This post was authored by Joseph G. Cacchione, MD, FACC, chair of the CQC Partners in Quality (PIQ) Subcommittee and chairman of Operations and Strategy for the Cleveland Clinic Heart and Vascular Institute.

The promise of payment reform to rescue the growth in health care expenditures is central to fundamentals of the Affordable Care Act (ACA). A 2010 study by RAND showed that only two things will bend the cost curve:  more financial risk for consumers and provider risk. Provider risk is not a new concept as the 1990’s version of “managed care” transiently muted health care spending increases but there was little attention to quality. The managed care/capitation era of the 1990’s gave way to an era of significant growth in health care spending with predominantly a fee-for-service (FFS) reimbursement system. The proposed novel payment changes ushered in by the reform movement are an expansion of provider risk and now include pay-for-performance, bundle/episode payments and total global payment. 

As stated in a Health Affairs article by Robert E. Mechanic and Stuart H. Altman: to be successful, payment reform options must include the following criteria: 1) Potential for reducing unnecessary utilization, 2) Encouraging high quality, 3) Supporting provider integration and 4) Operational feasibility.

The U.S. government has chosen to pilot bundled payment programs. Bundles are one claim for an event of care whereas episodes are time sensitive bundles and include both a hospitalization and some post-acute period.  Several health care organizations entered into pilot agreements around bundling services for a specific diagnosis and in many circumstances episode payment. As part of these bundle pilots, there are required commitments in cost savings to CMS. These pilots are just underway and the results will fuel further CMS programs.  In addition, pilots with bundling using the Prometheus grouper tool are underway. These programs have had limited penetration due to the inability to implement the new payment methodology in what has traditionally been a system that is dominated by FFS claims systems.

The constituents of any payment system include the insurers, patients and providers; and each will have challenges with the conversion away from FFS. The vast majority of health insurers’ systems are designed exclusively for FFS payments and adding in a bundled/episode claim program will be administratively challenging. As an example, related claims that should be inside a bundle may be paid as an individual FFS claim, thus causing rework and duplication. The operations of bundling will require modification of the insurer’s existing work flows and systems. In most cases the providers have little information about utilization patterns once patients leave the acute care setting. Many providers are entering into the pilots described above with CMS and other private insurers based on small amounts of claims data. It is hopeful that the experience they gain will allow them to take on the intended financial risk successfully. 

In addition to cost data, there will be the need for longitudinal clinical data registries with outcome measures at timed intervals that are coterminous with the episode period.  This is one of the major differences with the latest iteration of the risk programs compared to the 1990’s version, the addition of quality outcomes. 

Last but not least, patients don’t live in episodes nor do they understand how their financial responsibility may be impacted by these new payment methodologies.  Clearly the constituents of the health care system are on a very steep part of the learning curve for the new payment system.  Providers will need to garner far more information about longitudinal cost and quality measures before going at significant risk for bundled payments.  

Everybody has a budget. Your family does, my practice does, your state has a budget, the ACC has a budget... and so does the country (at least some of the time). This week the president released his 2014 budget and I thought you might like to see some of the proposed provisions that impact cardiology and the practice of medicine as a whole.

Interestingly, there is an assumption that Medicare payments to physicians will not be reduced by the mandated Sustainable Growth Rate (SGR) formula.  This formula is scheduled to cut payments to physicians by 25 percent in 2014, but previous scheduled cuts have been overridden by short-term Congressional action. Perhaps it’s time to just fix it already!

There is also a proposal to reduce payments for the so-called “indirect” costs of graduate medical education (GME) by 10 percent starting in 2014, at a savings of more than $10 billion over 10 years. This is an increasingly important topic that the ACC’s legislative team is following closely.

While it’s important to note that this budget proposal is likely to be dead on arrival given the divided Congress and president, imaging is another area that “we” (the collective ACC) will also be keeping close tabs on this year. The budget proposal includes a provision to mandate prior authorization of advanced imaging (CT, MR, nuclear), as well as a proposal to limit the availability of the in-office ancillary services exception so that advanced imaging services (CT, MR, nuclear) could not be provided if ordered by a physician in that office. (The budget proposal does indicate that the exception could still be available if certain undefined accountability standards are met. But….)

