This post was authored by Pranav Puri, winner of the best CCA poster award.

Early last summer, as the presidential campaigns began to heat up and national dialogue once again shifted to healthcare policy, I decided to leave the rhetoric of the campaigns aside and take a look at the raw figures of healthcare spending for myself.

After sifting through a couple pages of Google search results, I found myself on the website of the Organization for Economic Cooperation and Development (OECD), an organization of developed economies, and the numbers I found there were truly staggering. The U.S. spends $2.6 trillion on healthcare which is approximately 18% of GDP; to put that figure in perspective, the OECD average is 9.5% of GDP.

More importantly, however, the quality of healthcare in the U.S. ranks far closer to the OECD average than to the top of the list. Further research showed that roughly 3,700 percutaneous coronary interventions (PCIs) per million were performed in the U.S. while the OECD average was close to 1,250. Around that time, Trinity Regional Health System in Rock Island, IL, my hometown, had implemented the ACC's appropriate use criteria (AUC) for coronary revascularization.

With the OECD data fresh in my mind, I approached the cardiology department at Trinity to study the effect of implementation of AUC for coronary revascularization on volume of PCIs and cost savings. Data from six months after implementation of AUC was compared to that of corresponding six months in 2010 and 2011. The number of interventional cardiologists did not change over that time period while the number of patients seen by the cardiologists during the time period increased. The number of diagnostics decreased by 9 percent after implementation of the AUC, and the number of interventions decreased by 27 percent.

Due to a decrease in interventions and diagnostics, total hospital reimbursement over the six month time period decreased by 35 percent from the previous year. If the AUC for coronary revascularization were to be further implemented and similar trends were to be observed nationally, we calculated that $2.3 billion would be saved. The maximum decline, I hypothesize, was in interventions that would be labeled as "uncertain." The AUC's greatest impact, therefore, was on influencing physician behavior rather than cutting back on "inappropriate" cases. By adding an element of oversight and better informing staff and patients, the AUC influenced the physician's thought process and reinforced doubts about prospective procedures.

Upon entering Moscone West late Friday evening to complete my registration and pick up my ACC.13 badge, I was taken aback by the frenzy and sheer excitement surrounding the meeting. Coming from a small town of 40,000, it was hard for me to fathom the magnitude of ACC.13. The next day during my poster presentation, I was greeted by attendees that showed great interest in my poster and posed incisive questions. Overall, the attendees were extremely supportive and made ACC.13 a welcoming place for a 16 year old high school student amongst well tenured physicians and researchers. As I get ready to board my last flight home, I can't help but reminisce on the past few days and look forward to ACC.14 in Washington, DC.

One of the most incredible aspects of the cardiovascular community is that despite distance, demographic, geographic or socioeconomic differences of our regions, practice types, or experience – we are connected. We share and are united in a mission to transform cardiovascular care and improve heart health. The work of this mission begins in the ACC State Chapters.

This past year the chapters have been busy doing a lot of work and there were some incredible wins in the states, including smoke-free legislation in states like West Virginia and Indiana, as well as an ongoing fight for tort reform in Michigan, Washington and Ohio. In many states like Pennsylvania, Delaware, DC, Maryland and Virginia, Chapters collaborated for their annual meetings – leading to a more connected regional ACC. Million Hearts meetings popped up around the country this year – with partnerships in Kentucky, Arkansas, Colorado, Mississippi and West Virginia and many others.

The Board of Governors (BOG) themselves accomplished quite a bit this year, including instigating the updated methodology around appropriate use criteria, assisting in the launch of the Million Hearts Campaign particularly at the state level and increasing opportunities for early career and fellows-in-training at ACC.13 and beyond. The BOG is gathered today in the city by the bay for a day-long meeting full of brainstorming and planning ahead of ACC.13’s kick off tomorrow.

However, the Chapters fun is just getting started at ACC.13. All Department of Defense, Veterans Affairs or Public Health cardiovascular professionals are invited to attend a special breakout session which includes free lunch this Sunday, March 10 from 12 – 2 p.m. Pacific Time (PT) in the San Francisco Marriott Marquis in room Golden Gate C1. RSVP here. Also, there is a ACC Political Action Committee sponsored reception for domestic Fellows-in-Training and the BOG that same day, March 10 from 6:30 – 7:30 p.m. PT in the Moscone Center West Building Faculty Lounge in the second floor lobby.

