This post was authored by Dino Damalas, chief information officer of the ACC.

It’s no secret that technology is playing an ever increasing role in our daily life.  A study conducted by manhattanResearch in 2011 indicated smartphone penetration has reached 81 percent in the physician community and the reliance on these devices to connect with colleagues, search for treatment options, and stay informed is skyrocketing.  Cardiovascular professionals have always been on the leading edge of technology adoption, but is the College effectively leveraging technology to better deliver tools, services, and knowledge assets to help our members deliver better care?

This was the question at hand during a recent workshop that brought together College leaders, a representative group of members from around the country, patients and ACC executive staff. As part of a larger digital strategy discussion taking place across the College, the focus of the workshop was to develop a true understanding of the issues, challenges, and needs faced by cardiovascular professionals.

Workshop participants were presented with data from more than 70 individual interviews, shadowing exercises conducted at member practices, and a wealth of secondary research and were able to get an inside look at the behaviors, needs, and challenges related to use of digital technologies. This data was then used to develop a comprehensive user needs model based on several member segments that was then used to facilitate discussions around the many ways the ACC could leverage technology to deliver tools and services.

The workshop was eye-opening and the exercises enriched a collective understanding of how to better serve the cardiovascular community.  Moving forward there is still much more to do in order to move the concepts identified at the meeting from ideas to reality. The next step is to develop a comprehensive digital strategy and outline a roadmap that will help us move forward in meeting member needs in the digital future. What was also clear during this event – envisioning the future through technology is not a singular event.  Technology changes rapidly and so must the College. Leveraging the latest technology to bring the best possible science and education to our members, when they need it, where they need it is as core to our mission as developing practice guidelines.

This year, in addition to providing a discussion forum on various issues facing cardiology, I want to use the ACC in Touch Blog to provide you with a first-hand glimpse into the meetings, trips and other engagements that your ACC leadership team is undertaking on your behalf.

In the past two weeks, ACC President-Elect Dr. John Harold, Interim Chief Staff Officer Tom Arend and I flew to Boston to attend the Heart Rhythm Society's (HRS) Annual Scientific Sessions, which had close to 13,000 attendees. While there, we met with HRS leadership, including outgoing President Dr. Bruce Wilkoff, Incoming President Dr. Anne Gillis, and had an open discussion on how to improve overall communication between our two societies, as well as how best to collaborate around quality projects like NCDR.  Education was also a topic. We discussed including a full day of programming by HRS at ACC.13 in San Francisco (similar to ACC.12), and a reciprocal session on quality at the 2013 HRS meeting. Both teams felt this open face-to-face dialogue brought new perspectives and improved current relations and communication.

From there, we flew to Las Vegas for the SCAI 2012 Scientific Sessions, where we were joined by ACC’s Chief People Officer Cathy Gates and former ACC President Dr. Ralph Brindis. We met with the SCAI leadership including newly installed President Dr. Jeff Marshall, President-Elect Ted Bass and others. We discussed topics ranging from our collaborative efforts on clinical documents like appropriate use criteria, to the importance of ACE (Accreditation for Cardiovascular Excellence) for accreditation of interventional laboratories. We also clarified the role of the ACC Interventional Academic Council as an advisory body to College leadership on interventional matters. It was a welcoming meeting and one that I feel furthers our collaboration in the field of interventional cardiology.

On May 19, I found myself back in my home state of Texas to participate in two great events in Dallas. The first was the Texas ACC Chapter meeting.  Former AMA President Dr. Jim Rohack shared his views on the health care system and its future, while I spoke on why physicians should be involved and “get off the sidelines”—an important stance for advocacy, professional education, or even mentoring of the future generations of cardiologists. Many thanks to ACC Texas Governor and BOG Chair-Elect Dr. David May, as well as the program committee, for a very successful program.

Also on May 19, I attended the celebration of the 60th anniversary year of Mended Hearts. Mended Hearts and Mended Little Hearts are great organizations with more than 18,000 volunteers helping patients recovering from heart surgery and/or other procedures. I had the honor to be the keynote speaker at the event, sharing with the audience of close to 500 volunteers the latest advances in cardiovascular medicine, and importantly emphasizing our strong collaboration with Mended Hearts in patient education and engagement. Gus Littlefield, president of Mended Hearts and Mended Little Hearts, surprised me by affectionately presenting the College with a special recognition award for our collaboration and emphasis on patient-centered care.