On the brighter side, the budget proposal does contain provisions to increase funding for the FDA, partially by taking advantage of user fee programs authorized last year, previously existing programs for prescription drugs and medical devices, along with the new programs for biosimilars and generic drugs. Also $534 million in user fees are aimed at decreasing use of tobacco products. The National Institutes of Health also gets a small 1.5 percent bump from 2012 levels, for a total of $31 billion. The administration also includes funding for continued investment in health IT implementation and electronic information exchanges, given that current funds from the American Recovery and Reinvestment Act are beginning to expire.

Other proposals include a provision to lower the target growth rate for the Independent Payment Advisory Board so that the board could take binding action even with lower cost growth in health care.  Target growth rate would reduce to GDP plus 0.5 percent.  The IPAB, a major feature of the ACA, has yet to be formed. The budget would also extend funding for a consensus-based entity (likely the National Quality Forum) to focus on performance measures and quality improvement.  Current government funding for NQF expires at the end of 2014.

As I mentioned before, many of the items contained in the budget are unlikely to come to fruition due to the divided Congress and president. However the proposal provides a glimpse at administration priorities for next year. Perhaps we should all make sure to save the date for ACC’s Legislative Conference this September!

This post was authored by Jim Fasules, MD, FACC, senior vice president of Advocacy for the ACC.

Despite a rather recalcitrant Congress, last year saw very significant changes for health care and cardiology. After the swirling uncertainty surrounding the Affordable Care Act (ACA), the U.S. Supreme Court ruled the ACA, including its individual mandate, was constitutional. With the federal debate laid to rest, the action shifts to the states where for political and policy reasons a patchwork quilt of variability still leaves physicians, hospitals and patients perplexed on how to adapt to Medicaid expansion, the Exchanges and other insurance changes. Yet hidden in the rancor over the ACA were many challenges and changes effecting cardiology that the ACC tackled with a large degree of success.

For more than a decade, the sustainable growth rate (SGR) and the nearly 30 percent cuts associated with the flawed formula have threatened to impede improvements to the health care system and weaken the sustainability of practices nationwide. While a fight for permanent repeal of the SGR was unsuccessful, the last-minute “fiscal cliff” legislation delayed “the cliff” and its 27 percent cuts until 2014, at least restore a degree of financial security to physicians and ensure patients have continued access to quality care for 2013.

Besides helping achieve the SGR patch in the American Taxpayer Relief Act of 2012 (ATRA), the ACC team succeeded in helping cardiology in two other important ways.  First, last year saw an aggressive campaign waged to close the in-office ancillary services exception (IOASE), also known as the Stark exception that allows us to perform tests and imaging in our offices, mounted by radiology and others. Its inclusion in the ATRA was successfully prevented. In addition, the team’s work with the Senate Finance, Ways and Means and Energy and Commerce Committees, following the stellar testimony of ACC Past President Douglas Weaver, MD, MACC in July, resulted in the law providing that participation in qualified clinical data registries, such as the NCDR®, will count as PQRS participation in 2014. While many details still need to be worked out, this will allow greater ease of avoiding the cuts that now occur for non-participation in PQRS.

Despite our successes, 2013 has many risks. The 2 percent across-the-board sequestration cut to Medicare and the even greater cuts to public health remain a threat when the two month delay in the ATRA expires on March 1. The ACC adamantly opposes the 2 percent Medicare sequester and the approximately 8 percent sequester cut to NIH, CDC, AHRQ and other crucial agencies, and the College will continue to urge Congress to prevent the cuts from going into effect. While successfully prevented in 2012, the forces working to close the IOASE have already marshaled an even stronger campaign this year. In response, we are working with a broad coalition to demonstrate to Congress and the Administration that closure of the exception would cause great disruption to patient care and would effectively end the viability of private practice and actually result in greater expenses for Medicare and insurers. Similarly, the College remains opposed to enactment of prior authorization for imaging services under Medicare.

