Today the Bipartisan Policy Center’s Task Force on Delivery System Reform and Health Information Technology (IT) released an important report, Transforming Health Care: The Role of Health IT, which outlines recommendations for the most effective use of health IT to achieve the triple aim through new models of care delivery and payment reform. I am a member of the task force – we’ve been working on this plan for over a year.

Following the authorization of up to $30 billion to support health IT under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the report was created to identify real-world examples and best practices that facilitate coordinated, accountable and patient-centered care; and to make recommendations for ensuring that current health IT efforts support delivery system and payment models shown to improve quality and reduce costs in health care, in ways that best utilize scarce public and private resources.

I joined the Bipartisan Policy Center’s co-chairs, former Senators Tom Daschle (D-S.D.) and Bill Frist, MD (R-Tenn.), and former Governors Ted Strickland and John Engler, at a policy briefing featuring prominent leaders in the field to release the report and discuss how to make it happen.

The report identifies key gaps and barriers to achieving widespread adoption of health IT, including: misaligned incentives; a lack of health information exchange; limited level of consumer engagement using electronic tools; limited levels of Electronic Health Record (EHR) adoption; privacy and security concerns; and multiple federal priorities that all require focus and attention.

The task force also identified several goals and recommendations to overcome these barriers including: aligning incentives and payment with higher quality, more cost-effective health care, accelerating health information exchange efforts, accelerating and supporting engagement of consumers using electronic tools, expanding education and implementation assistance, addressing concerns about privacy and security, and further aligning federal health care and health IT programs. Incidentally, the task force has had a kind of brilliant idea on how to get beyond the unique patient identifier controversy – which is politically stalled. We suggest developing “patient tracking” systems to manage patients securely over the continuum.

After the press event was over I had lunch with Daschle, Frist, Strickland, and Engler to talk further about implementation ideas and how the ACC can help move this. The good news is most of the field of cardiology and the ACC with its quality tools and programs are already working to implement most of these recommendations, but as the health care landscape changes and the cost of health care increases, it is important now more than ever to adopt new models of care delivery.

For more information, visit www.CardioSource.org/HealthIT.

While listening to the President’s third State of the Union (SOTU) address since taking office, it was clear his messaging was very much the start of his campaign for re-election with themes like creating jobs and the economy. But unlike like his previous speeches, which I blogged about here and here, the President only touched on the Affordable Care Act (ACA) a few times, saying “I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage or charge women differently from men.” Although the ACA is now in the hands of the Supreme Court, I predict much of what the ACA has already implemented will NOT be undone for powerful political reasons.

The President mentioned innovation and research funding for medical advancements several times, claiming “don’t gut these investments in our budget. Don’t let other countries win the race for the future.” This innovation is something the ACC fully supports and stands behind, as it is innovation that will help combat the number one killer in the U.S.

Although the President didn’t speak of tort reform as he did in last year’s SOTU speech, he did speak of reforming Medicare, “I'm prepared to make more reforms that rein in the long term costs of Medicare and Medicaid, and strengthen Social Security, so long as those programs remain a guarantee of security for seniors.” This is encouraging as we are slowly approaching the deadline to do something about the sustainable growth rate (or SGRrrr expressed as a growl, Medicare’s broken physician payment formula). The profession has been urging Congress to use money from military savings to permanently repeal the SGR, noting it is politically still a long shot.

The President also spoke of putting politics aside to come together as one team to make some real changes. Let’s hope there can be some bipartisan compromise this year to address means of appropriately addressing the deficit reduction to include eliminating the SGR, but also without destroying health care in the process. We need to promote the paradigm shift of policy thinking from “cutting care” to “improving care” in order to address the deficit.

What an exciting weekend! I can safely say that the Cardiovascular Care Summit is not something that happened in Las Vegas that should stay in Las Vegas. Whether it was hearing from national health plan representatives on the role of the cardiologist and the cardiovascular program in a reformed reimbursement environment, or discussing best practices for building and managing a cardiovascular service line, this unique conference offered solutions for the entire cardiovascular care team to thrive in a time of change.