Winston Churchill said that “the farther backward you can look the farther forward you can see.” Looking back at the accomplishments of the states this year, I can see a very bright future ahead. Cheers to a great meeting and a wonderful new “ACC year” for ACC Chapters!

In the last 10 to 15 years, technological advances have completely changed the way we deliver patient care on a daily basis. For cardiology in particular, noninvasive imaging is now central to clinical practice and research, irrespective of the disease entity or the area of interest of the cardiologist. Despite its unquestionable benefits, and because of earlier trends of increased utilization, medical imaging has been an area of focus by policymakers at the state and national level, as well as private payers; attempting to control who can perform imaging tests and where, through administrative protocols or state and federal laws as a means of reducing health care costs.

In my newest President’s Page in the Journal of the American College of Cardiology, I take a closer look at the past, present and future of cardiovascular imaging.  In particular I focus on what I consider to be a new imperative for medical imaging in light of the trend towards a more value-driven health care system and the fact that technology will continue to improve, enhancing our ability to diagnose and treat patients earlier. Novel technologies need to show a positive effect in patient care and outcome since ultimately, our driving concern is to achieve the triple aim of quality care, reasonable cost, and the health of the population.

The ACC has developed several tools to address over- and under-use of procedures and technologies and is widely credited by payers, members of Congress, and other stakeholders for working to address a perceived problem and taking proactive efforts to ensure quality, cost-effective care. 

Notably, appropriate use criteria (AUC) define when and how often it is reasonable to perform a given procedure or test. When systematically implemented, AUC can be used to assess patterns of care in an effort to understand and improve the rate of clinically appropriate imaging tests, while reducing clinically less appropriate tests. By providing physicians with their imaging utilization, use of AUC also encourages the providers in shared responsibility for judicious use of imaging services and can effect appropriate change in behavior better than that observed with changing reimbursement.

Further, the College’s “Imaging in FOCUS” (FOCUS) tool, a self-directed, quality improvement software and interactive community was developed to help providers better understand their imaging practices, identify areas for improvement, and incorporate AUC at the point of care. It has proven successful in reducing overuse of imaging. Unlike Radiology Benefit Managers (RBMs) which have been criticized by health care providers for delaying or denying unnecessary administrative burdens, basing decisions on inconsistent rules and practices and lacking clinical guideline transparency, FOCUS is transparent, grounded in AUC, and provides opportunities, and in some cases, incentives, for improved AUC adherence.

Along the line of appropriate use, this past spring the ACC released a list of “Five things Physicians and Patients Should Question” as part of the Choosing Wisely campaign, led by the ABIM Foundation with eight other medical specialty societies. The list identifies five targeted, evidence-based recommendations that can support physicians and patients in making wise choices about their care. Three of the five recommendations were imaging related:

• Don’t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.
• Don’t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients
• Don’t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.
  

As we continue to work towards implementing quality tools and efforts to address over- and under-use of procedures, I am proud of the College and its members for being at the forefront of this continuously developing field and working to make sure that patients reap the benefits of advances in imaging technology in a transparent, evidence-based manner.

This post was authored by William R. Lewis, MD, FACC, chair of the ACC’s shared decision making workgroup and a member of the patient centered care steering committee.

In the current health care system, patients have traditionally played relatively passive roles in their own health care. They have little knowledge of their disease(s) and treatment options, leaving them not only ill-prepared to communicate their needs and wishes to their health care team, but to implement health plans when necessary. They have primarily relied on their physician for the majority of their medical information and have essentially left medical decision making up to their doctor.

Shared decision-making is one concept that is garnering closer attention for its ability to potentially improve outcomes, while at the same time facilitate patient involvement in their own health care decisions. The purpose behind shared decision-making is not to persuade but to improve patient knowledge and to provide information about the disease and clarify the risks and benefits of treatment or screening options and their associated outcomes. An article published in the Annals of Internal Medicine found that “patients who ask questions, elicit treatment options, express opinions, and state preferences about treatments during office visits with physicians have measurably better health outcomes than patients who do not.”