On the medical liability reform front for this year, the U.S. House of Representatives is expected to take action on the HEALTH Act once again, which includes MICRA-type liability reforms. The College will continue to work with other stakeholders to support this act and advance supplemental medical liability reforms. Often missed in the College’s activities is its work for public health and science.  Again this year, the College will work to support federal funding for NIH; AHRQ; the NHLBI; the Health Resources and Services Administration’s AED program; the Prevention and Public Health Fund; the Million Hearts™ initiative; CDC’s Heart Disease and Stroke Prevention Program; and congenital heart disease research and surveillance.  As Congress struggles to find spending cuts, Graduate Medical Education (GME) finds itself targeted.  Advocacy with the help of the Academic Council is working with the AAMC to prevent any disruption to fellowship training.

As you can see 2013 holds many risks to cardiovascular care.  There are many opportunities for U.S. members to get involved in ACC's advocacy efforts, including learning more about ACCPAC, and participating in legislator practice visits and Legislative Conference.

Stay tuned to CardioSource.org/Advocacy throughout the year for health policy updates. To get involved in ACCPAC, visit accpacweb.org.

This post was authored by Douglas Weaver, MD, MACC, past president of the ACC.

This year has been a painful one for healthcare providers due to the continued atmosphere of uncertainty.  Many of us began this year working on initiatives that deal with some of the changes attendant with the Affordable Care Act – e.g. reduce unnecessary admissions and change them to observation status, decrease readmissions for patients with a recent MI or for heart failure, and putting together means to provide better continuity of care.  Before the election, it was impossible to fully engage given the polarizing rhetoric between parties.  At the present time our payment policies don’t reward either physicians or hospitals for reducing readmissions, and rather we take a hit. 

However, even after the election, it still isn’t better. We are in an environment with continued partisan bickering about the legislation, lack of agreement on a common approach to sequestration, the tax cuts, unemployment benefit extension, reducing the deficit, how to pay for the SGR (and possibly with further Medicaid cuts, reduced NIH funding, loss of facility based E and M dollars, IME reductions).

After studying the issues and listening to the pundits, I have come to the following conclusions: first, our national debt is a major problem and one that needs to be fixed.  If you include the “promised entitlements” of Medicare and Social Security, it is close to 86 trillion dollars — and this number would require collecting 8 trillion dollars a year in taxes to just keep it from going higher. Congress can’t agree on ways to get a few hundred billion to balance the budget for the coming year. The total earnings of all of us filing tax returns is a little over 5 trillion dollars a year — and that is earnings not the taxes you and I currently pay.  Conclusion: we have to curb entitlements no matter what happens to taxes.

Second, people are spending less on healthcare. Visits are down, admissions are down—the cost curve has been bent already. If you count up the 50 million people in our country with no insurance, add 40 million who do, but who can’t pay their deductibles or co-pays, and the almost 55 million on Medicaid—this says that half the people in our country can’t afford our healthcare.  Conclusion: it is not about healthcare inflationary costs (these are now fixed), it is about the absolute cost.  Cost of healthcare in the U.S. is 1.5 to 2 times more expensive than elsewhere.  With peoples’ individual contributions increasing for care, they are voting with their feet and avoiding, when possible, doctor visits and procedures.

Lastly, there are some basic problems with the way we are approaching enacting “change.”  If all of our patients are going to pay more now for coverage and we are going to move to pay for quality, our patients should be getting something for this right up front—not years down the road.  Second, don’t harness the providers to the plain vanilla PQRS quality reporting measures and 18 month old administrative data to track performance. Instead, let specialty societies like the ACC, who can focus initiatives in areas where its members determine deserve improvement, and support these organizations to provide feedback and tools for improvement to their constituencies, instead of funding a larger, but less relevant reporting now done by the insurers.

We are adaptable—we can move more quickly and deliver more, but not at our own expense. We can however do so with a promised reduction in the overall cost of care and with equal or higher satisfaction from our patients.  

This post was authored by Mike Tempelhof, MD, cardiovascular disease fellow, Northwestern University Medical Center.

Beginning January 2013, the Affordable Care Act (ACA), the Budget Control Act of 2011, the Sustainable Growth Rate (SGR) formula and additional health care reform programs as proposed by the Center for Medicare and Medicaid Services (CMS) will be implemented. Unless modified, several provisions within these policies will have a detrimental effect on the quality of patient care, physician autonomy, reimbursement and the future of medicine in America. It is imperative that health care practitioners have an appreciation of the critical health care policy issues and how their implementation will limit our ability to continue to provide high-quality, high-value health care in the future.