David Lansky, PhD, president and CEO of the Pacific Business Group on Health; Deborah Ness, president of the National Partnership of Women and Families; Lonny Reisman, MD, chief medical officer at Aetna; and Reed Tuckson, MD, executive vice president and chief of medical affairs at UnitedHealth Group kicked off the Summit by providing a unique perspective on the cardiovascular community’s role in payment reform. Whether examining the components of value-based purchasing, helping to reduce patient readmissions, there are a number of opportunities to share our expertise and work with health plans.

The Summit also featured discussions on the future of health care reform and how the physician community as a whole can affect this process and lead change. Obviously, one of the key areas requiring substantial change is physician payment. Following on the heels of the health reform session, Summit attendees were able to take part in a panel discussion that looked at a variety of compensation models and their potential roles in the changing reimbursement environment. Breakout groups also offered opportunities to discuss major financial changes, ranging from contract negotiations, winning academic business models and how to financially survive in private practice.

Outside of payment and health care reform, the Summit also focused substantially on data collection and management, providing a focused look at the myriad of data available today and why accurately reporting data will be so critical in the future. The writing is on the wall, whether we like it or not, and future compensation models will be based at least in some part on quality of care and outcomes. We have the experience with NCDR to make sure this is done in a way that is transparent and accurately reflects the quality and appropriateness of care being provided.

Finally, the final day of the Summit really provided a comprehensive look at issues related to the cardiovascular service line. Physician management of the cardiovascular service line is today’s contemporary approach to a physician-driven, professionally managed cardiovascular program.

The integration of physicians into the management of the service line provides an opportunity to strategically and operationally align hospitals and physician groups. ACC leaders and other stakeholders involved in service line management provided first-hand reports and best practices for designing and leading a successful cardiovascular service line model.

I’d like to thank and recognize ACC leaders and staff involved in making this Summit a great success. It was a true testament to the many ways the ACC and its leaders are working to meet the needs of the entire cardiovascular care team in this time of rapid change. Viva Las Vegas!

One of the very few and somewhat mysterious successes in health care this year was recently chronicled by Lori Montgomery in an article in The Washington Post describing the substantial drop in the growth of Part B Medicare costs in 2011. Although these costs usually grow by 4% a year or more, they are now growing at a mere 2%. Everyone she interviewed about this was baffled. She writes:

“At first, chief Medicare actuary Rick Foster thought it was a mistake, perhaps a glitch in data collection. No other explanation made sense. Congress had just passed far-reaching health-care legislation that mandated cuts in Medicare spending. But the law was so new that rules for implementation had not been written.”

Montgomery goes on to interview a host of people who couldn't explain it. Some speculated that it is the recession. Others (Democrat politicians) thought it is the salutary effect of Obama's health care law. Still others argued that this shows how efficient the Medicare program is.

I think this is mainly related to the rising co-pay costs for Medicare beneficiaries. Folks are worried about paying their 20% of most services, and are delaying care and not picking up their meds as often as before. We know that’s true. Quest Diagnostics, for example, notes that more patients than ever are not pursuing their ordered lab tests (with co-pays attached) their physicians order, just to save money. This is not a good sign in terms of preventing preventable admissions and complications. But, it’s the result of the Great Recession’s impact on middle class beneficiaries.

For more information about Medicare physician payment, visit the physician payment issues section on CardioSource.org. Also check out the Payment Innovations Community.

Under the leadership of Alice Jacobs FACC, the ACCF/AHA Task Force on Practice Guidelines and ACC/AHA guidelines staff held a Methodology Summit in mid-December as part of AHA and ACC’s ongoing efforts to improve the guidelines methodology and rigorous development process. With the American Heart Association, our partner in these regards for almost three decades, we together also want to compare and contrast the current ACCF/AHA guidelines methodology with the standards proposed in the Institute of Medicine’s (IOM) two recently published reports, Clinical Practice Guidelines We Can Trust, and Finding What Works in Health Care: Standards for Systematic Reviews.