Key to shared decision-making is the ability of patients to become acquainted with the options available, the risks of each option and the outcomes anticipated from treatment with each option. Cardiovascular disease is particularly well-suited for the devel¬opment of shared decision-making tools that enable doctors to provide patients with an understanding of their options. Guidelines and evidence-based therapies form a solid foundation from which evidence can be distilled and shared with patients. In addition, there are many validated risk models of outcomes that can be used to inform patients of the outcomes of previously treated patients.

Cardiovascular care also involves many treatments for which small differ¬ences in outcomes exist, allowing opportunities for patients’ values and perspectives to play larger roles in the decision making process. For example, while bare metal stents result in more frequent repeat procedures than drug eluting stents, they require fewer blood thinners. As a result, patients concerned about bleeding or bruising, or who can’t afford medications, may select a bare metal stent, even if a drug eluting stent might minimize the likelihood of repeat coronary blockage.

Challenges of implementing shared decision making include lack of physician time to fully inform patients on all aspects of their treatment options including incorporating their values into the equation. Even if they did, the information retained during a single physician visit is limited, especially when there is additional stress involved.

In addition, patients need to know that the information they are reading is unbiased and complete. The solution to these problems is for a trusted organization, like the ACC, to build a website which can act as an extension of the physician’s office. With a tool like this, patients could gain the knowledge needed to make a quality decision and use tools to incorporate their values into the decision and develop questions for their doctor. The next physician visit then becomes a high quality meeting.

Other challenges involve aligning the goals of insurance companies with those of patients. Additionally, physicians are often judged on “quality measures” which, if contradictory to a patient’s values, might jeopardize a physician’s standing on a particular measure. For instance, if a patient chooses to take a lower dose of a cholesterol-lowering drug to avoid symptoms of muscle pain, their physician may be penalized for failing to achieve that lower cholesterol level.

The ACC is currently piloting several projects, one of which is focused on the use of ACC’s Appropriate Use Criteria for Coronary Revascularization. The goal is to use the results of these pilots to ensure that future shared decision-making models best meet the needs of patients and their families.

Additionally, CardioSmart.org is an excellent source of medical information and is trusted by patients and their cardiologists. The ultimate goal will be to develop shared decision making tools and make them interactive on CardioSmart.

If implemented correctly, shared decision making tools have the ability to drastically improve outcomes and will strengthen the provider/patient relationship.

To read more about the ACC’s plans for shared decision making, visit CardioSource.org.

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.

This post was authored by Scott Lilly, MD, PhD, chair of the FIT Committee and an Interventional Cardiology fellow at the University of Pennsylvania.

This year over 70 fellows-in training (FITs) from across the nation attended the 2012 Legislative Conference in Washington, DC where they met with ACC and congressional leaders to discuss current issues affecting practice of cardiology in both academic and private practice settings. Although it may be difficult to remain apprised of proposed and impending legislation during fellowship years – the conference format addresses this.  On Monday, there was an array of speakers that discussed specific issues for collaborative lobbying. These short (and often entertaining) presentations were interactive and reliably followed by practical questions from the nearly 500 physicians, cardiac care associates or FITs in attendance. In between the discussions, there were a number of breaks that allowed FITs to interact and introduce each other, have smaller group conversations regarding a particular issue, or meet with ACC leadership. Fully debriefed, we received our congressional visit schedules and prepared to “storm the hill” with our fellow state ACC members.

Among the issues we addressed this year was a proposed cut to ACGME spending – something that could directly affect on our training.  Whether these cuts would have a direct affect on the number of fellowship positions, or result in variations in educational infrastructure or national meeting subsidies is unclear. Regardless, these changes are clearly occurring at a time when there is a greater need for cardiovascular physicians – driven both by the aging population and the availability of new and effective therapies that mandate specialized training. The ACC has responded to this and other proposed cuts proactively by requesting a partnership with respect to health care reform. Through addressing overutilization via appropriate use criteria, and improving quality of care by advocating national registries, the hope is that we will be able to more effectively deliver care in a less costly manner.