If implemented, the SGR formula will cut Medicare physician payments by 28 percent starting Jan. 1, 2013, and budget sequestration targets as defined in the 2011 Budget Control Act will cut Medicare reimbursement annually by an additional 2 percent. The combined 30 percent reduction in physician reimbursement will limit critical investments in diagnostic and therapeutic equipment, ultimately threatening Medicare beneficiaries’ access to quality care. These reductions in Medicare funding will have a dramatic impact on Graduate Medical Education (GME) and research funding, which will likely reduce the number of trainee positions and de-incentivize trainees from pursing specialized medical training. At a time of growing physician shortages in conjunction with an aging population, these cuts would have a significant impact on the quality and availability of US health care in the future. Finally, sequestration is estimated to reduce federal funding of all scientific research by 8.4 percent. Any reduction to the already resource deficient medical research sector will further limit the innovation and development of new medical therapies that our medical system depends on. Such setbacks would stifle the recent gains made in the morbidity and mortality associated with cardiovascular disease.

The ACC is advocating to repeal the SGR, and stabilize sequestration payments until a new reimbursement system is in place. Juxtaposed to the current volume-based payment system, the ACC is strongly advocating for payment models that align payment incentives with evidence-based improvements in health care quality and outcomes. With a proactive approach to health care reform, the ACC has implemented quality improvement tools including clinical data base registries (NCDR, PINNACLE) and appropriate use criteria into clinical practice. This practice model affords the ACC the ability to hold cardiologists accountable for reaching benchmarks in standard of care. Evidence suggests that an evidence-based, incentive payment program modeled on similar quality improvement tools will improve the quality and cost-utility of health care in America. Therefore, the ACC strongly advocates for a quality and not volume-based payment system that aligns payment incentives with evidence-based medicine.

As our health care system evolves at this time of momentous reform, cardiologists and all practitioners must remain the patient’s strongest advocate by continuing to practice medicine with beneficence; delivering effective and efficient health care to all Americans. Collectively, we must act now to repeal the SGR and the sequestration cuts scheduled for January 2013. We must advocate for a meaningful medical liability reform and a sustainable payment system that incentivizes high-quality health care. Choosing not to act, would be the greatest risk to the future our patient’s lives and quality of their care.

By: Judy Tingley, MPH, RN, member of the ACC’s Clinical Quality Committee.

The Centers for Medicare and Medicaid Services (CMS) readmission payment penalties went into effect on Oct. 1.  Mandated by the Patient Protection and Affordable Care Act, this quality improvement initiative imposes financial penalties on more than 2,200 hospitals with Medicare readmission rates above the national averages.  The unintended consequence of these penalties is yet to be determined.

This new crackdown will have the greatest impact on the “safety net” hospitals that treat our poorest patients.  Current studies demonstrate that much of the variance in readmissions is due to factors beyond the hospital's control.  Many of these community hospitals have limited resources, antiquated medical records systems, serve late presenting and/or underinsured clients, and are at greatest risk for financially failing.  This reality reaffirms that quality metrics identification and measuring outcomes has never been more important.  As we move toward data driven reimbursement models, it is critical that the implementation of “patient centric quality metrics” does not get lost in the quagmire of financial and regulatory demands.  Quality needs to remain the focus of “quality metrics.” 

Of late, safety measure techniques used by the airline industry have been meaningfully translated to health care delivery systems.  Pre-operative checklists (modeled after pre-flight checklists) have significantly improved patient safety.  Just as regular and consistent communication between the crew and air traffic control helps thwart potential problems and keep the skies friendly, so should regulators, payers, hospitals, patients and practitioners communicate to keep patient safety at the forefront.  If not, we should brace for the impact of the unintended consequences of making worse a system that is very much in need of patient centric reform.  

