This post is authored by Cathie Biga, RN, MSN, president and chief executive officer of Cardiovascular Management of Illinois.

I just finished a remarkable two days at ACC’s Legislative Conference in our nation’s capital.  While I have been privileged to attend in the past, this was the first time I had the honor of being on the Hill with the ENTIRE cardiac team representing Illinois! Led by our current Governor Marc Shelton, MD, FACC, Past Governor Jerome Hines, MD, PhD, FACC, integrated and independent physicians, FITs, CCAs, and practice administrators, we were 11 strong and hit nine offices.

Sharing our message from the “trenches” was important to all of us, and explaining the vast landscape of cardiology care in Illinois was a challenge we tried to hit head on.  From patient access (explaining why imaging cannot be reduced any more or reductions for same day of service is problematic) to the administrative burdens and cost of running a practice, we relayed our message and asked for their help. 

While speaking with our Legislative aides, chiefs of staff, and a few members of Congress, we relayed that while payment reform will inevitably happen (and it really must), we MUST ensure accurate quality data is used to drive this process – which the College has. In addition, physicians and their team MUST be at the table when these decisions are made.

Change is inevitable and hopefully our trek to the Hill will remind us all how important this health care message is for cardiology and why EVERY member of the team needs to be involved. 

P.S., You don't have to fly all the way to Washington to get involved -- our Senate and Congressional representatives live in your neighborhood! Get to know them, call them, invite them to your practice and support them!

Hope to see you all next year!

For additional coverage of the 2012 Legislative Conference, visit CardioSource.org and check out the photos on ACC’s Facebook page.

I have said before that ACC’s Board of Governors (BOG) are the foot soldiers of the College, and with a teamwork-focused BOG, previously insurmountable changes can be more easily attainable. The power of the BOG recently came into play when Kentucky Chapter Governor-Elect Jesse Adams III, MD, FACC, reached out to his BOG colleagues to get their feedback and recommendations about a situation he was encountering at his hospital.

Dr. Adams noted that at one of the large local hospitals, administration decided to implement a policy that only intensivists would be able to write orders in the ICU. Dr. Adams approached the BOG to get their thoughts to see if type of model could be found anywhere else, and if specialist were prohibited to write orders in the ICU, how it would impact the hospital’s adherence with guidelines.

He received feedback and guidance from BOG leaders ranging from concerns about order writing, intensivists as the only primary team in this situation, and concerns about the patient. As Dr. Zoghbi noted, “to deny a cardiologist (and all other specialists in this situation) management of their patients, particularly in most acute medical conditions where they provide the expertise needed is completely unacceptable.”  With this powerful feedback from ACC’s leaders, Dr. Adams then took the conversations to the administration and they rapidly clarified and modified the policy which now allows for optimal collaborative involvement of intensivists and cardiovascular specialists consistent with ACC/AHA guidelines.

As we have seen the landscape of cardiology change drastically over the past few years, situations like these are sure to occur in different forms. It is up to the leaders of the College to stand up and bring our expertise and guidance when something is wrong. By banning together to support one another, this advocacy becomes possible. Kudos to Dr. Adams, Dr. Juan Villafane, and the entire Kentucky Chapter, who not only had a successful chapter meeting last weekend, but also had a minor “win” for cardiology with this example. Job well done!

Do our patients know the signs of a heart attack and what to do if someone goes into cardiac arrest? When every minute counts, are we meeting the standards for door to balloon (D2B) times? These are the questions the ACC’s North Carolina Chapter has focused on over the past decade in collaboration with hospital systems throughout the state.

The Regional Approach to Cardiovascular Emergencies (RACE) project was developed in 2003 as a statewide system for providing rapid artery reperfusion for patients with ST-elevation myocardial infarction (STEMI). The RACE system is the largest state-wide STEMI system in the U.S. and incorporates the quality improvement efforts of over 100 hospitals, 700 emergency systems, and thousands of health care professionals working in a coordinated effort in order to improve timely reperfusion.