Next stop was Washington, DC, for the ACC’s Clinical Quality Committee retreat chaired by Dr. Joe Drozda. During a break in the meeting, I was introduced to “Twitter” – a form of social media I had avoided until I learned that more than 12,000 ACC members, media, consumers and others are “followers” on at least one of the College’s Twitter feeds. I am now honored with the distinction of being the first ACC Tweeting president! You can follow the various ACC Twitter accounts, as well as my own at @williamzoghbi.

My last stop in the week was San Juan, Puerto Rico, for the 23rd Annual Puerto Rico Chapter Meeting. I was here last year, and was reminded again this year about just how impressive this educational meeting is. Besides excellent scientific sessions with speakers like Drs. Mike Adams, Anne Gillis and Mike Quinones, the unique evening gala dinner brought together ACC members and their families celebrating distinguished faculty, research fellow winners and graduating fellows from training programs. Big thanks to Puerto Rico Governor Dr. Luis Rodriguez Ospina for his phenomenal leadership.

As president, my travel and other schedules may be grueling, forcing many life changes, including the art of exponential multitasking. However, being there with you, learning your issues, receiving your feedback first hand (positive or critical) and getting to connect with many of you (even through our blog or Twitter!) is what this experience is all about… it is priceless.

Today it was announced that I have been chosen by the Coca-Cola Company to represent ACC and CardioSmart in the Olympic Torch Relay leading up to the 2012 Summer Olympics in London.  It is truly an honor to be part of this historical event, which brings together people from around the world in the spirit of competition.

The relay, which takes place over 70 days, began May 19 and will include 8,000 torch bearers who will run through more than 1,000 cities, towns and villages in the UK, leading up the Olympic Opening Ceremony on July 27. I am one of 22 participants chosen by the Coca-Cola Company to carry the Olympic Flame, which I will be carrying through Bicester, England on July 9. Other participants chosen by Coca-Cola include leaders of national health organizations, former Olympians including Michelle Kwan and Summer Sanders, and young people representing charitable organizations. Participants were selected due to their commitment to live positively and make a difference in their communities.

The Olympic Flame, Torch and Relay are based on traditions that date back to the ancient Olympic Games in Greece. According to historical records, the first Olympic Games can be traced back to 776 BC. “A very precise ritual for the lighting of the Flame is followed at every Game. It is lit from the sun's rays at the Temple of Hera in Olympia, in a traditional ceremony among the ruins of the home of the Ancient Games. After a short relay around Greece, the Flame is handed over to the new Host City at another ceremony in the Panathenaiko stadium in Athens. The Flame is then delivered to the Host Country, where it is transferred from one Torchbearer to another, spreading the message of peace, unity and friendship. It ends its journey as the last Torchbearer lights the Cauldron at the Opening Ceremony in the Olympic Stadium, marking the official start of the Games. The Flame then stays lit until it is put out at the Closing Ceremony, signifying the end of the Games.”

Every four years Olympic athletes inspire us with their physical abilities and their dedication to health, sport, and country.  This year will be no different with approximately 10,500 athletes hailing from more than 200 countries who will compete in 26 sports for 302 medals.

It is truly an honor to be part of this tradition and to be representing ACC and CardioSmart, which encourages people to play an active role in their own heart health. Visit the special Olympic Torch Relay tabs on ACC and CardioSmart’s Facebook pages for more information and to stay up-to-date on the latest activities.

Also look for me on the live Olympic Torch Relay video on July 9 as I carry the Torch through Bicester, England!

This post was authored by Thad Waites, MD, FACC, past chair of the Board of Governors.

The ACC is launching a vigorous digital transition. In fact, the world is launching this transition. The House of Medicine and the health system in general has been said to be late going digital. But now with the Centers for Medicare and Medicaid Services’ (CMS’) Meaningful Use criteria, the federal government's encouragement, and the broad global rollout of new clinical technologies, we can’t afford not to move forward. Unfortunately, even the computer world is learning how difficult it is for Medicine to go digital.

In the microcosm of my clinic in Hattiesburg, MS, we have transitioned to a new electronic medical record (EMR) system, and there are certainly some lessons learned. My clinic consists of 250 multispecialty doctors with satellite clinics and a close connection to a single hospital system. Before we transitioned, we already had a very acceptable web-based software program that was modular, served our needs fairly well, but was outpatient. We needed to evolve into a larger program and would that also could be seamless with the hospital's system.