Our population is changing and if you’ve seen one patient, you’ve seen one patient.  There will never be a one-size-fits-all model to eliminate readmission.  Therefore, the impact of demographic characteristics, co-morbidities, socioeconomic parameters, post-discharge environmental factors and regional health care delivery disparities all must be considered in strategically planning meaningful cost efficient care.  As our patient population ages the economic impact of this reality is yet to be seen:

• Half of older women 75+ live alone
• Persons reaching age 65 have an average life expectancy of 18.1 additional years
• The 85+ population is projected to increase to 9.6 million in 2030
  

Improved efficiency and reduction in avoidable readmissions is imperative.  Methods to better identify patients at risk for readmission, reduction of hospital complications, improvement in transitional care and overall communication between providers and patients are important ways of improving quality care.

There remains much work to be done in order to transform today’s health care into the efficient quality centric delivery system needed for the future.  The ACC has taken the lead in providing tools to help practitioners review and provide a transition of care plan.  Specifically, Hospital to Home (H2H) is a national quality improvement initiative developed to help hospitals reduce all-cause readmissions among patients with heart failure or acute myocardial infarction.  As health care providers, we must continue striving toward a coordinated multi-disciplinary strategy to effectively address improving quality of care in a fiscally responsible way.  If we fail, brace for impact!

This post was authored by Jim Fasules, MD, FACC, senior vice president of Advocacy for the ACC.

This week more than 350 ACC members were in our nation’s capital for the College’s 21st Annual Legislative Conference. ACC’s leaders, FACCs, FITs, CCAs, Practice Administrators and even international members were all on hand to participate in briefings on the critical health policy issues facing medicine today.

The conference kicked-off on Sunday with a special reception and dinner celebrating the 10th Anniversary of ACC’s Political Action Committee. During the keynote speech, Pulitzer Prize winner and syndicated Washington Post columnist George Will shared his insider’s perspective of the current political climate and the impending presidential election. Filled with facts and baseball references, Will was able to engage a packed room full of attendees from both sides of the aisle.

On Monday members heard from ACC President William Zoghbi, MD, FACC, who presented results from the 2012 Practice Census, (read more about the results on CardioSource.org), as well as from a range of politicos including an election outlook from Ronald Brownstein.

Earlier today Rep. Michael Burgess, MD (R-TX) was presented with the President’s Award for his distinguished public service and support of the College’s health policies that promote high-quality patient-centered care.  Soon after, conference participants headed to Capitol Hill for a day full of pre-arranged meetings with their members of Congress. Given the current health care landscape, members stressed the importance of Congress avoiding further harmful spending cuts and reforming the Medicare payment system. With 295 separate legislator meetings scheduled, the ACC’s commitment to quality and patient-centered care was heard loud and clear on the Hill.

Our actions and advocacy efforts this week are important for many reasons. We are dependent on Congressional action to prevent upcoming cuts from the sustainable growth rate (SGR). In addition, the Centers for Medicare and Medicaid Services (CMS) has already proposed an array of new policies for the 2013 Medicare Physician Fee Schedule (read ACC’s comments on the proposed rule here) that include both threats and opportunities for cardiology. These proposed policies include:

• The final year of transition to new PE RVUs causes small reductions to most cardiology services.
• A proposed multiple procedure payment reduction for a wide range of diagnostic cardiology services (e.g., echocardiography, stress tests, vascular ultrasound) would reduce the technical component payment for the second and any subsequent service by 25 percent if performed on the same day.  ACC has vigorously opposed this proposal.
• Medicare has proposed for the first time to pay for transitional care services for patients discharged from hospitals or skilled nursing facilities. Physicians providing care coordination services within the first 30 days of discharge would have the opportunity to bill Medicare for these services. The ACC sees this as an important step forward for Medicare, but expressed some concerns about the specifics of the proposal. We’re hopeful that CMS will make some changes to ensure that patients with cardiovascular disease benefit from the new policy.
• If CMS goes forward with its proposed rules, physicians in groups with 25 or more practitioners will be the first to be subject to the value-based payment modifier established in the Affordable Care Act. Also, beginning in 2015, groups of 25 or more will be subject to a 1 percent penalty or may be eligible for bonus payments based on PQRS participation and performance on quality and cost measures in 2013, and practices with 25 or more physicians and other practitioners will need to take action in the first quarter of 2013 to avoid the penalty and ensure potential eligibility for bonus payments.

