Great news for our NCDR Registries! The NCDR has secured its second multi-year Task Order contract with the FDA. Right now, we provide analyses of the diffusion of ICDs and carotid stents into the marketplace. The FDA recently asked us to respond to three new proposals: one for a study of atrial fibrillation ablation, one for a study of B-type Natriuretic Peptide and one for a study of lead safety. The FDA this week awarded us all three studies to be conducted over the next two years. This is an important signal of regulatory confidence in the outcomes-based evidence the NCDR can provide. Congratulations to all involved!

David Blumenthal, M.D., M.P.P., director of the Institute for Health Policy and an advisor to the Obama campaign, earlier this month published a sharp critique of Sen. McCain’s health care plan in the New England Journal of Medicine. "Primum Non Nocere — The McCain Plan for Health Insecurity" identifies McCain’s proposals with the Bush administration’s health policies, and warns that the Republican candidate’s plan would decimate the current employer-sponsored health insurance system.

Of course, in one sense no surprise -- the NEJM emanates from a very liberal area, and Blumenthal is an Obama advisor. But, I think there’s something of interest here for you, regardless of who you support in the presidential campaign. McCain wants to unleash the free market to lower costs, promote choice, and improve quality... Who can argue with that? But, given the complexity of health care, moving toward that goal precipitously could create a crisis even bigger than the current banking nightmare. Blumenthal has to be seen as partisan; but there are concerns there that I wish McCain’s advisors (Doug Holtz-Eakin and others) had thought through more carefully before putting incomplete ideas out there  Not that Obama’s ideas are complete strategies either. As I’ve shared previously, I think both party platforms are worrisome for doctors and ACC. That’s why we need to engage and get involved in the final products. But this makes thoughtful reading if you extract the partisan bias. I’d be interested in your thoughts.

Politico on Monday featured my letter in response to the “Dear 44” columns it has run recently offering suggestions on health care reform — among other topics — for the 44th president. In my letter, I emphasize the need for systemic reform and ACC’s evidence-based approach to high-quality, high-value health care, and...

... actually, please look at my letter. I’d like your feedback about whether what I’m suggesting (ACC policy) is where YOU think we should be heading.

We have now reached China on our cardiovascular tour through Asia. ACC President Doug Weaver and I, along with our ACC delegation, are attending the Great Wall International Congress of Cardiology. This is our 3^rd year in this joint sponsorship of a major meeting -- this year with over 2500 cardiologists from China and Asia attending. It has been a great and eye-opening trip. The science exchange is very valuable for BOTH sides. Dr. Weaver and I had an incredible visit to Fu Wai hospital, China’s largest CV center. Just in the one year since former President Jim Dove and I were there, the changes are impressive. Fu Wai is a D2B partner and they feel they are well within the 90 minute reperfusion goal -- and they’d be interested in using the NCDR to be consistent with ACC in data exchanges. Their outcomes in PCI, CABG, CHD, and transplants closely parallel ours, but CV disease is rapidly growing in China, partly because of worsening Western habits of diet and exercise, but also because so many people (mostly men) still smoke here. The Great Wall Conference is probably the biggest anti-smoking venue that occurs in this country -- given the government conflict with significant ownership of tobacco income -- and this is a really bold aspect for the Chinese contingent of our joint meeting.

For anybody who hasn’t been to Beijing recently, it is almost shocking to see the near absence of bicycles and scooters, replaced by modern, up-scale and luxury vehicles and super-modern transit and infrastructure. I don’t think there is a U.S. city as modern, clean and affluent in general as this place. There is no ‘bad section.’ Most Americans don’t know this. The rural areas may be far behind -- but watch how fast they start to catch up too. The energy, passion to achieve, and work ethic is what our country was like until recently. By comparison, we seem to have developed a society that feels ‘entitled’ in many ways in the U.S. (in my opinion), versus the ‘fire in the belly’ passion and personal responsibility ethic to succeed that one can’t help feeling here. But, people are very, very nice. They seem to like us and the U.S.

