Wired

by Jack Lewin November 29, 2007 21:48
The WIRED for Health Care Act, seemingly dead earlier this month, has apparently been defibrillated back to life. Our protests about provisions for collection and dissemination of Medicare claims data in the last version are having some effect though. There is now talk of using clinical data, and of having only limited amounts of data releasable in any case. It would be good to get these concerns resolved, given the bill’s main goal of setting interoperable standards for health care is sorely needed.

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Health IT

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Prescription Pad Days Numbered

by Jack Lewin November 28, 2007 21:41
HHS Secretary Mike Leavitt recently proposed new standards for electronic prescribing. While e-prescribing is not currently required for physicians and pharmacies, those participating in the Medicare Part D program will be required to abide by the standards if they choose to send or receive prescriptions electronically. Congress and others, however, are considering measures requiring widespread e-prescribing adoption. Senators John Kerry (D-MA) and Debbie Stabenow (D-MI) are drafting a proposal to attach to Medicare legislation this year and have asked ACC for input. Currently, less than 50 percent of Medicare Part D prescriptions are submitted electronically. If e-prescribing measures become mandatory immediately, many physicians may find it difficult to comply. The ACC is following this issue closely.

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Health IT

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Temporary Peace on the Hill

by Jack Lewin November 20, 2007 16:20

Congress has recessed for two weeks for Thanksgiving (they went home for a different kind of “gobble-de-gook”). After failing to pass or veto-override any major health or domestic spending legislation recently, the fate of the impending physician payment cuts is grim. 

When lawmakers return on Dec. 3, they will have very little time to get their business done before adjourning as late as Dec. 21. As we were quoted in Congressional Quarterly (CQ) this week, the “only good news is that both Houses desperately want to get a two-year SGR band-aid proposal passed next month so as not to have to face this issue again next year in an election cycle." But, if they do pull a rabbit out of the hat, where’s the money coming from? Hopefully not from imaging or procedure cuts---and we are working hard to prevent that approach.

IT’S NOT TIME TO GIVE UP for this year! This is where the ACC and all of you reading this can play a critical role. Our ongoing efforts to stop the Medicare physician payment cuts and fix the “Un-Sustainable” Growth Rate Formula (SGR) are the top priority. All ACC members should use the ACC’s CardioAdvocacy Network (www.acc.org/can) to contact their members of Congress and urge them to stop the latest round of cuts. VISITING MEMBERS OF CONGRESS WHILE THEY’RE HOME FOR THE RECESS WOULD BE POWERFUL.

On a broader level, the ACC’s involvement in health system reform is key to truly transforming the health care system. We talk about that in every Congressional encounter. Faced with the latest CBO projections (see earlier post), we owe it to the future generations of patients and health care professionals to start searching for viable solutions now--or, more realistically, over the next few years.

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Costs/Value | Payment Reform

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A Scary Projection

by Jack Lewin November 20, 2007 16:18

The Congressional Budget Office (CBO) has just released an important new study suggesting that future health care spending could be far higher than government experts currently project. According to the study, total spending on health care would rise from 16 percent of gross domestic product (GDP) in 2007, to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082. These findings are nearly 50 percent higher than previous projections.

This is huge. Current estimates put social insurance commitments and other fiscal obligations for Medicare and Medicaid at $50 trillion, up from a $20 trillion estimate in 2000. This shortfall represents four times the nation's total economic output. According to U.S. Comptroller Tom Walker, unchecked rising national health care costs are the greatest threat to future economic stability.  He’s talking about 30 year projections--the 70 year projections are clearly even more untenable, without major tax increases, reductions in benefits and mega-system changes.

Most of us won’t be here in 2080 -- unless of course there are major advances in bionics and cell-biology.  If we are here, we may look like lizards from hell, and also need considerable personal wealth to afford health care. The point is that without changes in federal law, spending on Medicare and Medicaid is on a path that cannot be sustained. We as physicians have a challenge and an opportunity to figure out how to slow these cost increases, to make sure each dollar spent produces more health, and to thus promote maintaining an equitable health care system for all.

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Costs/Value

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Check Out These Resources on Health Care Coverage

by Jack Lewin November 19, 2007 15:37

I received an email last week announcing the Alliance for Health Reform’s latest toolkit on child health coverage. This toolkit provides a great overview of the State Children's Health Insurance Program (SCHIP), with an update on congressional reauthorization of the program. This is the third in a series of five Alliance toolkits for reporters supported by the Robert Wood Johnson Foundation. I also encourage everyone to check out their toolkit on the uninsured, which offers links to resources that will help you understand who lacks health coverage in the U.S. and the consequences of being uninsured. It also provides links to proposals for change, including Web sites that track presidential candidates' plans, as well as to public opinion polls and updates on state-level reform. Coming soon will be kits on health care costs and health information technology. For more information, go to: http://www.allhealth.org/.

 

 

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Access | Costs/Value

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Defining Transparency in Physician Reporting

by Jack Lewin November 8, 2007 20:16

When it comes to public reporting and transparency, the ACC is still in the process of defining a precise policy. It's not easy. As a result, suggestions and feedback on this topic are helpful as we attempt to reach a consensus.