Not included in the proposed rule, but of great significance to cardiology, we also expect 2013 coding and valuation changes to result in cuts of 20 percent or more for EP/ablation services and some PCI services, but exact impacts will not be available until Medicare releases payment information on Nov. 1.

Although CMS will review comments and release final decisions on these proposals soon, our efforts on the Hill this week will inevitably help raise awareness of the issues facing cardiology today. Stay tuned to the ACC Advocate and CardioSource.org for updates this fall. Also stay tuned for individual perspectives from Legislative Conference here on the blog in the coming days.

The long-awaited U.S. Supreme Court ruling regarding provisions in the Affordable Care Act (ACA) was released yesterday. In a majority decision, the Court ruled that the ACA, including its individual mandate that virtually all Americans buy health insurance, is constitutional.

The ACA is the largest expansion of health care coverage since Medicare and Medicaid were initiated in the sixties. Having this decision behind us means that we can continue to move forward with supporting policies and provisions within the law that are in line with our overarching health care reform principles – particularly those that expand health care coverage, encourage preventive care, and foster innovative payment and delivery system models that reward quality and ensure value.

At the same time, the College will also continue to work with Congress and the Centers for Medicare and Medicaid Services (CMS) on provisions that affect cardiovascular care. Among those:

• Implementation of the controversial Independent Payment Advisory Board, a 15-member Board tasked with developing and presenting proposals to the president and Congress, starting in 2014, to extend the solvency of Medicare, slow cost growth, improve quality of care, and reduce national health expenditures. The College remains concerned by the authority granted to an independent body to determine payment cuts for only physicians, particularly in light of ongoing payment reductions as a result of the Medicare physician payment formula.
• Implementation of the Physician Payments Sunshine Act requiring that industry disclose payments to physicians and teaching hospitals, both direct and indirect. While the ACC supports the overarching objectives of the Act, the College has raised concerns regarding CMS’s interpretation and proposed implementation of the Act. Final regulations are expected in the coming months so stay tuned!

Outside of the ACA, there remains a lot of hard work before we can arrive at a sustainable health care system that emphasizes value and a strong patient-doctor relationship. In the coming months the College will actively be advocating for overarching payment and medical liability reforms that are critical for comprehensive health reform to be truly effective. In addition, our Advocacy team is focused on several regulatory proposals and legislative efforts that will have major impacts on cardiology. Among them:

• The 2013 Medicare Physician Fee Schedule (the proposed rule is expected any day);
• Additional cardiovascular coding changes as a result of continued bundling efforts;
• The annual battle to repeal/stop the flawed sustainable growth rate (SGR) formula used to calculate Medicare physician payment.

These topics, as well as life after the Supreme Court decision and the 2012 elections, will be the focus of the College’s annual Legislative Conference in Washington, DC, this September. (Registration is now open to all ACC members.)  Additionally, the ACC continues to be engaged with CMS, industry and other stakeholders as appropriate on all of these issues. It’s definitely a time of change for health care in the U.S. However, it’s this change that provides the most prospects for action. I’m excited by the opportunities not only for the College, but for the cardiovascular profession as a whole. Now is the time to leverage our successes over the last six decades in improving cardiovascular care and ensure that future policies and programs further these results. Let us work all together for this ultimate goal.

As we wrap up ACC.12 after soaking in all the new and best cardiovascular science and education, I’m continuously amazed at how much progress is made from these meetings. Over the past few days I’ve both presented with and had the honor to learn from some of the most astounding cardiovascular health care innovators in the field. Now the challenge lies in taking what we’ve learned and implementing it – and, as Immediate Past President David Holmes, MD, noted in his ACC.12 Opening Session address, using it to transform how we provide care to patients and work in partnership with others.

With the recent two year anniversary of the Affordable Care Act (ACA) and the start of the Supreme Court hearings of the constitutionality of it all, I’d be remiss not to also mention the timely discussions that took place throughout ACC.12 on health care reform and its impacts on everything from health IT, to imaging, to academia, to the future.

