Author + information
- Kim Allan Williams Sr., MD, FACC, ACC President∗ ()
- ↵∗Address correspondence to:
Dr. Kim Allan Williams, Sr., American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
The American College of Cardiology (ACC) has long been known for its dissemination of education to cardiovascular specialists. More than 65 years ago, the College’s founders made continuing education of practicing clinicians a core mission of the College. However, as early as the 1960s and 1970s, the College expanded this mission to include quality improvement and advocacy—recognizing the need to provide clinicians with the tools to keep up with an explosion of cardiovascular research, as well as the need for the cardiovascular community to have a voice on Capitol Hill, in state and local governments, and with regulators and insurers.
These strategic objectives have since embedded themselves into the foundation of the College and are literally etched in stone in the walls of ACC’s “Heart House” headquarters in Washington, DC. However, a recent editorial in the Journal takes a closer look at these newer elements of the College’s mission and voices strong opinions about physician responsibility and the role of advocacy (1). In particular, the editorial raises questions about the proper role of the ACC and physicians in the advocacy arena, asking if our advocacy initiatives are for us or for our patients. How can we best maintain our primary patient-centered focus, while also respecting the needs of members? Beyond this, what are our obligations to the individual patient—and society at large—to improve systems of care?
These are important questions to ask, and we should examine our initiatives at every turn, keeping “patient first” principles in mind whenever College leaders and staff make policy decisions. The long-term advocacy focus of the ACC has been, and continues to be, on the ultimate well-being of patients. Our interactions with Congress, federal agencies, state legislative and regulatory bodies, private insurers, and other policymaking groups are critical to maintaining a focus on a quality-driven health care system, maintaining provider stability and ensuring patient access to care, improving population health, and charting the future of cardiovascular medicine and research.
Some of the ACC’s recent advocacy efforts help to prove this point. On the prevention front, the College, a number of ACC chapters, and partners such as the Campaign for Tobacco Free Kids have been working together to urge the U.S. Food and Drug Administration to extend its regulatory authority to cover electronic cigarettes and additional tobacco products. Additionally, the ACC and its chapters are actively advocating for smoke-free policies at the state level. In 2014, significant strides were made in many states to advance legislation for critical congenital heart defects screening. To date, approximately 40 states have laws requiring newborn screening for critical congenital heart defects using the pulse oximetry test.
The College has also played an important role in advocating for patient access to care, the incorporation of appropriate use criteria and clinical decision support for advanced diagnostic imaging, and the use of scientific registries for quality improvement. Just last year, our then ACC President Patrick T. O’Gara, MD, MACC, shared his perspective on personalized medicine with the House Energy and Commerce Committee as part of the 21st Century Cures initiative, a series of hearings and stakeholder roundtables intended to promote the discovery, development, and delivery of new cures and therapies. A draft legislative package on this initiative was released for discussion in late January. Also last year, the Center for Medicare and Medicaid Innovation awarded the College a $15.8 million grant to support SMARTCare pilot projects designed by the ACC’s Florida and Wisconsin Chapters. These innovative pilots aim to reduce health care costs by providing tools to help doctors and patients communicate about options for their care while helping physicians apply the latest guidelines to the decision-making process.
On an even broader level, the College has expanded its advocacy work into the international sphere over the last few years. Working with our international chapters and other stakeholders, the College has participated in the United Nations’ efforts around the prevention and control of noncommunicable diseases, with the goal of reaching a 25% global reduction of premature deaths from noncommunicable diseases by the year 2025 (2). With nearly 50,000 global members and 33 international chapters and growing, these activities are crucial to the success of our strategic efforts to improve population health around the globe. We support and partner with several global organizations, including participating at the leadership level with the World Heart Association.
Physician reimbursement and work with payers are the areas of advocacy where there are often questions about member needs versus patient needs. At face-value, these topics could be perceived as self-serving. However, in reality, advocacy in these areas is just as important to patient care. In a recent ACC in Touch Blog post, ACC President-Elect Richard Chazal, MD, FACC, wrote, “if physicians are not able to maintain viable practices or provide the services necessary to ensure appropriate and necessary care, patients will suffer. As such, advocating for patient access to a comprehensive array of services at the hospital or in the office and working to ensure adequate resources for practices to support patient care and reduced administrative burdens are important advocacy priorities” (3). It is also important to note that there are many cases where doing the right thing for patients may be at odds with financial incentives under the current physician payment model; the use of appropriate use criteria or participation in clinical data registries are some recent examples that have resulted in a reduction in unbridled use of imaging and procedures, which has lowered both health care costs and physician income.
The editorial published in the Journal is absolutely correct that “as physicians, there is an obligation to be altruistic, because our true calling is to serve patients—and not simply our own patients. Physicians must be rooted in a desire to help humanity through furthering the field of medicine” (1). For this very reason, the ACC Board of Trustees recently endorsed the Physician Charter on Medical Professionalism, which recognizes that professionalism “demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health” (4).
It is precisely in this spirit of service and professionalism that we appreciate and respect the staff and volunteer members who take the time to advocate on behalf of patients and the broader cardiovascular community. To leave this advocacy responsibility to politicians without the input of those who serve patients would be an abrogation of our responsibilities and of our oath. Without these efforts, we would not be positioned to encourage the creation of a value-driven health care system that improves the care experience for patients, enhances the health of populations, and reduces health care costs, nor would we be at the table for discussions aimed at fostering research and innovation in cardiovascular care—or, arguably more importantly, ensuring a stable, informed, and reliable cardiovascular workforce for the future.
Is has been stated that “Altruism is innate, but it's not instinctual. Everybody’s wired for it, but a switch has to be flipped” (5). At the ACC, the switches are indeed flipped, and the lights are always on.
I am always interested in what we can learn from supporting and opposing views, and I can be reached at blog.acc.org) to share your thoughts on this piece and/or answer the following questions: 1) Have you attended an ACC Legislative Conference or other ACC advocacy activity? 2) Are you aware of ACC’s advocacy agenda?. We want to hear from you about ACC’s Advocacy efforts. Visit the ACC in Touch Blog (
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