The decision to buy a new EMR from one of the major software vendors was not an easy decision. The cost was high, and the work required to transition was immense, it pulled professionals away from their jobs in the clinic. At some point personnel and physicians from every area had to train at the software vendor's campus. Additional costs were also involved, not to mention it was difficult to convince 250 physicians that this was the right thing to do.

The project was painstakingly done. It took two years to fully transition and involved carefully established timelines. It was important to have a physician champion as the leader of the project and it also helped that this physician was on the clinic governance board.

The clinic transitioned on a single launch date. Expecting the unexpected certainly applied to the first several days after the launch. Our servers malfunctioned, users were being shut down throughout the day for several days, and doctors, who had already reduced their workload for the transition, were greatly affected. Needless to say, there was a great deal of consternation. Fortunately the problem proved to be software glitches and not hardware problems. Since we had major brand servers and one of the leading software vendors, it was a surprise that these glitches had not been encountered before in other launches. Once the initial problems worked out, it has been relatively smooth sailing ever since. However, since doctors were seeing fewer patients, the entire system experienced a decrease in the bottom line during that time.

There were several lessons to be learned in our launch. Transitioning from regular dictation to voice recognition dictation or template notes has been a vital but difficult part of the transition. In addition, going from check-off order sheets to a computerized physician order entry (CPOE) has been critical but difficult as having to find the right name for a procedure, the associated diagnoses, and even where to sign the order takes time. Whether it is better to launch in one fell swoop rather than unit by unit is definitely open to debate. It is important that all issues post launch are handled by a helpdesk that is specific to EMR issues and that has adequate personnel to handle the load. It has also been vitally important for the end users to help each other.

We are now approximately 9 months into the transition and from what I hear our production is within 5 percent of what it was prior to the launch. This may or may not be a permanent decrease in production, but based on conversation with other health systems, this may just be a permanent effect of “going digital.” As for the hospital, we are now gearing up for the transition to the same EMR software.

There is no doubt that if we could transport ourselves into the future, all of American medicine will be digital. This will be beneficial to patients, the system, and even the providers. It is the going over, however, that can be quite bumpy. I therefore will end with a quote from William Shakespeare: "I am in blood steeped in so far that should I go no more, returning were as tedious as the going o’er."

This post was authored by Bob Hendel, MD, FACC, chair of the Imaging in FOCUS work group.

Overuse has been a potential problem for some time with the fee-for-service model of care. As mentioned in last week’s history of Appropriate Use Criteria (AUC) post, more than a decade ago, usage statistics for diagnostic imaging showed imaging to have the fastest growth among all medical services covered by Medicare. Additionally, marked geographic variation in use patterns is present, further raising questions about the appropriateness of cardiac imaging in certain setting. This procedural growth has slowed in recent years, with a number of factors contributing to this decline.

In 2010, the ACC developed Imaging in FOCUS, a national quality improvement initiative designed to help cardiovascular professionals best use AUC and ultimately reduce inappropriate imaging. The FOCUS initiative is comprised of a voluntary community as well as a case review tool to provide appropriate use determinations for individual patients and allows physicians and other organizations to track AUC patterns and exceptions over time.

To date, Imaging in FOCUS is comprised of over 600 sites distributed throughout the country. Sites document their AUC patterns, goals, and action plans in a structured, three-part performance improvement module and utilize the FOCUS Community resources to help inform their work. The community is also working on best practices in implementing AUC. Many sites are imaging labs reviewing AUC patterns for quality improvement credit toward lab accreditation. ABIM maintenance of certification Part IV (quality improvement) credit is also available for participating physicians.

Since the FOCUS community’s start, the College has already documented significant improvements in appropriate use (as high as 50% reduction in inappropriate use). The College has also been working with ACC Chapters and insurance companies to widely adopt a new web-based tool powered by Medicalis as an alternative to third party radiology benefit managers that require prior authorization for procedures.  This tool provides a way for physicians and their staff to implement AUC at the point of care (web portal or EHR integration). This approach is currently in use in Delaware. It is built upon ACC core competencies and offers a performance-based, transparent and accountable solution to reduce inappropriate testing, not just indiscriminant volume reduction. This same product will be offered directly to practices and hospitals later this year for direct use in patient care on an ongoing basis and contract negotiations with individual payers.