Yesterday I gave the presentation, “ACA for Dummies,” giving a play-by-play of the ACA’s nine separate independent titles, as part of a session that looked at where cardiology will be as a profession in 2015. The bottom line is even if the decision is to rid of the ACA we will still be faced with immense access, cost and quality problems. Our goal at the College is to ensure that we’re poised to help ensure these changes put patients first and reward physicians and other medical professionals for their commitment to quality and evidence-based care.  Congress’ traditional cost reduction strategies of price controls and caps on spending -- as in the broken SGR (or sgrrrr, expressed as a growl) Medicare payment formula -- just won’t work. Instead we need to systematically improve care.

Also yesterday, I was on a progressive panel discussion about the Future of Cardiovascular Diseases: Where Are We Going (and Where Do We Want to Go?) with ACC’s new President Bill Zoghbi, MD, President-Elect John Harold, MD, Million Hearts Director Janet Wright, MD, and others, which discussed the recent UN Summit on NCDs, and others initiatives to combat the growing epidemic of cardiovascular disease. I think Huon Gray, MD, said it best: “Since CV disease knows no boundaries with regards to the patients it affects, nor should the organization and cardiologists whose job it is to help them.”

Professionalism has to be a part of our changing future and the patient must be the center. We have to change the physician/patient relationship and move toward patient centered care, something that Zoghbi is focusing on during his presidential year. We’re not just embracing change, we need to lead change!

Overall it was a great meeting, folks and thanks to everyone who made the journey to the Windy City. Save the Date for ACC.13, March 9-12 in San Francisco!

PS the fun never stops here on Hollywood on the Potomac, check out my testimony before a House Appropriations subcommittee here where I was able to discuss the need for more funding for cardiovascular disease research (just like what was presented at ACC.12), prevention and treatment.

This post is written by Kathy Jenkins, MD, FACC, Chair of the Adult Congenital and Pediatric Cardiology Council

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Congenital Heart Defects Awareness Week is Feb. 7-14. According to the Center for Disease Control and Prevention (CDC), “congenital heart defects affect nearly 1 percent of infants born in the U.S.” As medical care and treatments have advanced, infants with congenital heart defects are living longer and healthier lives and over the past 10 years we have seen a 25 percent reduction of congenital heart disease (CHD) morbidity and mortality. It is estimated that approximately two million people of all ages are living with congenital heart defects in the U.S.

There is still a lot that can be done to help those who are living with congenital heart defects and the physicians who treat them. Since its inception in 2005, the College’s Adult Congenital and Pediatric Cardiology (ACPC) Section has been working to bring quality care to children and adults with CHD through education, quality and advocacy efforts.

The ACPC section has identified several tools for CHD patients as they transition between a pediatric cardiologist and an adult congenital cardiologist, including the Adult Congenital Heart Association’s Personal Health Passport and other tools like Follow My Heart, an electronic based personal health record (PHR). These types of tools are important as CHD patients transition into an adult congenital clinical setting. A CHD patient’s ability to access electrocardiograms and echocardiogram, heart catheterization, and operative reports and other important medical information will help his or her various healthcare providers understand the patient’s unique health care needs.

On the quality side, the College’s continued efforts with NCDR’s IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) is an enormous step in measuring outcomes and care for CHD patients undergoing a diagnostic or treatment cath. Additionally, the ACPC Section has other quality effort underway to develop quality metrics in CHD which may ultimately be used in local or national Quality Improvement initiatives.

On March 1, the ACPC Section will join the Adult Congenital Heart Association and Mended Little Hearts for National Congenital Heart Lobby Day. Together we will lobby Congress for continued funding for the Congenital Heart Futures Act, (included in the ACA and passed into law in 2012). The law established a population-based surveillance registry (through the CDC's existing National Center on Birth Defects and Disabilities). This registry will allow for increased research to better understand congenital heart disease incidence, prevalence and disease burden, as well as a CHD public health impact assessment.  Congenital Heart advocates will also promote the recently established Congenital Heart Caucus chaired by Representative Bilirakis.

A welcome reception for National Congenital Heart Lobby Day will be held February 29 at Heart House. The reception is generously sponsored by the Texas Chapter of the ACC. Thank you also to ACC’s Iowa, Georgia, and Louisiana Chapters who have provided funding to benefit this advocacy effort for ACC members, as well as congenital heart disease patients and family members.

To join us or for more information about the National Congenital Heart Lobby Day click here.  For more information about the College’s ACPC Section visit www.cardiosource.org/ACPC.