While we as FITs may spend most of our professional time at the bedside or in the latest scientific journal, I was reminded this weekend of the world outside of the clinic. We have cardiologist advocacy leaders – individuals that, despite busy practices devote a significant amount of time to preserving our ability to learn, care for our patients and help to secure our future. When FITs participate now, it strengthens the delivery of these messages to congress, broadens our perspective, and will hopefully cultivate the next generation of these cardiologist advocacy leaders.

For the many FITs that visited the Capitol last week, I hope you arrived home safely; to the rest, I hope to see you next year.

One might not initially think that cardiologists and football players have a lot in common. However, coming out of the standing-room-only Board of Governors (BOG) meeting this past weekend, I can tell you that the team spirit and tireless work ethic of ACC’s cardiovascular “team” rivals that of the best players on the football field.

The September BOG Meeting is always one of my favorites. We’re moved beyond saying “here’s what we’re going to do” to “here’s what we’re doing.” It’s a time to look back on early accomplishments, reassess priorities if needed, and celebrate where we’re going.

Among the early accomplishments this year:

• A formal recommendation regarding Appropriate Use Criteria terminology. The BOG has been an integral part of these discussions over the last several months and   we believe that the recommended changes will address many of the concerns raised by members at the grassroots level, particularly regarding the use of the term “Inappropriate.”
• The development of a Digital Strategy. No, the BOG is not responsible for developing the Digital Strategy, but many governors have been involved in some manner in its development, whether it’s sharing feedback from Chapter members, actively taking part in usability testing or simply using the College’s online and mobile resources.
• Participation in the Million Hearts initiative. We heard from Janet Wright, MD, FACC, executive director of Million Hearts, that the College and its Chapters are among the biggest contributors to Million Heart activities. As the initiative enters its second year, even more opportunities for involvement are expected.

Looking ahead, the College’s new Lifelong Learning Portfolio offers unprecedented new learning opportunities for ACC members. There are also incredible new quality improvement tools in development or newly launched that are intended to help cardiovascular professionals not only adhere to guidelines and best practices, but also involve patients in their care. Among these resources: Clinical Toolkits for atrial fibrillation and heart failure, and growing opportunities to use Imaging in FOCUS tools in practice. New CardioSmart initiatives like CardioSmartTV, which puts patient-themed content on waiting room televisions, offer up unique new ways to reach patients. As Dr. Wright also mentioned, we still have four more years to reach the Million Hearts goal of preventing one million heart attacks and strokes.

Of course, I’d be remiss not to mention some of the health policy issues ahead. There is no doubt that health reform implementation will continue to have impacts on the current practice environment, as will continued cuts to Medicare physician payment. There is a need for the entire cardiac care team to come together as one voice to make sure that policies moving forward are in the best interest of our patients. Issues like public reporting, the Physician Payment Sunshine Act and other policies being discussed will have profound impacts on how we practice and it’s important that the College and its members be heard.

This weekend reinforced that the ACC’s BOG is comprised of an amazing team of men and women who selflessly volunteer their time in many different ways, with the ultimate end goal of ensuring patients living with, or at risk of, heart disease are receiving the best, most appropriate care possible. Like the football teams who took to the field this weekend, we will take some hits and might even lose a few yards, but at the end of the day there’s a sense of accomplishment for all the yards run and the touchdowns that were made. As the old saying goes, we “come together, share together, work together and succeed together.”

This post is authored by Joe Allen, director of Translating Research into Practice at the ACC.

We have come a long way over the past few years with the implementation of Appropriate Use Criteria (AUC) and recognizing the value it provides for patient and physician decision making. The College is often credited by our members, payers, members of Congress and other stakeholders for taking proactive efforts to identify care with minimal benefit and provide tools to guide more appropriate, cost-effective care.

There is a positive outlook for AUC, as accreditation agencies, MOC Part IV, and Physician Quality Reporting System (PQRS) participation in 2013 all offer incentives in many states for use of AUC that can enhance the value of these efforts in a direct way.

