Author + information
- 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.
Each year, the American College of Cardiology’s (ACC’s) 48 U.S. chapters are asked to reflect upon the year in its entirety. What went well? What could have been improved? What is the general climate among membership? This annual look at the “State of the States” provides countless examples of how ACC’s chapters are meeting the needs of cardiovascular professionals across the United States and furthering the College’s mission of transforming cardiovascular care and improving heart health.
In these reports from the front lines, it is encouraging to see that collaboration and innovation are cornerstones upon which chapters have built their programming and goals. A successful approach used by the Kentucky Chapter to attract groups outside of the typical physician attendees to their programming, including nurses, echocardiography technicians, nuclear medicine technologists, and catheterization laboratory staff, is being considered in Colorado. Other chapters are choosing to combine strengths and hold regional meetings, with examples of this occurring among the Minnesota, Iowa, and the Great Plains chapters (North Dakota and South Dakota); Utah, Nevada, and Wyoming; Illinois and Wisconsin; as well as the Mid-Atlantic Capital Cardiology Symposium encompassing the District of Columbia, Pennsylvania, Delaware, Virginia, and Maryland. Defining and exporting best practices across state lines to the chapters has been a goal of the College.
The ACC chapters are also focused on aligning their activities with the College’s strategic plan, with the goal of positioning the College and its members for success in meeting the “triple aim” of improving cardiovascular health through lower costs, better health, and better outcomes. The following are some of the top accomplishments from across ACC’s chapters in 2015, delineated by key pillars of the College’s strategic plan.
Member Value and Engagement + Advocacy
As the professional home of the entire cardiovascular care team, it is important to the ACC that cardiovascular specialists identify the College as such, and the chapters serve as the front line to showcase the value of ACC membership. Chapters demonstrate member value in many ways, including providing opportunities for leadership development and expanding mentoring programs, focusing on fine-tuning and proliferating member communications, and more.
As of 2015, nearly all domestic ACC chapters are engaging in activities to support fellows in training (FITs). The ever-energizing FIT Jeopardy contests took 28 chapters by storm this past year as chapters held the event during their annual meetings, with winning teams planning to take part in the ACC.16 FIT Jeopardy competition at ACC’s Annual Scientific Session in Chicago next month. The Kansas Chapter’s Follow Your Heart program matches member champions with high school and college students interested in shadowing a cardiologist, observing the functioning of a clinic or hospital, taking part in patient encounters, and experiencing early targeted exposure to the health care system. Arkansas reinstituted their annual meeting and focused on population health, drawing members and nonmembers alike.
Another important way in which chapters provide member value is by advocating for their members and their patients and by ensuring that the College remains a leading voice in shaping public policy. In states across the country, chapter-led efforts have resulted in the passage of smoke-free legislation, life-saving pulse-oximetry screening laws for newborns, protection of in-office medical imaging, and more. In Pennsylvania, the Chapter’s advocacy committee led the effort to draft legislation that will help eliminate the need for prior authorization for noninvasive testing and replace it with appropriate use criteria as per the ACC FOCUS tool.
At the national level, chapters are playing an important role in educating members about the effects of critical legislation, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Strong showings from ACC chapters are also a large reason for the success of ACC’s annual Legislative Conference, which provides opportunities for cardiovascular professionals to meet face-to-face with their senators and representatives in Congress.
Transformation of Care
The ACC is committed to transforming care and ensuring that patients receive the highest quality, patient-centered, cost-effective cardiovascular care with improved outcomes. In the states, chapters like California are making this strategic priority of the ACC a chapter programming imperative. In 2015, the California Chapter developed a statewide valvular heart disease initiative called CAL-VALVE, which aims to educate patients at risk for valvular heart disease. The Chapter also provides peer-to-peer education on valvular heart disease for Fellows of the American College of Cardiology in California, which can be shared with other cardiologists and primary care practitioners.
The Great Plains Chapter developed a Cardiac System of Care, thanks to funds from the Leona M. and Harry B. Helmsley Charitable Trust. A portion of the fund was used to equip local emergency medical services with cardiac monitors, as well as implement the capability to transmit electrocardiograms directly to the on-call cardiologist's mobile phone. South Carolina is making transformation of care possible by putting dollars behind members conducting research. The Chapter has set aside grant opportunities for Chapter members who are conducting meaningful medical research, an important investment in the future of cardiovascular medicine and care. The Virginia Chapter launched its participation in the Virginia Cardiac Services Quality Initiative, a collaborative statewide program involving cardiothoracic surgeons and cardiologists looking at quality and cost across a spectrum of diseases and utilizing NCDR (National Cardiovascular Data Registry) and The Society of Thoracic Surgeons databases.
Purposeful education—developing a personalized, competency-based educational experience, with a curriculum that addresses clinical, administrative, and leadership skills, as well as engaging and expanding the community of learners—is another strategic priority of the ACC and thus its chapters. A number of chapters offer innovative educational offerings, including an exchange between FITs at 2 different institutions in Wisconsin that allows for enhanced exposure to multiple programs and emerging technology.