Personally, I have complete faith in our country to continue to lead and succeed in the changing world, but success in the future will not be handed to us on a platter of entitlement. I’m not talking about lower income people here, I’m talking about us ALL! We need to keep our antennae up to deal with the competition we face in the future. I think we’re up to it -- but not in the way old Europe and America feel entitled to more time off, more benefits, higher pay without higher performance, etc. If America doesn’t start replacing our aging infrastructure, for example -- and be willing to pay for it -- we will become obsolete over the next decade in this new world. But, we won’t let that happen. Right?

HHS Secretary Leavitt last week warned that Medicaid now covers more than 50 million American (one out of six citizens). With the program costs rising much faster than Medicare’s % rates -- Medicaid expects an 8% jump this year -- the program is untenable for the federal budget, and even more so for states. This perfect storm scenario begs the need to real system change…

Stephen Schoenbaum, M.D., M.P.H., EVP at The Commonwealth Fund, commented last week to national leaders in D.C. on the United States’ continued poor performance on measures like mortality amenable to health care, life expectancy and infant mortality. Infant mortality has actually slipped backwards over the past 2 years. According to Dr. Schoenbaum, this is due to flawed preventive care and a broken health care system that often fails to identify underlying chronic conditions. With respect to infant mortality, our performance is complicated due to some of our unique social issues like drug abuse and obesity. Dr. Schoenbaum calls for health system reform with an emphasis on measured quality for prevention — sound familiar?

Dwindling 401k’s are not just a headache. They could result in serious health problems for Americans who are delaying care for chronic conditions due to financial concerns. The New York Times reported yesterday that Americans are cutting back on meds, and the Washington Post reported last week that the economic downturn is prompting many Americans to perform self-triage, delaying preventive and other regular care for a variety of conditions. Gruentzig may have performed coronary catheterization on himself on the kitchen table, but I don’t recommend to others. This will hurt prevention efforts.

A new report by Paul Ginsburg at the Center for Studying Health System Change concludes medical technology is significantly the culprit for soaring health care costs. AdvaMed and advocates for technology advances strongly disagree.

New technology does contribute to higher costs, and physicians should be careful about how they use it. But that doesn’t mean we shouldn’t use it. Technology, properly used, can avoid more expensive inpatient care and medical complications due to delayed diagnoses. This is where the ACC’s Appropriate Use Criteria and evidence-based guidelines come in. Using advanced technologies appropriately will help save dollars and lives. But, given the growing financial crisis, there will only be more calls to reduce costs, and some of them will be shortsighted in terms of longer term cost savings.

With physician supply problems in cardiovascular care looming, having likely new cuts in Medicare and Medicaid could actually reverse progress in CV morbidity and mortality in the near future. We can’t let that happen.

WSJ’s Health Blog on Friday discussed one area in which McCain and Obama actually agree on in health care: that reform to the Medicare payment system is necessary. Reform to the SGRrrr is necessary and should be based on “coordinated and quality-outcome-based care” (according to McCain advisors) and “patient outcomes” to promote “better health, not just more care” (according to Obama advisors).

WSJ’s Jacob Goldstein writes:

“The prospect of linking doctor pay to patient outcomes makes lots of doctors nervous. Many doubt that a payment system can accurately account for important differences between patients. And they worry that any changes will only mean more paperwork and administrative hassles.”

Maybe true, but the benefits outweigh any concerns. The ACC is highly supportive of payment reform based on quality.

• The ACC supports CMS efforts with the Physician Quality Reporting Initiative, even though it is a baby step without sufficient incentive to work or promote HIT adoption
• The ACC is promoting a pilot that would focus payment on improved outcomes and better patient care through health IT adoption and e-adherence to guidelines
• The ACC’s Quality First campaign supports financial incentives that allow physicians to strive toward providing the highest quality of care possible

Despite that recent events may make payment reform a long way off, ironically, it’s a reform that could save some money, improve care and cost far less than any other reform proposed. It could be all that happens next year after the SCHIP and SGRrrr reauthorizations -- but it’s necessary if we are to sustain our health care system.