A recent study published in Circulation authored by NC Chapter Governor James Jollis, MD, FACC, who has been a champion on this issue, and colleagues looked at expanding regional coordination to the entire state of North Carolina. In doing so, rapid diagnosis and treatment of STEMI has become an established standard of care independent of health care setting or geographic location, and has resulted in improvements in timely coronary artery reperfusion.

Without a doubt, teamwork and grassroots efforts were needed to accomplish this streamlined effort. However, patient education and involvement is also a big component of helping to save lives.

The ACC, the NC Chapter and CardioSmart recently headed to Charlotte, NC, home of the NASCAR Hall of Fame, to participate in the Coca-Cola 600. As recently updated CPR guidelines recommend compression-only CPR, representatives from the RACE program were on-site to give CPR demos teaching race car fans about the 5 C’s (check, call, compress, continue, connect) and how to save a life. Cardiac arrest is a prominent issue in North Carolina and will affect an estimated 8,000 North Carolinians this year, of which only 1 in 4 will receive bystander CPR and only 1 percent will have an AED used on them.

In addition to the CPR demos, blood pressure screenings and fact sheets on CPR and heart health were given to thousands of race car fans. Dr. Jollis and Philip Iuliano, MD, FACC, also took the stage during the track walk alongside NASCAR racers and discussed tips for avoiding heart disease, keeping active and living a healthy lifestyle. CardioSmart’s partnership with Coca-Cola has given the College numerous opportunities to increase awareness of heart health and get out into the community.

I am encouraged by state-wide efforts such as the North Carolina RACE program that focus on coordinating and improving treatment times. It goes to show that by working together through quality improvement programs and initiatives we really can make a difference.

This post was authored by John Shuck, MD, FACC, governor of the Delaware Chapter of the ACC.

Over the past few years the issue of appropriate use and radiology benefit managers (RBMs) has been a “hot topic,” particularly in Delaware. Recently, the misuse of RBM's in denying cardiac stress imaging within the state came to national attention.  A Delaware patient was denied a cardiac stress test by an RBM used by a major health plan in Delaware. The patient was ultimately admitted to the hospital emergently for a catheterization and a lifesaving CABG was performed.  This patient's plight became well-publicized and sparked investigations by the U.S. Senate Commerce Committee and Delaware Insurance Commissioner as to why the test was denied.

Thanks to the efforts of many at the ACC national and state level, this past fall the Delaware Insurance Commissioner announced that the health plan will support use of the ACC’s FOCUS: Cardiovascular Imaging Strategies tool by Delaware cardiologists to make decisions about certain diagnostic imaging tests, as an alternative to RBMs. Unlike RBMs, the FOCUS tool engages providers in ongoing feedback reports and quality improvement activities. At the same time it reduces third-party costs to physicians and health plans (read more about FOCUS in a blog post here).

In January 2012 the FOCUS health plan product went live incorporating many of the same elements present in the FOCUS performance improvement module. Under the agreement, the health plan will pay for cardiologists in the state to use the online tool, which allows for consistent application of appropriate use criteria to determine when cardiovascular imaging tests are needed. Importantly, the program also provides feedback reports on the patterns of appropriate use to physician practices and health plans. FOCUS participants then use the reports to complete action plans and share best practices.

This model for managing medical costs by focusing on patient-centered decision making and quality care will hopefully be implemented by other insurers and within other states when it comes to ensuring appropriate use of medical imaging. I’m happy to see our efforts to implement this program in Delaware have not gone unnoticed as several other ACC chapters are currently in talks with health plans to implement this program at the state level.

For more information about Imaging in FOCUS, visit CardioSource.org/FOCUS. 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.

According to the Centers for Disease Control and Prevention, it has been estimated that at least 280 infants with unrecognized critical congenital heart defects (CCHD) are discharged each year from newborn nurseries in the U.S. Pulse oximetry newborn screening, a simple bedside test to determine the amount of oxygen in a newborn’s blood and the pulse rate, can identify some infants with a CCHD before they show any signs.

The ACC has long advocated for the universal coverage of CCHD screenings for newborns. Studies have shown that this approach to early detection of more subtle forms of congenital heart disease can prevent related complications and promote early diagnosis and treatment.

