I've talked pretty extensively over the past couple of weeks on this blog about ACC’s position on conflicts of interest and relationships with industry. In a response released yesterday, the ACC again outlined its "stringent approach to ensuring responsible, transparent relationships, in which industry support has no influence on educational content, quality measures or scientific research.”

Institute of Medicine Report
We also signed on to a joint statement with several other medical societies responding to the April 28 Institute of Medicine report on the topic. On Tuesday, I interviewed current ACC President Fred Bove, M.D., Ph.D., F.A.C.C., on the report. He said, “The report made it very clear that there’s a value in working with industry ... We can’t divorce things, one from the other; but rather, we must come up with the proper solutions for transparency, with review processes that prevent bias ...” Check the video below for the full interview.  I was also interviewed by MedPage Today on the report.

The College is committed to responsible and transparent relationships with industry. While the potential for abuse is there, by following responsible, ethical, and transparent policies, industry support can produce positive patient and societal benefits, including much-needed funding for research, evidence-based quality improvement and unbiased medical education.

This post comes from ACC Secretary and Board of Governors (B0G) Chair John Gordon Harold, M.D., F.A.C.C. Dr. Harold is cardiologist at Cedars-Sinai Medical Center, and has held a number of leadership posts within the College, including as a past president of the California Chapter and immediate past governor for Southern California. As BOG Chair, Dr. Harold will champion the 2009-2010 BOG priorities, in particular focusing on state advocacy.

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At any given moment, states and their lawmakers are thinking about, drafting, considering or even voting on legislation that will impact the way you practice medicine. As a practitioner, you may never hear about these initiatives – even though you could be directly affected.

This is where your local chapter comes in. ACC chapters work together with the ACC to pursue critical state legislative initiatives, such as maintaining access to office-based imaging, ensuring appropriate STEMI care, championing health advocacy and promoting public safety. The chapters and the ACC also work closely with the Board of Governors (BOG) Steering Committee and State Advocacy Work Group (formed by the BOG in 2008 with a mission to increase and improve state advocacy and outreach). This group maintains regular contact with Jim Boxall at the ACC, who is a virtual clearinghouse of information on legislative and regulatory issues and how-to tips for expanding Chapter state advocacy programs. 

Through these collaborations, the College is pursuing a multi-faceted policy and legislative agenda that reflects the diverse needs and interests of members. This agenda includes holding enhanced lobby days and “Cardiologist for a Day” programs, improving online advocacy tools, and increasing collaboration with the American Heart Association (AHA) and other groups.

In addition, the College, through its State Advocacy Workgroup, is working closely with six chapters that have the staff and resources to be models for other states. Using ACC National Funding Proposals, these chapters -- Alabama, Arizona, Iowa, Kentucky, Rhode Island and Washington -- will build relationships with other medical groups and their respective state legislatures to influence policy.

California Chapter: An Example

In my chapter, the California Chapter (CA-ACC), we have a history of state legislative victories. This is because Chapter staff, in cooperation with ACC state advocacy staff, closely monitors all legislation and actively lobbies to defeat adverse legislation while supporting legislation to promote the quality of cardiovascular patient care.

In one particular example, Chapter leadership reached out to colleagues at the American College of Radiology through the California Radiologic Society (CRS).  The discussion revolved around a proposed Assembly bill that could potentially limit office-based cardiac imaging. When the bill came up, I recommended contact with CRS to see where we could find common ground, as the stated focus of the bill was eliminating "fraud and abuse." The inter-society discussions went well and both groups agreed to focus on mutually acknowledged areas. Both the CA-ACC and CRS lobbyists worked together and came to an agreement on bill language.

For other state chapter examples, visit the ACC Chapter Web site. 

Get Involved!

The ACC is only as strong as its members. You can help advocate for quality health care—and influence health care policy—at both the state and federal level in several ways: 

1. Get involved with your ACC Chapters by contacting the Chapter Executive in your state.
   
   
2. Get involved at with ACC’s grassroots efforts (www.acc.org/CAN) and help shape health care policy at the federal, state and local levels.
    
   
3. Support candidates who understand the importance of cardiovascular care by donating to the ACC Political Action Committee (PAC).
   