Originally, AUC moved the discussion away from self-referral and allowed us to focus on quality with legislators avoiding several efforts to remove the Stark exemption. Congress has approved a specific demonstration project on AUC now being implemented by Centers for Medicare and Medicaid Services (CMS). This bill allowed us to offer an alternative to various payment cuts and avoid movement toward radiology benefits managers (RBMs) for now by CMS.

Several payers have begun discussions with ACC about implementing an alternative to RBMs through a FOCUS decision support tool and Quality Improvement program. Maryland and several other states were able to use AUC as a part of discussions about how standards should be set for review of percutaneous coronary intervention use.  Several states had their own efforts begun to develop their own state based standard and dropped theirs to adopt the ACC AUC.

Some RBMs, although not 100 percent concordant, have changed their policies for approval to more closely align with ACC over time. Some plans also have aligned coverage policies with the AUC, including expanding coverage in some cases for computed tomographic angiography. AUC are being used by the ACC Wisconsin and Florida Chapters to engage payers and the business community in a dialogue about how to stabilize and reform payment using AUC measures and shared decision making.

While there are instances in which AUC have been linked to review, authorization, and other policies that misuse the AUC for individual case review, these policies often preceded the AUC or would have occurred anyhow using more arbitrary criteria. Proactive adoption of AUC tools, review of AUC registry data, engagement in quality improvement efforts like FOCUS, and patient outreach like the Choosing Wisely Campaign can help obviate the need for such third party review in the future. The Criteria are never a perfect match for every patient and thus they should be used to inform and not dictate care for individual patients. AUC are best used to engage patients and practices in discussions of appropriate use, as a mirror to understand patient case mix over time, and to benchmark patient populations against others.

AUC can and will evolve in the future in response to member concerns about cookbook medicine, barriers to care, and misuse of the AUC.  However, the items above are just a few of the many ways AUC have been used to empower physicians and patients and counter the desire for third party regulation of clinical practice.  By doing so, the profession demonstrates the value of various procedures while helping all stakeholders engage in a dialogue on the value of various procedures for different patient populations.

The ACC’s 2012 Legislative Conference is coming up on Sept. 9-11. Also don’t miss the Annual Scientific Session of the American Society of Nuclear Cardiology (ASNC) held Sept. 6-9 in Baltimore, which will cover the latest advances in nuclear cardiology and multimodality imaging. Click here to register.

If you’ve visited the Education section of CardioSource.org lately, you may have noticed new and exciting developments. The College recently soft launched our new Lifelong Learning Portfolio (LLP) section.

In my latest President’s Page in JACC, I detail the various offerings within the portfolio which includes a customized and enhanced approach to educational activities. Through this LLP, the ACC aspires to become the primary source for maintaining and documenting the highest level of physician competence in terms of patient care. The College is indebted to Rick Nishimura, MD FACC for his vision, to Mary Ellen Beliveau, ACC’s chief learning officer and senior vice president of the Lifelong Learning Division, to Dino Damalas, ACC senior vice president for Information Technology, and to the many member volunteers and staff for making this vision a reality and for breaking new grounds in Education.

Each ACC member will have his/her own LLP that stores personal data. The LLP will enable members to design, access, and fulfill their own personalized curriculum based on their own interest areas, preferred learning formats, and practice gap areas. The “My Transcript/My MOC Tool” will help members understand changing certification requirements and track their progress in continuing medical education and maintenance of certification (MOC). Any credits earned through the ACC will be automatically transmitted into an individual's portfolio, while any credits earned outside the ACC can be manually entered and scanned to maintain a complete transcript. 

We are excited to announce that BOT Member Harlan Krumholz, MD, FACC, will serve as the LLP's new editor-in-chief beginning in January 2013. Dr. Krumholz and his editorial team will increase the online product portfolio to 300 activities, to provide even more options for maintaining and enhancing competency.