In September 2011, HHS Secretary Sebelius approved adding screening for CCHDs to the Recommended Uniform Screening Panel, which has been invaluable information as states pursue this policy. Members of the ACC’s Adult Congenital and Pediatric Cardiology Section including Gerard Martin, MD, FACC, worked with HHS to develop recommendations for the implementation of the screenings.

At the state level, there has been a push by several of ACC’s chapters working with other pediatric and cardiovascular societies to introduce policies for the newborn screenings.

Just last week Virginia Gov. Bob McDonnell originally vetoed a bill supporting legislation that would establish a public-private work group to develop a program for screening newborns for critical congenital cyanotic heart disease using pulse oximetry monitoring and providing appropriate early intervention services to infants identified as having the disease. But upon further review and discussions with key stakeholders led by ACC Staff including Delegate Patrick Hope, the ACC Virginia Chapter and others including Mended Little Hearts and AHA, McDonnell decided to implement an executive order that would put the congenital heart disease screening policy in place and officially signed the order today. This is a great example of how a strong grassroots push can be effective and instrumental.

To date Indiana, Maryland, New Jersey, Tennessee, and West Virginia have approved plans that will assure universal testing of newborns for congenital heart disease. The New Hampshire legislature recently passed a CCHD screening bill, which will be reviewed by an oversight committee prior to the Governor’s evaluation and signature, and the Connecticut Senate recently passed a bill to require CCHD screening. The health departments of Michigan, Ohio and Alabama are also currently crafting regulations to require the screening.

The ACC’s State Government Relations team is currently strategizing with stakeholders to advance the screening requirement in several other states. We’ve come a long way over the past few years as the implementation of policies for CCHD screening becomes more widespread.

It is both an honor and a privilege to be a member of the cardiovascular community. But there is a responsibility that comes with the designation. The ACC and its members are committed to quality cardiovascular care in an effort to do the right thing for our patients.

Over the past two years, the Maryland Chapter of the ACC under the leadership of Sam Goldberg, MD, FACC, past president of the chapter, and several others at the chapter and national level have been working to develop an oversight system for all state hospitals performing PCIs. (Read previous blog posts on the topic here and here). The bill was introduced over a year ago, and just this past week the Maryland Legislature passed the bill which for the first time requires a state agency to develop requirements for peer or independent review, consistent with the ACCF/AHA/SCAI Guidelines for PCI, of difficult or complicated cases and for randomly selected cases for Maryland hospitals.

In a statement issued by the Maryland Chapter, Marc Mugmon, MD, FACC, president of the Maryland chapter stated, “Peer review is a fundamental component of any comprehensive continuous quality improvement effort and will enhance patient safety by providing constructive, objective feedback to cardiologists in a collaborative environment. Independent, external review will be free of bias and politics, and by identifying individual operator strengths and weaknesses, it will help achieve the highest standard of performance. This process will complement robust internal programs and will rapidly identify and address potential deviations from accepted evidence-based guidelines for the use of stents.”

The Maryland Chapter, at the invitation of the Maryland Health Care Commission, will be an integral part of the regulatory process to implement regulations and ongoing performance measures as a member of the newly establish Clinical Advisory Group.

This is a great example of what we can accomplish at the state level though the hard work of our Board of Governor leaders. Earlier this year the Maryland Chapter was presented with the award for Advocacy at the Leadership Forum, and I am pleased to see all of their hard work and efforts have come to fruition. I hope their efforts can be a model for other states.

Yesterday I officially handed over the responsibilities of the Chair of the Board of Governors (BOG) to Dipti Itchhaporia, MD, FACC. We also said goodbye and a big thank you to the chapter Governors whose term has ended and welcomed the Governors who will begin their three year term. I cannot express how grateful the ACC is to have such strong, dedicated leaders at the state level. Taking on a BOG position in addition to the daily responsibilities and demands of our jobs is not an easy task. I can tell you from experience it can be a challenging role at times, but in the end, the opportunity to make a difference for the College and the profession is well worth the struggles.

