Author + information
- A. Allen Seals, MD, FACC, Chair of ACC’s Board of Governors∗ ()
- ↵∗Address correspondence to:
A. Allen Seals, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Advocacy is a vital part of the College and its strategic efforts to transform cardiovascular care, help members maintain professional competency, and support population health management in the changing health care landscape. Through its advocacy efforts, the American College of Cardiology (ACC) is shaping federal and state health policies; navigating state, regulatory, and payer issues; and empowering members across the cardiovascular care team to become effective advocates.
The current health care environment presents unprecedented opportunities for the College and its members to have an effect on health policies and the future of medicine as a whole. The climate is ripe for the ACC and its members to educate policymakers about the effect that their decisions have on both the cardiovascular profession and, more importantly, patients. Cardiology has long been perceived as a leader and innovator in evidence-based medicine and, as such, ACC members offer unique expertise that can truly influence health policy.
One of the top advocacy priorities for this year and beyond is to educate and prepare members for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA, which was signed into law last year, significantly changes how Medicare will reimburse cardiologists and their practices in the future. Instead of the fee-for-service payment model that used volume of services provided, MACRA establishes a framework focused on quality and value of care and improved patient outcomes.
The early years of MACRA implementation will undoubtedly pose some very real challenges to physicians and patients who are accustomed to the current system. Resource allocation, use of electronic health records, quality efforts, and clinical practice improvement are all key elements of MACRA. Ensuring that clinicians understand these elements and the effects (or potential effects) on their practice is critical.
The College and its chapters are already working together to provide members with a basic understanding of MACRA and its components. Among the tools currently available: an online hub on ACC.org (http://www.ACC.org/MACRA) and special sessions at all live educational meetings throughout 2016. Physicians who are participating in the ACC’s outpatient PINNACLE Registry and submitting data to the Centers for Medicare and Medicaid Services (CMS) for the Physician Quality Reporting System and the Electronic Health Records Incentive Program are also ahead of the game in terms of preparing for MACRA participation.
ACC’s leaders and advocacy team also continue to be engaged at the federal level to ensure that the voice of cardiology is heard as details of how MACRA and its provisions are proposed and finalized. In response to an April 2016 House Energy and Commerce Health Subcommittee hearing on physician efforts to prepare for MACRA, ACC President Richard A. Chazal, MD, FACC, noted that the College has been engaged in “positive and productive” conversations with the cardiovascular community as well as CMS about the intricacies of implementing MACRA since its passage. More recently, the ACC sent detailed comments to CMS on its proposed MACRA rule urging a streamlined and flexible approach that “truly rewards clinicians across all specialties for their efforts to provide evidence-based care and seek innovative ways to manage costs without threatening patient outcomes” (1).
Looking ahead, the final MACRA rule is expected this fall, and the ACC is already engaged in identifying member needs and developing additional tools and resources to help with successful implementation. Whether it is helping physicians understand how to leverage National Cardiovascular Data Registry data, providing focused education and tools for practice administrators, and/or identifying partnership opportunities among ACC chapters and other cardiovascular and medical specialties, the College is committed to providing all of its members with access to the things they need to succeed and thrive in the new health care environment.
Advocacy in the States
Other ACC advocacy priorities include ensuring patient access to care and cardiovascular practice stability, promoting the use of clinical data to improve care, funding research and innovation in cardiovascular care, and improving population health and preventing cardiovascular disease. In many cases, great headway has been made in these areas thanks to the hard work of ACC chapters.
For example, prior authorization has been an ongoing issue when it comes to getting patients’ access to appropriate, evidence-based care. The ACC's Ohio Chapter, working closely with the Ohio State Medical Association and other organizations, succeeded this June in advocating for passage of a law strengthening the communication among patients, providers, pharmacies, and insurers. The new law will ultimately improve the prior authorization process to allow patients to more easily be granted coverage for the care they need. Delaware passed a similar bill to Ohio's in July, and the ACC is working with the state medical society on implementation. In Pennsylvania, after years of discussions with the payer community, state insurance commissioner, and stakeholders, ACC's Pennsylvania Chapter and medical society were able to get a bill introduced earlier this year that would increase the transparency and consistency of the prior authorization process. Although legislation in Hawaii did not pass this session, the ACC Hawaii Chapter has been designated to work with the Hawaii insurance regulators to craft necessary reforms.
Chapters are also making big differences when it comes to quality improvement. The ACC's Illinois Chapter—working with the state hospital association and physician groups—recently defeated a proposal to update the state's ST-segment elevated myocardial infarction (STEMI) program by creating new agencies whose oversight would be duplicative of hospitals. The Chapter is now working with the American Heart Association and other stakeholders to improve STEMI response time and access without new and costly regulations. The ACC Colorado Chapter is taking a strong leadership role in improving their state STEMI program. As an appointed member of the state’s 3-year STEMI task force, they worked with hospitals, the emergency medical technician community, and the American Heart Association to craft recommendations for legislation that include data analysis from the National Cardiovascular Data Registry’s Action–Get With The Guidelines registry and meaningful, ongoing input as a stakeholder member of the Colorado health department’s Heart Attack Committee. This approach is preferred because it facilitates collaboration among stakeholders without expanding government oversight and establishing new fees. The bill was tabled at the end of the 2016 legislative session but will be reintroduced in January. In addition, effective local, state, and regional STEMI networks of coordinated care have been established without the need for obtrusive state legislation. In many examples, such as in North Carolina and Mississippi, the extraordinary efforts of chapter leadership have been complemented with assistance and counsel from ACC state advocacy staff.