Last August, the Task Force initially commissioned five Workgroups to consider what, if any, changes or improvements should be implemented to enhance our development process and evidence review and evaluation. Each Workgroup was charged with 1) reviewing the IOM Report recommendations and sections of the current tools available for developing/conducting systematic reviews relevant to their topic; 2) comparing and contrasting the recommendations with our current ACCF/AHA methodology, including an analysis/discussion of the gaps and barriers; and 3) drafting recommendations/considerations for changes and improvements to the evidence review process and the COR/LOE including a discussion of why we may or may not implement changes.

The invited members of each Workgroup (including all Task Force members), in addition to guests at the Summit, brought a diversity of experience and expertise to this initiative. Participants included methodologists, biostatisticians, clinical and research cardiologists, epidemiologists and nurses as well as leadership from both the ACC and AHA. An official report which will include the final proposals and recommendations developed during the Methodology Summit is being prepared. This report will be shared with the leadership of the ACCF/AHA and then published.

We are also thinking to increase the technological ability to search the huge volumes of clinical recommendations we have amassed to allow clinicians to be able to more effectively and instantly use this science and knowledge more effectively at the point of care. Dr. Rick Nishimura wowed the Task Force with a strategy and plan to create what I’d call a ‘virtual curator’ IT system that could re-structure the data in our future (and present) guideline data to make it available in new ways. It’s time!

If you are attending ACC.12 in Chicago, be sure to check out the session “What’s New in the ACCF/AHA Guidelines,” on Sunday, March 25, from 4:30 – 6:00 p.m. in McCormick Place North, N228.
The session will discuss the recently published ACCF/AHA Clinical Practice Guidelines as well as an update on changes to the ACCF/AHA methodology.

I have perhaps too often emphasized the negative side of politics and economics of health care this past year. I feel justified in this. Congress is certainly not heroic; and the looming consequences of health care’s overwhelming contribution to the growing national debt are very concerning. But there are some very positive trends and issues to take into consideration as well.

Medicare cost trends have been considerably lower than CBO projections over 2011 -- of course, the overall costs of Medicare are growing as 10,000 baby boomers a day become eligible, and new diagnostics and therapeutics are being introduced -- but the slowing of the cost curve projections is a positive and unexpected phenomenon.

Science is clearly advancing rapidly, despite the economic downturn. New therapeutic frontiers in cardiovascular care alone are impressive. For example, the promise of much-heralded CETP (cholesteryl ester transfer protein) inhibitor drugs; rapidly evolving genomic, cell therapy, and electrophysiological and imaging advances; and new procedures including transcatheter valve therapy (TVT) are all examples of the stunning pace of scientific evolution.

Despite the controversy surrounding the Affordable Care Act, publicly funded programs have enabled 1.2 million children to gain health insurance since 2008, and according to Obama administration officials, this is in part due to the efforts by many states to sign up eligible children. In addition, millions of previously uninsurable people with high risk conditions now have affordable coverage.

Further, despite the growing political and economic strains on the profession and medicine in general, the best and the brightest physicians and nurses and other clinicians-in-training still aspire to cardiovascular careers and participate with the ACC on the ongoing and stunning reduction of morbidity and mortality in cardiovascular disease.  The ACC itself has been able to grow by about 5 percent year-over-year since the recession of 2008 to better serve the CV community and CV patients.

2012 will host the all-important November elections, the Supreme Court ruling on the Affordable Care Act, and the need for deficit limit and reduction action -- it won’t be a boring year. In fact this year will call all of us in medicine to seek ways to help the entire nation deal with all of these critical issues.

There’s still a lot to be optimistic about, folks, but it’s certainly not all rosy.

Congress has given us all a holiday gift and has passed an amended version of the Senate's $30 billion package that would, in part, delay the Jan. 1 Medicare physician payment cut for two months. The amended language calls on Senate leadership to agree to a conference early next year to negotiate a full-year extension of current Medicare reimbursement rates and the payroll tax holiday. This measure cleared both chambers by unanimous consent and President Obama has already signed the legislation into law.