In general, however, I believe we cannot afford not to act on this issue. The absolute reality is that public reporting and transparency on outcomes and performance is coming! If we are not bold and we fail to claim the quality reporting and evidence-based transparency space, others will claim it. We will be told what to do, rather than have a say in how to do it!

I realize there is a wide array of opinions and emotions on this subject. For example, we believe that we should continue efforts to support public reporting initiatives such as the Physician Quality Reporting Initiative (PQRI), while also developing our own tools and resources. This builds bridges in Congress on our advocacy agenda, making them less likely to whack reimbursements on imaging or procedures, for example.

In addition, our work toward promoting participation in the NCDR through clinical data collection at the point of care is bearing some fruit. CMS is doing two studies to evaluate registry use as a means of measuring quality and we are also beginning to win support in Congress and elsewhere on the value of our approach.

But, what should our transparency policy be to keep us at the table when these kinds of national policies are being crafted? ACC leaders are working to tackle this tough issue and develop a position. Your feedback on this important topic as we consider our present and future policy would be invaluable.

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Measurement | Transparency

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Claims Data and Physician Quality Reporting

by Jack Lewin November 6, 2007 08:02

ACC is clear in our advocacy and quality efforts that the use of claims data to attempt to measure physician quality performance is a seriously flawed idea. While there are some legitimate uses of claims data (ie. estimating volume/usage of procedures, drugs, diagnoses, hospital readmissions, etc), more information is needed to truly measure performance.

The recent ruling by the U.S. District Court for the District of Columbia that would allow the release of Medicare physician claims data for Illinois, Maryland, Virginia, Washington state and Washington, D.C., highlights the need to develop a solution to this problem.  While there are already various proprietary firms using commercial claims data to provide very worrisome "outcomes" information to health plans, this new assault is scary.

Fortunately HHS Secretary Leavitt reacted to physician concerns about this proposed unfiltered release of data, and has appealed the court ruling. The ACC is planning on being an amicus (friend of the court) partner on that suit! In addition, given the lawsuit and increased discussions in Congress and among payers about the use of claims data as a means of measuring physician performance, ACC leaders are in the final stages of defining principles for public reporting. 

Greater transparency of health care quality is a goal to which we as physicians, other health care providers, payers, and consumers should continue to strive, but only if this “clarity” accurately reflects the performance of those being measured and only if these reports serve to improve health care, including access to it, for patients. Stay tuned for more information.

 

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Measurement | Transparency

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ACC Leadership on Quality Opens Doors

by Jack Lewin November 1, 2007 06:51
In my frequent travels around the country, I’ve heard from physicians, patients, business leaders and elected officials collectively frustrated with the current health care system and its misaligned incentives, lack of coordination of care and inconsistent quality. Couple this frustration with 47 million uninsured Americans, an increased focus on cutting costs and rapid growth of new technologies, and you have a system in dire need of reform … and quick!

The good news is that the ACC is increasingly recognized as being at the forefront of efforts to transform the health care system – from the "inside out." Just recently I  was at the ACC’s Medical Directors’ Institute (MDI) in Phoenix, where representatives from UnitedHealthcare, Wellpoint, Blue Cross Blue Shield and other health insurance companies both large and small repeatedly praised the ACC for its leadership. The College’s data registries, appropriateness criteria and performance measures and guidelines were lauded as innovative tools that could be used to reduce costs, improve outcomes and bring about timely, efficient and equitable care.

It’s one thing for the officers and me to promote the ACC’s quality efforts, but it’s another to have it recognized by others – especially those who have a huge stake in the development of health system reform. This external acknowledgement that we are on the right track presents exciting opportunities to explore partnerships and potentially develop alternative solutions to the measures and programs being proposed by health plans and CMS. 
 
Our plans for expedited guidelines and clinical consensus documents, ambulatory data collection, and initiatives designed to bridge the gaps between science and practice are more attainable than ever before. UnitedHealthcare’s recent partnership with the ACC on the development of a pilot program to test Appropriateness Criteria for SPECT MPI is one example of an opportunity turned into action. Others will follow.

I’m excited about the possibilities ahead and I hope you will join me by taking an active role in discussions around health system reform and taking advantage of the ACC’s tools and resources already in place to help patients and practices. We must continue to make this issue a priority and continue to lead. The issues surrounding quality improvement and health system reform affect us all.

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Costs/Value | Measurement

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About the Authors

The ACC in Touch Blog is primarily co-authored by current ACC President John Gordon Harold, MD, MACC, and Board of Governors Chair David May, MD, PhD, FACC.

Harold John Gordon Harold, MD, MACC, became ACC president in March 2013. Dr. Harold is a clinical professor of Medicine at the Cedars-Sinai Heart Institute in Los Angeles.

May David May, MD, PhD, FACC, began as the chair of the Board of Governors in March 2013. Dr. May currently works as a managing partner at his private practice, Cardiovascular Specialists, PA (CVS) in Lewisville, Texas.

Learn more about Drs. Harold and May.

Statements or opinions expressed on the Blog reflect the views of the contributor, and do not reflect the official views of the ACC, unless otherwise noted.

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