In addition, the College has released CardioCompass, a semantic tool that will help users navigate guidelines, appropriate use criteria (AUC), and other clinical documents. By simply entering an open-ended question into CardioCompass, individuals will be pointed to the specific portion of the guideline, AUC, or clinical document that addresses their needs. In the future, CardioCompass will also be available as a pop-up user tool while learning activities are in progress in order to provide immediate access and answers to clinical documents. CardioCompass will also be available as a mobile application for use at the point of care. By the ACC.13 Scientific Sessions, we hope to add additional source documents to CardioCompass, such as self-assessment programs, consensus documents, the clinical trial database, and journal scans.

All of the tools and offerings within the new LLP are truly unique and align with my presidential year focus of 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. By providing members with tools that will strengthen their education, knowledge and continuous learning, we are well on our way towards providing the best care possible for our patients.

By early 2013 we will “hard launch” the Lifelong Learning Portfolio, which will allow for the features and functionality needed to simplify the many challenges of a clinician's day-to-day activities. I encourage you to look around the new LLP and use the comment section below to give us your feedback to further enhance the product, and let us know what you think of these exciting new tools!

A recent New York Times article reported that a hospital system in Florida is being investigated for possible overuse of cardiac procedures and percutaneous coronary interventions (PCI). Although the facts currently available to the public are limited, the mere possibility of inappropriate procedures with little regard for patient well-being evokes feelings of incredulity, shock, and dismay. The kind of clinical practice depicted in the article flies in the face of all of our ACC core values and mission—values that are wholeheartedly embraced by the vast majority of cardiologists. Unfortunately, unprofessional behavior can arise anywhere in society, through myriad circumstances. In medicine, however, even a single occurrence that puts a patient at risk is one too many. Beyond the effect on the individual patient, unprofessional behavior betrays patient trust and, when portrayed at the national level, sends shock waves into good patient-physician relationships.

The College has always emphasized professionalism and quality of care. As new discoveries are applied to practice and our knowledge increases, the ACC updates an extensive array of educational and quality improvement tools to help guide appropriate care: educational programs, comprehensive guideline and quality standards, Appropriate Use Criteria (AUC), the National Cardiovascular Data Registry (NCDR^®) and more. These tools provide a source of information to the health care team on the latest science and evidence-based medicine as well as a means to evaluate and measure quality parameters of the care rendered. Ultimately, the best care is accomplished in the context of an enduring relationship between a patient and the physician/health care team.

In recent months I’ve highlighted the importance of involving patients in their care and rekindling the patient-physician relationship. The ACC’s desire to encourage patients to take an active role in their own care is evidenced by resources such as CardioSmart. We have also invested a great deal of time and effort developing tools for physicians, such as the College’s AUC. The criteria define “when to do” and “how often to do” a given procedure based on a patient’s profile and evolving scientific evidence, combined with a physician’s seasoned judgment (click here to view a recent blog series on AUC, and check out the current issue of Cardiology magazine for a story on the purpose behind AUC).  Over the past few years, these documents have tackled a variety of diagnostic procedures and therapeutic interventions. An AUC document on coronary revascularization was published in 2009 and more recently, one on cardiac catheterization.

An independent program, Accreditation for Cardiovascular Excellence (ACE), sponsored by the ACC and Society of Cardiovascular Angiography and Interventions (SCAI), was started a few years ago to provide accreditation and continuing quality improvement services for cardiac catheterization, PCI and carotid artery stenting, as well as external peer review for coronary angiography and appropriate use. Through its external cath lab evaluation, the program can assess cath lab quality, appropriateness and angiogram film reviews to evaluate accuracy of coronary assessments.

As ACC Past President Ralph Brindis, MD, MACC, said in an ACC in Touch Blog post on the overutilization issue in 2011, “how we react to this overutilization storm will determine our future.”   The ACC’s Maryland Chapter, who at that time was faced with a similar situation, was exemplary in the way they tackled their own crisis and worked tirelessly with SCAI and state officials to advocate effectively for oversight and guidelines for cath labs performing PCI.

A medical professional carries two primary levels of responsibility: toward our profession and toward our patients. The majority of physicians are caring, competent and good-natured. Incidents that cast doubt on our collective integrity may distort our practices and relationships in numerous ways, but they also present an opportunity for each of us to reaffirm, in the strongest terms, our fundamental ethical commitments.