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- Robert Shor, MD, FACC, Chair, ACC Board of Governors∗ ()
- ↵∗Address correspondence to:
Robert Shor, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
I think we collectively strive to continue to learn and grow as a profession. Lifelong learning is woven into the very fabric of what we do. I remember when I first began training, beta-blockers were contraindicated in systolic heart failure, we did not call it “heart failure with reduced ejection fraction,” and we had not clearly defined stages A to D. What was heart failure with preserved ejection fraction? We had just begun to give intracoronary thrombolytics for acute myocardial infarction, and we collectively took a sigh of relief when the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico) and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) studies came out and we were able to give intravenous thrombolytics. Aortic valve stenosis was a purely surgical disease.
A lot has changed in the last few decades. Cardiovascular medicine has evolved in many exciting new ways and will undoubtedly continue to do so. Imagine 30 years from now what today’s fellows-in-training will be saying about changes to the profession since their early career days. Will patient-directed smartphone rhythm monitoring be a regular course of treatment, or a thing of the past? Will PCSK-9 inhibitors be a normal course of clinical practice? What other bioengineering and technological feats will be at their disposal or on the horizon?
Although all of these advances bring new opportunities for patients and providers alike, they also come with many other changes and challenges that seem to impede patient access and the ability for the cardiovascular professional to provide the right care for patients. Many of the biggest challenges are associated with largely 1-size-fits-all regulations that seem to cost providers more in terms of time and paperwork rather than be of actual benefit to patients. For example, 2 of the most prevalent issues involve changes to the American Board of Internal Medicine’s (ABIM’s) Maintenance of Certification (MOC) process, as well as what seems like a marked increase in the number of studies denied by payers, despite physician use of evidence-based appropriate use criteria (AUC) and clinical practice guidelines.
MOC is an ongoing flash point for American College of Cardiology (ACC) members. The ABIM was founded “in 1936 to answer a public call to establish more uniform standards for physicians. Certification by the [ABIM] has stood for the highest standard in internal medicine and its 20 subspecialties” (1). According to the ABIM website, its mission is “to enhance the quality of health care by certifying internists and subspecialists who demonstrate the knowledge, skills, and attitudes essential for excellent patient care” (1). The changes initially launched by the ABIM in January 2014 clearly went beyond this mission in the minds of the majority of internal medicine providers, including ACC members.
Over the past year, ACC leaders made it their number 1 priority to document the concerns of its members and to advocate for changes to the process at the highest levels of ABIM leadership. The February 2015 e-mail from ABIM Chief Executive Officer and President Richard J. Baron, MD, noting the ABIM “clearly got it wrong” and “launched programs that weren’t ready” is a testament to these efforts (2,3).
As the ABIM continues to re-evaluate their program, ACC leaders have not stopped working with the ABIM to modify the MOC to something relevant, meaningful to us and our patients, and that understands the cost and multiple boards many of us are required to complete. I, personally, have been fortunate to have long discussions with Dr. Baron and have also stressed the need for simple, less costly alternative pathways to meet the mission of lifelong learning to maintain our competence and for the public interest. I have urged a short timeline for implementation of these new MOC processes and clear demonstration and validation of any process to ensure that these are indeed meaningful.
Insurance denials are another hot-button issue. There are countless anecdotal stories about physicians who are trying to do “the right thing” by following guidelines and AUC, but who are denied a test or procedure by payers. Fortunately, the ACC’s Payer Advocacy team has proven to be an effective resource in helping cardiovascular professionals to advocate at the regional, state, and individual levels. The ACC’s ongoing commitment to the evolution and development of AUC, as well as decision support tools like FOCUS to guide and improve appropriate ordering of cardiovascular imaging and tests, are also making some headway in helping providers demonstrate appropriate care with minimal workflow hassles.
However, there is still more work to be done. The College is committed to better quantifying the number and type of denials to get an informed idea of how best to move forward. Stay tuned in the coming months for an easy-to-use, Health Insurance Portability and Accountability Act–compliant survey that individual physicians or practices can complete and send back to the ACC. Results from this survey will be shared in a Leadership Page later this year.
Whether it is advocating for a more meaningful MOC process or finding better ways to help physicians and practices ensure that their patients are able to receive the evidence-based, high-quality care they deserve, the ACC’s Board of Governors is committed to being the on-the-ground voice for the cardiovascular professional and to collectively working to find meaningful solutions to issues that impede care. Take advantage of your Board of Governors representative, as well as your state chapter; we are here to represent you!
- 2015 American College of Cardiology Foundation
- ↵American Board of Internal Medicine. About ABIM. Available at: http://www.abim.org/about/. Accessed March 31, 2015.
- ↵American Board of Internal Medicine. MOC FAQ. Available at: http://www.abim.org/maintenance-of-certification/moc-faq/default.aspx. Accessed March 31, 2015.
- ↵O’Gara PT. ABIM announces big changes to MOC process. ACC in Touch Blog. February 3, 2015. Available at: http://blog.acc.org/post/abim-announces-big-changes-moc-process/. Accessed March 31, 2015.