvular AF patients at high risk for stroke are prescribed guideline-recommended anticoagulation therapy, leaving room for improvement and increased education about oral anticoagulants (1). Similarly, although PINNACLE Registry data overwhelmingly show that providers regularly record each patient's blood pressure (95.1%), only 34.5% of providers have indicated that they have hypertension care plans (1). Using this data as an early benchmark, it will be interesting to see what impacts that individual practice improvement efforts, as well as programs like the ACC's Anticoagulation Initiative or the national Million Hearts campaign, can have on guideline adherence and ultimately on patient outcomes over time.
The PINNACLE Registry also provides significant member value in the form of data submission in the federal Physician Quality Reporting System (PQRS). Physicians who actively participate in the PINNACLE registry can choose to have their data submitted to the Centers for Medicare and Medicaid Services for PQRS incentive eligibility and protection from PQRS and Value-based Payment Modifier (VM) penalties. In March 2014, the PINNACLE Registry completed a record number of submissions to the Centers for Medicare and Medicaid Services for the 2013 PQRS program, successfully reporting up to 23 PQRS performance measures on behalf of 1,236 providers across 96 practices. Of those 1,236 providers, 818 also submitted to the 2013 eRx incentive in that program's final year as a standalone program (2).
As these programs shift away from solely providing incentive payments for participation to penalties for nonparticipation, this value is only heightened. The PINNACLE Registry provides a trusted and proven way to collect necessary data with minimal impact on practice workflow. For example, beginning in 2014, the PINNACLE Registry now serves as a specialized registry for Stage 2 of the Medicare and Medicaid Electronic Health Care Records Incentive Program (commonly called Meaningful Use), allowing participants to meet 1 of their required menu set of options for incentive eligibility. In addition, successful reporting for 2013 PQRS will earn providers an incentive payment of up to 0.5% of all 2013 Medicare Part B fee-for-service claims and protection from a −1.5% penalty, which will be assessed on claims across 2015. Providers must report at least 3 measures covering a minimum of one National Quality Strategy domain for the 2014 program year to avoid the PQRS −2% payment adjustment in 2016. PQRS performance rates reporting through PINNACLE will contribute to differential payments as determined by the VM. All groups with ≥10 providers are subject to the VM for 2014. Non-PQRS reporters for the 2014 program year will incur an automatic −2% downward payment adjustment in 2016. The VM adjustment is in addition to the −2% adjustment under PQRS itself.
The PINNACLE Registry also provides opportunities to help physicians meet certification requirements. These opportunities will only increase as the College continues to focus on purposeful education and meeting the educational needs of members at all stages of their careers. Given the recent changes by the American Board of Internal Medicine to its Maintenance of Certification requirements, this is more important than ever. As the College works with the American Board of Internal Medicine to improve the process moving forward, there is a real need for the College to continue building a cadre of Maintenance of Certification offerings to help members meet these requirements in the short term.
Focusing on population health is another key strategic driver for the College, and another area where the PINNACLE Registry is positioned to play a leading role. Whether using the registry's quarterly reports to determine how many patients who are eligible for beta-blockers are receiving them or tracking noncompliance associated with oral anticoagulants, the registry provides a means to identify, track, and improve cardiovascular care beyond an individual patient or even a practice, but rather across the cardiovascular community. When linked with other programs like the College's CardioSmart patient-centered care initiative that are targeted at raising public awareness and education about cardiovascular disease and prevention, we should be able to look back 5 years from now and see a difference across patient populations. As the PINNACLE registry begins to expand worldwide, even more opportunities to track and improve patient populations around the globe also exist.
Most recently, the PINNACLE registry is also helping to generate meaningful clinical research and patient participation in clinical trials through the PINNACLE Registry Research Alliance. The Research Alliance provides opportunities for PINNACLE-participating practices to participate in a range of clinical trials, observational studies, and investigator development programs aimed at furthering best practices and quality improvement in cardiovascular care. The Diabetes Collaborative Registry is another exciting effort underway that leverages the PINNACLE Registry's technology platform. The ACC, in partnership with the American Diabetes Association, the American College of Physicians, and the Joslin Diabetes Clinic, recently announced the development of this new registry, which will be the first aimed at tracking and improving the quality of diabetes and cardiometabolic care across the continuum of primary and specialty care. The Diabetes Collaborative Registry will provide researchers with a seamless view of patients with diabetes across specialties.
Programs like PINNACLE are fundamental in ensuring that cardiovascular professionals and their practices are equipped not merely to handle the changing healthcare environment, but also to continue to successfully practice care in a way that ensures the best, most appropriate care possible. The PINNACLE Registry highlights just how we, as a College, can take advantage of the newest generation of data and quality capabilities to make a real difference in patient care and outcomes. As we move forward with implementing our strategic plan, it will be exciting to see the PINNACLE Registry grow and mature as more and more practices take advantage of the very real and tangible benefits it provides across the spectrum of quality improvement, education, and care transformation.
- American College of Cardiology Foundation
- Masoudi F.A.,
- Ponirakis A.,
- Yeh R.W.,
- et al.
- ↵American College of Cardiology. March 2013 PQRS and eRx Submissions. March 24, 2014. Available at: https://www.ncdr.com/webncdr/pinnacle/pinnaclenews/2014/03/24/march-2013-pqrs-and-erx-submissions. Accessed June 4, 2014.