As the opportunities for the BOG as a whole to come together to share ideas for the future are limited to a few times a year, we also took the opportunity to discuss several important issues facing the field.  Our keynote address was Dr. Richard Anderson, CEO of The Doctors Company. Dr. Anderson explained the new ACC national medical professional liability insurance program with The Doctors Company (meeting attendees can learn more Monday, March 26 from 2-3:30 p.m. during a session titled “Issues That Have Caused Medical Professional Liability Claims: Are You at Risk?”) We all know medical liability is a huge issue at the state and national level so his presentation was helpful to put things into perspective.

John Shuck, MD, FACC, governor of Delaware gave an update on the FOCUS program in Delaware and the progress since it has been mandated by Blue Cross Blue Shield of Delaware earlier this year. In addition we heard from Andrew Freeman, MD, FACC, about the Walk with a Doc program.

Even more importantly we had our first-ever Town Hall Meeting with the Board of Trustees (BOT) where we discussed the future of the ACC’s Appropriate Use Criteria (AUC). Given the continued focus on reducing escalating health care costs, more and more attention is being given to appropriate use criteria (AUC) as a means of reducing variations in care and ensuring appropriate use of technologies and therapies. (Read a previous blog post from Dr. Ralph Brindis about the future of AUC here).

Team BOT/BOG engaged in a lively discussion on AUC methodology and what needs to be improved going forward. Individuals spoke about the role of payers; the burden of expectations from patients, referring physicians, and other specialties; and the need for increased data and patient education. Others advocated for AUC to become living documents in the future. These conversations hopefully will guide us as we continue to find ways to help cv professionals understand and best utilize AUC and respond to concerns that may arise.

Overall it was a productive meeting and a great way to start ACC.12!

Last month at Leadership Forum I was pleased to present the esteemed James T. Dove Quality Award to the Wisconsin Chapter. The award is named after former ACC President and Chair of the Board of Governors, who left to us the legacy and the challenge to always strive to continually improve our practices, environments, patient care, and profession, no matter the challenges.

The chapter, through the guidance of Tom Lewandowski, MD, FACC and other Wisconsin ACC Leadership, has truly been a champion of implementing the ACC’s quality tools to improve patient care in the state.  The chapter recently engaged on an ambitious quality improvement project to combine all of the ACC’s tools into a focused project to address documented clinical quality, resource use, and cost variation in the treatment of stable ischemic heart disease (SIHC) called SMARTCare.

Using ACC-developed tools like FOCUS and data from the registries, SMARTCare brings science to the bedside to create a more robust method for assessing quality, cost and outcomes for care delivery. The chapter has been working closely with ACC staff to develop this ongoing project which is a collaboration with integrated health care systems, statewide, multi-stakeholder collaborative groups, including business coalitions, measurement and data collaborative groups, and a payment reform partnership.

This groundbreaking project aims to change the face of cardiology nationwide and will be a model for other states to use in the future. The chapter continues to develop SMARTCare Delivery and has even combined efforts with the Florida Chapter to develop a joint Center for Medicare and Medicaid Innovation Center (CMMI) Innovation Grant proposal. This proposal results from an immense amount of work, dedication, and time on the part of many, many hard working professionals.  We learn of the results of the grant proposal within the month. Congratulations and good luck!

The topic of inappropriate use of stenting has been a hot topic this past year in several states including Maryland. As Immediate Past President Ralph Brindis, MD, MPH, MACC wrote in a previous blog entry, “To be perfectly clear, the ACC does not condone inappropriate use of coronary stenting, overuse or misuse of any cardiovascular technology or therapy. That said, what’s happening in Maryland is a prime example of how a negative situation can be turned into a positive opportunity to improve quality and appropriateness of care.”

Over the past year, the Maryland Chapter, along with the Society of Cardiovascular Angiography and Interventions (SCAI), have been advocating for oversight guidelines for cath labs performing percutaneous coronary intervention (PCI).