We’ve come a long way over the past few years but our work is not yet done as we still are working to educate health plans and members of Congress about the benefits of AUC, as well as what the College is doing to put AUC directly in the hands of providers and ensure appropriate testing. Through these efforts and other programs, the College wishes to promote optimal patient care and resource-sensitive procedural utilization.

For more information on how to engage health plans or other stakeholders around these issues as well as more about ACC's Imaging in FOCUS initiative, visit www.CardioSource.org/FOCUS.

This post was authored by John Gordon Harold, MD, MACC, president elect of the ACC.

While flipping through the latest issue of CardioSource WorldNews, I came across the Up and Coming Section featuring “Future Stars of Cardiology” like Patrick Calvert, MD, PhD, who has just finished at 1-year research and interventional fellowship at Hôpital Bichat in Paris, and Marc Dweck, BSc, MBChB, a cardiology specialist registrar and BHF clinical research fellow in Edinbergh, UK.

Several years ago I developed the International “Twinning Program” for ACC along with catalyzing the creation of the UK-Ireland Chapter. “Twinning” involves an ACC state chapter and an international chapter partnering to collaborate and share educational programs and resources, as well as participating in institutional visits, lecture tours and mini-preceptorships.

The California Chapter of the ACC and the British Cardiovascular Society (BSC) created the first “Twinning Program” and I helped implement the ACC-BCS Fellowship in Cardiovascular Imaging between California’s Cedars-Sinai Medical Center, where I currently practice, and London’s Royal Brompton Hospital.

Last year Marc Dweck approached me during the BCS Meeting in Manchester and asked if he could come to Cedars for a Cardiac CT preceptorship. I arranged the opportunity and Marc spent several fruitful weeks at Cedars (read an article of his in a recent issue of JACC here). During the exit interview we discussed our mutual heritage. My ancestors were from Scotland, England and Ireland. I also shared that my Grand Uncle died fighting for the British Army during World War I. Marc mentioned that his wife had lost a relative in World War I as well. Upon returning to Scotland, Marc sent an e-mail several weeks later asking about some coincidences he observed as his spouse has a relative with the last name Harold. It turns out we lost the same relative in World War I, and I am a second cousin. I was completely unaware of this section of the family! The picture in CardioSource WorldNews of Marc’s family includes their most recent addition who was baptized in the same robe as my Great Uncle – as it has been passed on to Marc’s wife’s family. The robe was first used by the Harold family at York Minster in 1861.

I’ve also learned that Patrick Calvert who was also honored in the same CardioSource WorldNews article is the brother-in-law of Marc! He also stood on the ACC.10 dais behind me and I had no idea at the time that they were related. I had two relatives on the dais with me at ACC.11.

What a celestial convergence! In order to hopefully help us learn about these coincidences and foster these relationships moving forward, we are working on developing a Facebook group for the Celtic and British Cardiac Community for all cardiovascular professionals who have the Celtic and British background. It will launch in the coming weeks, so stay tuned!  Also be sure to check out the International Center on CardioSource, CardioSource.org/International.

This post was authored by James Fasules, MD, FACC, Senior Vice President of Advocacy.

E-prescribing has been shown to improve safety and convenience for patients and clinicians, while also saving clinicians and pharmacists time and money. In an effort to encourage e-prescribing use, the Centers for Medicare and Medicaid Services in 2009 launched the E-Prescribing Incentive Program. As part of the program, providers that met the program criteria are able to earn an incentive payment on top of their Medicare Part B earnings.

Three years later, the program is still moving forward. Providers who e-prescribe 25 times between Jan. 1 and Dec. 31, 2012 will receive a one percent bonus – a definite incentive in this time of declining reimbursement. (Other restrictions apply and can be found here.) The newest addition, however, is that all eligible providers not participating in the program are subject to gradually increasing penalties. While it’s too late to avoid the 2012 penalty, there is still time to avoid the 1.5 percent penalty for 2013 … although the June 30 deadline is fast approaching.

According to CMS, individual eligible professionals and group practices can avoid the penalty by meeting the following six-month reporting requirements between now and the end of June:

• Individual eligible professionals: 10 e-prescribing events via claims
• Small e-prescribing group using the group practice reporting option (GPRO): 625 e-prescribing events via claims
• Large e-prescribing group using the GPRO: 2,500 e-prescribing events via claims

More information is also available here.