   
4. Attend the American College of Cardiology’s 2009 Legislative Conference taking place Sept. 13-15 in Washington, D.C. Take advantage of this opportunity to help educate Congress about the needs of cardiovascular professionals and patients.
   
   
5. Visit the Web site of ACC’s health care reform campaign, Quality First, and visit often! Here you can learn about how the ACC is working to transform health care from the inside out, as well as the latest Quality First news and events.

- By John Gordon Harold, M.D., F.A.C.C., Chair, ACC Board of Governors

* Dr. Harold's post is part of a monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform! 

*** California State House. Image from Flickr (fusionpanda). ***

Get ready -- and tell your friends. We’re going to get health care reform this year. We’re now at 50 million uninsured. A combined Senate bill on health reform (Finance and Health, Education, Labor and Pensions) and a House bill (Ways & Means and Energy & Commerce) are theoretically on track to be marked up for hearings in the first week of June. A flurry of debate and discussion will happen thereafter in June and July. Congress recesses for the entire month of August, but I suspect a good deal of behind-the-scenes lobbying by ACC will be conducted with the administration and congressional staff all through the sweaty month of August.

Senate Roundtable
Senate Finance had a roundtable last week to discuss delivery system reform. American College of Physicians and American Cancer Society were the only professional society reps asked to give formal statements. They didn’t have much new to mention we haven’t covered here (SGRrrr, patient-centered medical home, health IT). However, Glenn Steele, M.D., CEO of Geisinger, gave in my view the most compelling suggestions on how delivery system reform might succeed -- he was surely and deservedly the rock star there. As he has discussed previously with the ACC, Geisinger is showing the way to reduced waste, reduced readmissions, and improved coordination of care. Steele is also interested in working with the ACC on our quality networks ideas, AUC, and registries.

But 85-90% of health care isn’t in integrated systems like Kaiser and Geisinger -- yet. More...

The Accreditation Council for Continuing Medical Education (ACCME) will not take any action to end the commercial support of accredited CME, according to a report from their March board meeting. The report underscores ACCME's belief that its Standards for Commercial Support and associated ACCME policies "support the development of independent continuing medical education that is free from commercial bias and does not result in an inclination by professionals to direct care that is unwarranted or unnecessary."

The report notes that the ACCME will consider creating a new designation for CME that is free of commercial support, as well as an independent, nonprofit granting entity to accept unconditional and unrestricted donations from all U.S. sources to distribute to ACCME-accredited organizations for development of CME.

All the major participants in the governmental reform processes — Congressional Committees and the White House — are putting words to their ideas for health care reform at a frenetic pace (just look at the media coverage). ACC has been asked for feedback again this week from all of these key determiners, including intense meetings with the Office of Management and Budget team and with the Senate Finance Committee staff leadership.

The Senate Finance Committee has begun their debate three buckets of health reform issues earlier this week: delivery system, coverage and financing. Of course, most of our issues fall under delivery system reform, but financing is where it will all happen or not. The roundtable included input from payers, think tanks, providers, consumer advocates and business. WE have made sure our views are on the table. Most of what happens is behind the scenes -- the window dressing is just to make sure the media knows things are happening.

Legislation is still likely to officially emerge from these almost-occult processes in May or June. Rumors abound about what it might look like.

What Reform Could Look Like
Reforms will likely be proposed and funded over three time phases: immediate changes (in the next one to three years); intermediate reforms (over two to five years) and longer-term reforms (over seven years). In each phase, the delivery system, payment models, financing structures, and administrative and regulatory systems will undergo fairly dramatic change. The administration reiterates the future health care system should preserve choice, should cover all citizens, should promote quality and should do all this while slowing the rate of cost increases. More...

Medicare Payment Advisory Commission reported last week that 28% of Medicare beneficiaries had trouble finding a new primary care physician in 2008, up from 24% the year before. Some other stats they noted:

• The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance.
  
  
• HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate [among providers] from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.
  

This data reveals that the Medicare access problem -- before the boomer hit -- is serious already. We need to bolster primary care, but also to fix the entire Medicare mess.