Also employing an FIT-focused education strategy, the Michigan Chapter expanded FIT programming at its annual conference to include a well-attended half-day seminar exclusively designed for FIT attendees on obesity; a town hall luncheon forum for FITs to interact with ACC leaders and learn about career strategies; an oral case competition; case and research poster competitions, and FIT Jeopardy. Heading south to Mississippi, the Chapter hosted a heart failure conference in conjunction with the University of Alabama versus Ole Miss baseball game. The event focused on new modalities of heart failure management, including aldosterone antagonist therapy and valvular issues, and drew a large audience, including many nurse practitioner enrollees. In Kentucky, their annual meeting was structured in a track format, with a particular portion of the day devoted to the business of cardiology, highlighting the unique information disseminated at and value of the ACC’s annual Cardiovascular Summit.
One of ACC’s strategic priorities for 2016 is to implement a 5-year population health plan through the expansion of the scope, depth, and breadth of ACC’s activities aimed at the prevention of cardiovascular disease and improving cardiovascular outcomes at the population level. The ACC’s chapters are uniquely positioned to take local and regional action in this space, and as is evident, many have already made prevention and population health a priority.
Several chapters have instituted programs supporting the World Health Organization’s 25 × 25 initiative, which is focused on reducing premature mortality from noncommunicable diseases by 25% by 2025. Additionally, a number of chapters supported legislation requiring high school coaches and trainers to be instructed in risks and early signs of sudden cardiac death in early athletes, along with a continued focus on and support of cardiopulmonary resuscitation and automated external defibrillator legislation.
The Alabama Chapter tackled tobacco by serving as the founding member of the statewide coalition called Alabama Healthy Change, a nonprofit coalition of health and child advocates supporting a meaningful tobacco tax increase. It also continued its role as a longtime supporter of the Coalition for a Tobacco Free Alabama. In partnership with these organizations and the Alabama Department of Public Health, the Chapter supported a 5-year plan to address the harmful effects of tobacco use in the state. On this front, the Alabama Chapter also supported efforts to increase the state’s tobacco tax, resulting in a successful increase of 25 cents/pack this year.
The West Virginia Chapter set its sights on patient education, conducting seminars in collaboration with ACC’s CardioSmart patient initiative, as well as hosting local health in concert with private medical groups. In Illinois, the ACC Illinois Chapter partnered in the International Cardiovascular Nutritional Summit, and in the southwest, the ACC’s Texas Chapter provided a grant to Championship Hearts Foundation for analysis of the data from over 7,000 athlete heart screenings, as well as man-power support for the events held in 2015.
Common Challenges and Opportunities
Despite differences in geography and demographics, ACC chapters share many of the same challenges and suggest similar areas of opportunity, improvement, and growth. In the membership arena, many states are finding that it remains a challenge to capture the attention and retain engagement of FITs, early career professionals, cardiovascular administrators, and cardiovascular team members. Some opportunities for improvement in this area include suggestions to add FITs to chapter councils, as well as to develop a stronger collaboration with member sections. FITs are also the focus of many chapters’ desire to create more FIT and early career education and mentorship opportunities. It is clear that our state chapters appreciate the value of the next generation of cardiovascular professionals.
To further transform care, ACC chapters suggest improving communication and coordination among health systems, industry and insurers, and other cardiovascular groups like the American Heart Association. Some areas for improvement that chapters mention include expanding the proliferation of automated external defibrillators in the athletic space beyond public school grounds, as well as improved relationships with insurers to facilitate patient access for expensive treatment modalities. Linking electronic health records with registries, as well as expanded registry participation, is another area that chapters see as an opportunity to advance the transformation of cardiovascular care for patients.
A number of chapters reported that there is great opportunity in significantly changing the Maintenance of Certification process, and the College has been actively involved at a national level in discussions with the American Board of Internal Medicine to do just that. Additionally, ACC chapters cite the need for continued and expanded patient education around sodium intake, tobacco use, obesity, and prevention, driving home the ACC’s national commitment to focus on population health as a strategic priority.
Pre-authorization, insurance denials, and test substitutions remain ongoing challenges. Many options are being explored, and multiple segments of the College, including the Board of Governors, are working collaboratively to accomplish meaningful change.
Through the chapters, members have expressed angst regarding the unknowns surrounding MACRA, the replacement for the sustainable growth rate. A MACRA Task Force has been established with a tight timeline to offer recommendations reflecting the rapid time line put forth by the Centers for Medicare and Medicaid Services. Many chapters have held sessions reviewing the Cardiovascular Summit, the annual ACC meeting focusing on the business of medicine, which has dedicated much time to MACRA and, in the past, sustainable growth rate.
Chapters continue to work tirelessly to provide value to members as the local and regional touch point of the ACC, and they have accomplished great things. Chapters have begun to align their goals, programming, and benchmarks with the ACC’s overarching strategic plan, and the results are outstanding. As we move into a new year, it is my hope that chapters will continue the trend of collaboration and sharing best practices and that ACC members will become increasingly involved in their local ACC chapters. Ultimately, we strive to maintain relevance to our members by removing impediments to caring for our patients as we collectively try to transform cardiovascular care and improve heart health.
- American College of Cardiology Foundation