In addition, individual eligible professionals and group practices can also avoid the penalty by filing for a significant hardship exemption. Hardships exemptions are available to providers who are unable to electronically prescribe due to local, state, or federal law or regulation; have or will prescribe fewer than 100 prescriptions during a six-month reporting period (Jan. 1 – June 30); practice in a rural area without sufficient high-speed Internet access; or practice in an area without sufficient available pharmacies for e-prescribing. Hardship exemptions must be submitted through the Quality Reporting Communication Support Page no later than June 30. These requests are granted on a case-by-case basis and all decisions are final. Given the issues experienced last year by providers trying to request exemptions via the website, CMS has developed two documents outlining how to navigate the support page (Quality Reporting Communication Support Page User Guide and Tips for Using the Quality Reporting Communication Support Page). The College urges members not to wait until the deadline to file for an exemption!

For more information on health IT visit CardioSource.org/HealthIT.

This post was authored by Michael Wolk, MD, MACC, past president of the ACC.

We’ve come a long way over the past eight years with the development of Appropriate Use Criteria (AUC). To understand why these criteria are important to our daily practice, we must remember why the concept was first developed. More than a decade ago, usage statistics for diagnostic imaging was shown to have the fastest growth among all medical services covered by Medicare. At the same time, health plans in California were starting to review and question PCI and CABG cases based on RAND appropriateness criteria developed during the 1990s. The ACC’s Medical Directors' Institute, as well as leaders from our Board of Governors, saw this as both a challenge and an opportunity to look at both over- and under- use of procedures.

Upon approval by the Board of Trustees, we accepted the challenge of providing guidance regarding appropriate use of cardiovascular procedures, and ran with it. We created an Appropriateness Criteria Working Group involving several ACC leaders and published the document, ACCF Proposed Method for Evaluating the Appropriateness of Cardiovascular Imaging. Soon after, in October 2005, the first AUC document was published for SPECT MPI, ACCF/ASNC Appropriateness Criteria for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI). Upon completion, we held a summit to receive feedback on the process and how it might be improved. This information was used to refine the process including introducing early review of proposed clinical scenarios, larger expert panels, more comprehensive lists of clinical scenarios and ongoing coordination with clinical guidelines and other ACC policy documents. To date, the ACC has developed AUC for echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, cardiac radionuclide imaging, coronary revascularization and diagnostic catheterization. Currently under development are documents on implantable defibrillators and cardiac resynchronization, peripheral arterial and venous ultrasound, ultrasound use in pediatric patients, and multi-modality imaging use in heart failure, chest pain, and stable ischemic heart disease.

AUC define “when to do” and “how often to do” a given procedure in the context of scientific evidence, the health care environment, the patient’s profile and a physician’s judgment. The criteria can help inform individual patient care decisions but are best used to evaluate patterns of care by physicians over time.  All of the criteria are developed by panels of clinical experts from the ACC Foundation and its partner organizations based on evidence and when necessary expert opinion. The panels assess the benefits and risks of a procedure for different indications or patient scenarios and then determine whether the indication is appropriate, uncertain, or inappropriate. It is important to note that AUC ratings often contain more detailed scenarios than the recommendations covered in practice guidelines and thus subtle differences are possible. The criteria are also based on current understandings of technical capabilities and potential patient benefits of the procedures examined, and future evidence development will require these ratings to be updated on a regular basis.  In general, the documents have been updated every one to two years with all except the CMR AUC having been revised at least once since their original ratings.

I wrote in a 2004 President’s Page that "some may not see the importance of the College's efforts to address appropriateness. Some might argue that explicit guideline performance indicators can be divisive and prefer we not enter this arena. However, if we do not lead in this effort, others may set criteria that may not be wise either for us as physicians or for our patients.”

Eight years later, I believe the same scenario rings true. (Although looking at today’s use of radiology benefit management companies, I would change the last part of the sentence to “others WILL set criteria …”) It is our duty as a profession to work together with policymakers, payers and other medical societies to ensure patients are receiving the most appropriate care, while also reducing unnecessary health care costs and limiting wide variations in care delivery. This is about “doing the right thing” and is best done by our own standards based on the latest science.

For more information about AUC visit CardioSource.org/AppropriateUse.

This post is from a special AUC series on the blog focusing on the “basics” of what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available. Click here to read more.