The Maryland Chapter has been diligently working to implement internal and external peer review, but as MedPage Today recently reported: “a Maryland plan to regulate stent procedures has elicited a push-back from local chapters of the American College of Cardiology and the Society of Cardiovascular Angiography and Interventions (SCAI).” The “public outcry over” allegations of over-stenting have “spurred a technical advisory group to the Maryland Health Commission to recommend giving the commission the authority to regulate stent procedures as well as continuing evaluation of hospitals with stent programs.” However, “both the Maryland Chapter of ACC and the Maryland SCAI chapter said a better plan would be a two-tiered system of checks that includes an internal review that meets specific standards and an external peer review as an auditing mechanism.”

Although the battle in Maryland continues, their gallant efforts have not gone unnoticed, and this past week at Leadership Forum BOG Chair-Elect Dipti Itchhaporia and I presented Sam Goldberg, MD, FACC, governor of the Maryland Chapter with the ACC Chapter award for Advocacy.

As the famous Robert Frost saying goes, “Two roads diverged in a wood, and I - I took the one less traveled by, and that has made all the difference.” I applaud the amazing efforts of the Maryland Chapter who is working to do something more effective to prevent inappropriate uses.

Tobacco use continues to be the leading preventable cause of disease and premature death in the U.S. As such, there are many targeted efforts at the local, state and federal levels to not only educate consumers about the health risks related to tobacco use, but ban its use in public places. The new Million HeartsTM initiative, in which the ACC is a partner, lists smoking cessation as key element in reducing one million heart attacks and strokes over the next five years. Just this last week the ACC and its CardioSmartTM National Care Initiative took part in the American Cancer Society’s Great American Smokeout campaign.

At the state level, great strides have been made to enact smoke-free legislation. In fact, in my home state of Mississippi we are making headway in reaching our goal of passing a statewide smoke-free law. The Mississippi State Department of Health is undertaking a major project funded by the Centers for Disease Control and Prevention called “Smoke-Free Air Mississippi.” As a board member of the State Board of Health, I had the privilege a few weeks ago of working with the health department and State Health Officer, Dr. Mary Currier, in presenting information on the success of this project. Even though the state as a whole is not yet smoke-free, most of the major Mississippi communities are smoke-free. In fact, 80 percent of Mississippi adults and more than 50 percent of Mississippi smoking adults favor a law prohibiting smoking in most public places.

I personally like some of the slogans from the campaign: "Every child deserves to breathe smoke-free air;" "Breathing smoke is not on any job description;" "Breathing is not optional—smoking is.” Communities with casinos have been hard nuts to crack, and the restaurant industry was initially a main opponent to the project, but once several prominent restaurateurs invoked no smoking rules in their restaurants, they actually saw their business improve. This was especially true for family-focused restaurants. Now many restaurants are strong supporters of ordinances in their community, as well as the goal of a statewide smoke-free law.

Do smoke-free laws improve health? Surely they do, and the data are impressive.  A study from Mississippi State University involving three hospitals, including my own, showed that during the 900 to 1,000 days following implementation of the smoke-free ordinance, there was a 27 percent reduction in one community and a 14 percent reduction in another in heart attack admissions. To me this is incredible information since it even shows the short-term effects of active and passive smoking.

Currently, there are twenty-nine states, DC, Puerto Rico and the U.S. Virgin Islands, plus numerous cities and counties that have enacted smoke-free laws. The National Conference of State Legislatures, of which the ACC is a Foundation Member, has compiled a map (current to November 2010) of states that have indoor smoke-free laws. This is a key issue that the ACC State Advocacy team follows, and they will continue to work with ACC members and stakeholders to pass laws that support smoke-free environments.

I congratulate all of the states and communities that have enacted smoke-free laws, and I have hope that one day it will become the law of the land!

As the recent Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease recommend, “[e]very tobacco user should be advised at every visit to quit.” The single most important thing that clinicians can do is to encourage patients to stop smoking. CardioSmart has several useful resources available online for patients looking to quit, and is supporting the National Cancer Institute’s SmokefreeTXT program, geared toward teens and young adult smokers.