So many programs and initiatives aimed at preventing and treating cardiovascular disease start in the states. For example, “cardiopulmonary resuscitation (CPR) in schools” legislation continues to be a priority for ACC chapters. In collaboration with the American Heart Association and through a successful grassroots approach that included meeting with legislators, providing testimony, and reaching out to media, 7 states (New Mexico, Kentucky, South Carolina, Wisconsin, Ohio, Arizona, and Missouri) have enacted laws requiring high school students to receive CPR training as a condition for graduation. These actions bring the total of states requiring CPR training for high school graduation to 34. Final action mandating the requirement in Michigan and the District of Columbia is anticipated before the end of the year.
Meanwhile, Kansas, Vermont, and Wyoming are on the way to requiring newborns to receive pulse oximetry screening for critical congenital heart disease, bringing the number of states with critical congenital heart disease screening requirements to 49, along with the District of Columbia. Idaho is the only state that has not enacted legislation or addressed the issue through regulations.
On the tobacco policy front, California enacted 5 tobacco control laws this year, including the nation's second “tobacco-21 law” that raises the purchase age for all tobacco products to 21 years, and a comprehensive e-cigarette law that adds the devices to the state's smoke-free law. The District of Columbia Council appears positioned to follow in California's footsteps before the end of the year, with both a tobacco-21 bill and a smoke-free sports venue measure under review. Meanwhile, 6 states have enacted tobacco tax increases in 2016: Connecticut (25 cents), Louisiana (22 cents), Minnesota (10 cents), Oregon (1 cent), Pennsylvania ($1), and West Virginia (65 cents).
Practice stability is another issue of great importance. Many states continue to reject proposals to scrap current state litigation systems and replace them with a workers' compensation model that would create regulatory, quasi-judicial “expert panels” with authority to identify valid claims of injury and patient compensation. Proponents promise that physicians will no longer need legal representation or malpractice insurance, but fail to explain how the administrative function and patient awards would be funded. Working with state medical societies and The Doctors Company this year, ACC chapters helped to defeat proposals in Maine, Tennessee, and Ohio. ACC's Indiana Chapter worked with the state medical society and others to pass legislation to raise the cap on noneconomic damages. Although the medical community does not usually support such increases, Indiana's cap had not been raised in several years, rendering it vulnerable to elimination. Further adjustments may be needed to ensure that the cap remains.
These are but just a few examples of the many ways the College and its members are actively working with Congress, state governments, and other key stakeholders to develop a health care system that puts patients first and rewards cardiovascular professionals for their commitment to quality, evidence-based care. These examples are proof that advocacy work is truly effective when members are highly involved.
A Call to Action
Successful pursuit of ACC’s advocacy agenda demands that we continually strengthen and enhance cardiology’s voice in health policy at all levels. One of the ACC’s most involved advocate leaders, Eugene Sherman, MD, FACC, said it best: “I’d like to challenge us all to think about ‘advocacy,' not in the polarizing political party sense, but as two-way communication with policymakers, regardless of political affiliation, about how we can best work together to ensure cardiovascular patients have access to the best and most appropriate care” (Personal communication, August 2016). Working together is the key to success in advocacy, and involvement is where it begins.
The ACC offers a number of ways for its members to get involved in advocating for health policies that ensure continued patient access to quality, cost-effective care. Whether it is sending an e-mail to members of Congress, inviting lawmakers for a practice visit, taking part in ACC’s annual Legislative Conference in Washington, DC, or taking part in the ACC’s Political Action Committee, the College has resources and options to enable members to become effective advocates for their patients and their profession.
One of the most exciting outgrowths of the ACC’s advocacy space is the new Emerging Advocate program, created thanks to the ACC’s commitment to leadership development. This program is a unique opportunity for ACC members, particularly fellows-in-training, early career professionals, and cardiovascular team members, to increase their knowledge of, and participation in, the College’s legislative, regulatory, and state government relations; payer advocacy and value solutions; and population health efforts. During the 2-year program, the emerging advocates will learn directly from the College’s advocacy leaders and identify opportunities where they can advance ACC’s advocacy activities.
The future of cardiovascular care is at stake, and it behooves each of us to make advocacy a professional and personal priority.
- American College of Cardiology Foundation
- ↵American College of Cardiology. ACC: MACRA should be flexible and support evidence-based care. Available at: http://www.acc.org/about-acc/press-releases/2016/04/19/10/32/acc-macra-should-be-flexible-and-support-evidence-based-care?w_nav=S>. Accessed August 8, 2016.