I hope you all enjoy the holiday season and rest assured that we will come back in full force in 2012 to work for a permanent fix so we won’t have to deal with this never-ending SGR madness.

In this last week of Congressional action in 2011, on Saturday it seemed as though Congress at the last second would approve a package funding the government into the next year, and in a parallel last-minute decision, the payroll tax cut extension and the SGRrrr (the un-Sustainable Growth Rate Medicare physician payment formula expressed as a growl) seemed to have been saved by the U.S. Senate for two months (through February 2012).

But unbelievably this afternoon the House rejected the two-month extension since they want a longer extension instead. The Senate has already adjourned for the holidays and it is unlikely an alternative resolution to prevent the pending SGR cuts will be resolved before the Jan. 1 deadline. This is a clear failure by Congress and its impacts will be felt by practices and patients as we head into the new year. Once again physician practices are subjected to financial uncertainty and disruption of business. Most importantly patients' access to life-saving quality health care is on the line.

The Centers for Medicare & Medicaid Services (CMS) announced that if Congress hasn’t acted by the start of the new year it will hold claims until Jan. 17 before they start the automatic Medicare payment cuts.

This circus has played itself out. We are in serious trouble if both parties are unable to abandon partisanship to seek a middle ground to solve the huge problems and risks we face. We’re certainly not the shining example of how democracy should responsibly function for Egypt to emulate, or for mentoring any emerging democratic nation. Our Congress is currently broken. We need the next generation of leaders to work on fixing this never-ending SGR ping pong match.

It’s been a while since we’ve heard about the Physician Payments Sunshine Act, (read previous blog posts here and here) but this week the Centers for Medicare & Medicaid Services (CMS) released the long-awaited proposed regulations.  A requirement of the Affordable Care Act, the Sunshine Act requires drug and medical device companies to publicly report their payments to physicians.

CMS had missed their deadline of October 1, but after some pressure and criticism from lawmakers and industry, the agency released the rules just in time for the holidays. Since the rules are late, data collection will not begin until the final regulations are issued.

The ACC has a stringent position on conflicts of interest and relationships with industry, and while we strongly support transparency in physician and physician organization relationships with industry, we believe that it is critical this information be placed into the proper context, and made publicly available in a format understandable by the average consumer.

The College will be submitting comments on these proposed regulations to make sure the Sunshine Act process is as transparent and accurate as possible. View the comments submitted to CMS earlier this year here. For more information, visit www.cardiosource.org/Advocacy.

A recent article in Health Affairs examined the supply and distribution of the cardiology workforce across the country given “a sufficient cardiology workforce is necessary to ensure access to cardiovascular care. Specifically, access to cardiologists is important in the management and treatment of chronic cardiovascular disease.”  The paper was co-authored by Harlan Krumholz, MD, FACC, a member of the ACC Board of Trustees and professor of medicine and epidemiology and public health at Yale University School of Medicine.

The results showed that there has been a modest increase in the cardiology workforce over the past 12 years, whereas the primary care physician and entire physician workforce shortages are more pronounced. But there’s also a big disparity in the geographic distribution of cardiologists across the country, specifically in rural and socioeconomically disadvantaged areas.

As the U.S. “baby boomer” population becomes older, it is clear we will need to rely on team-based practice models to deal with the cardiovascular demands on the U.S. health care system that are certain to increase. A team-based model will enable delivery system and quality of care improvements as it offers solutions to the workforce shortage, and will expanded physician productivity, and improve job satisfaction by reducing workloads and preventing burnout.

According to the CDC, since 1950, age-adjusted death rates from cardiovascular disease have declined 60 percent, representing one of the most important public health achievements of the 20th century. Despite this huge reduction in morbidity and mortality, just imagine what we can accomplish when we work together in a team-based setting using NCDR^® and PINNACLE Registry^® data to systematically improve patient outcomes, and simultaneously improve efficiency and value.

We still have a long way to go in fighting the leading cause of death in the U.S., so let’s get to it!