As I’ve mentioned in several previous posts, my thematic focus for this year is patient-centered care – a style of care that emphasizes education and involvement of patients in medical decision making; integration of medical care, and application of principles of disease prevention and behavioral change. At the end of the day, I want to be able to say that the College has indeed improved patient access to the best cardiovascular health information, as well as provided new tools for health care providers to strengthen patient communication and ultimately improve outcomes.

Today’s release of our health policy statement focused on patient-centered care, is just one more way we are moving closer to achieving these goals. The document – an outgrowth of the commitment by the ACCF beginning in 2009 to develop a patient-centered approach to cardiovascular care – was developed by a writing committee made up of a wide range of representatives from general medicine, the cardiac care team, consumers, and advocacy.

In particular, the paper highlights several key elements to PCC care, including enhanced clinician/patient communications; health literacy; clinician-directed patient education; assessment of patient-centered outcomes; shared decision-making, and patient empowerment and self-management. The statement provides detailed recommendations related to each of these topics and stresses the importance of health policies that facilitate these recommendations and move the concept of patient-centered care from a much-discussed principle to actual reality.

Moving forward this new health policy statement will serve as the cornerstone of the College’s efforts to 1) transform the delivery of cardiovascular care to empower patients across the care continuum; 2) enhance the patient–cardiovascular specialist relationship through the recognized voice of the ACC; and, 3) develop clear recommendations for content to the ACC patient-centered portfolio of tools, campaigns, resources and projects.  The ACC’s Patient-Centered Care Committee under the capable guidance of Mary Norine Walsh, MD, FACC, continues to make headway on a number of other efforts, including enhancing our CardioSmart web portal so that it is the go-to source for patient education and engagement. We are also continuing to build strategic business partnerships with consumer companies interested in health and wellness and fostering community engagement at local and national levels through health fairs and other health-related events. Finally, a dedicated group of ACC members is analyzing the role of cardiovascular specialists in the patient-centered medical home, while other ACC leaders are taking the lead in incorporating patient-centered care elements into their work. (For a personal perspective on patient-centered care, I invite you read my upcoming "President's Page" in JACC on "Restoring the Patient-Physician Relationship."

All of this work is invigorating! Ultimately, medicine is about a healing connection between human beings. We need to re-establish the ideal of medicine as an art as well as a science, and restore the patient-physician relationship. Patient-centered care is the right thing to do, both in principle and in practice.

That great, growling engine of change – technology – Alvin Toffler, Future Shock, 1970. (Harper, S&S)

The ACC this week submitted its comments to the Centers for Medicare and Medicaid Services (CMS) on its proposal for the second stage of the Electronic Health Record (EHR) Incentive Program. EHR adoption and meaningful use of these technologies is not an easy feat given the constant development of new technologies and the many challenges associated with true interoperability across different platforms. CMS and the Office of the National Coordinator (ONC) for Health IT have definitely undertaken a herculean task. The College’s comments outline the concerns with moving forward with Stage 2 without a careful analysis of Stage 1 – including the challenges associated with participation, as well as the positive results. To quote our comment letter: “We are concerned that the sum total of the requirements contained within this proposal seek to change behavior too rapidly without enough appreciation for the potential consequences.” We will be continuing to work closely with both CMS and ONC to refine requirements in a way that helps, rather than hinders, participation by cardiovascular specialists. (Read the ACC’s summary of Stage 2 requirements).

Meanwhile we are still in the first stage of the EHR Incentive Program, which is good news. However, this year marks the last year for physicians interested in participating to receive the maximum benefit of program participation. Physicians can earn up to $44,000 over five years if they meet the program requirements and begin participating in 2011 or 2012. First-year participants must only comply with the program’s requirements for 90 days, which means interested parties (not already participating) have until Oct. 1 to comply. (Check out this helpful guide from CMS).

We have also partnered with the Managed Care Advisory Group (MCAG) to help members receive incentive payments under program. MCAG uses a dashboard to track physician progress in meeting the Meaningful Use requirements and help identify problem areas. Once requirements are met, MCAG completes and sends the application for the incentive bonus to CMS. MCAG will be hosting a free webinar for ACC members from 1-2 p.m. on May 24, so stay tuned for more information on how to register. CMS also offers a number of resources, accessible via the College’s Health IT page, to help providers through the process themselves. The College is working with CMS to co-host a webinar later in June.