*** Image from Flickr (Ben Zvan). ***

• Senators Set Timetable for Health Care Bills (Robert Pear, New York Times): "The chairmen of two Senate committees told President Obama today that by early June they would finish writing legislation on health care to 'provide coverage to all Americans.'"
  
  
• Congress Inclined to Act First on Health (Greg Hitt, Wall Street Journal): "Shortly after Congress returns from recess Monday, lawmakers will have to choose which Obama promise to make a higher priority -- overhauling the health-care system or addressing climate change."
  
  
• Senate to tackle health care reform (Erica Werner and Ricardo Alonso-Zaldivar, Associated Press): "This time it's really going to happen. Or so they claim."
  
  
• Senate, House to Hold Meetings on Health Care Reform (Ridgley Ochs, Long Island Newsday): Both Senate and House committees will be holding meetings this week on overhauling health care, with an eye toward having legislation ready by August.
  
  
• Obama’s Revenue Plans Hit Resistance in Congress (Carl Hulse, New York Times): "President Obama is running into stiff Congressional resistance to his plans to raise money for his ambitious agenda, and the resulting hole in the budget is threatening a major health care overhaul and other policy initiatives."
  
  
• Congress makes health care top priority (Sean Lengell, Washington Times): "When President Obama vowed last week to rebuild the nation's slumping economy on the strength of "five pillars," there was little doubt on which column construction would begin first - health care reform."

UPDATE: The ACC has released this statement on our committment to comparative effectiveness, in response to a recent Bloomberg article on a new coalition called the Partnership for Improving Patient Care, an organization formed to promote comparative effectiveness and comparative effectiveness research (see yesterday's post on the subject "Clinical and Cost Effectiveness: The Bloomberg Boo Boo). It states:

We must develop much-needed randomized clinical trial data to fill many research gaps in the current environment. CE and CER provide a critical means to address these data and research inadequacies. Without a multi-billion dollar ongoing commitment to comparative effectiveness through federal funding, many unanswered vital clinical questions could persist for decades. This is unacceptable.

The College fully understands that cost effectiveness also is important to society and to health care reform and that it is an important parallel process to clinical effectiveness. If we are to distribute scarce resources fairly to the most important scientific and clinical priorities and to all patients regardless of income, we must determine cost effectiveness of care options, once the science is clear, and recognize that marginal increases in clinical effectiveness with very large price tags will not be affordable in a sustainable health system.

It concludes: "There’s no conspiracy here. ACC’s participation in PIPC is consistent with our principles, policies, commitment to ethics and appropriate relationships with industry."

Bloomberg News this week reported a damning story on a new organization called the Partnership for Improving Patient Care (PIPC). PIPC is a benign and positive new coalition (about 4 months old), which industry folks have decided to participate in.

The Bloomberg story suggests PIPC is nothing more than a front for big PhRMA, and actually opposes comparative effectiveness. Wrong. ACC joined PIPC about two months ago (for a nominal membership fee) to be part of a very broad constituency of consumer groups, professional societies and others who believe that comparative clinical effectiveness is a critical priority in health care reform, as well as a process that must be determined in a scientific, unbiased and pure fashion -- and thus not mixed up with cost effectiveness as the hidden goal -- in order to have the respect and trust of physicians and patients.

Other members of this partnership include the American Association of People with Disabilities, American Academy of Nursing, the American Association of Neurological Surgeons, the Association of Clinical Research Organizations, Easter Seals, the National Alliance for Hispanic Health, the AIDS Institute and many more. Some pharmaceutical companies, device manufacturers and related coalitions have recently also joined to support the aforementioned goals. That shouldn’t be surprising. More...

You probably noticed that one of the studies presented at this year’s Annual Scientific Session showed sudden deaths occurred nearly twice as often in athletes participating in triathlons as in athletes participating in marathons: 1.5 per 100,000 versus 0.8 per 100,000. Investigators examined deaths that occurred in 2,846 triathlons featuring 922,810 participants. Nearly all the triathlon sudden deaths took place during the swimming portion of the event. 

Noting this unexpected differential, I've asked ACC Board members and officers to stick to marathons from now on.

*** Image from Flickr (Diamondduste). ***