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.

There is no denying that change is in the air when it comes to large medical meetings like the ACC’s Annual Scientific Session and Expo. Not only has the rapid growth and use of mobile technologies made it easier to stay up-to-date on scientific research and guidelines, tough economic times and increasing regulations governing relationships with industry have limited travel sponsorships and overall meeting funding.

However, while these changes are very real and require a shift in focus from decades past, they don’t overshadow or negate the importance of these meetings in providing a one-stop-shop for the hottest clinical breakthroughs, increasingly important maintenance of certification opportunities, and forums for professionals across the spectrum of care delivery to network and share ideas.

At ACC.12 in Chicago, the College under the guidance of ACC President David Holmes, Jr., MD, FACC, has taken a renewed look at the meeting format and offerings and developed a well-rounded agenda that accommodates both the changing landscape of cardiology and the changing needs of the professional world.

In particular, the meeting format has been changed to feature new science in the mornings, followed by afternoon sessions focused on actual application of the science. Many of these sessions take advantage of innovative new technology to allow for the “piping in” of live cases from around the globe, as well as online debate and conversation with panel presenters while the session is occurring.

In addition, the College recognizing the importance of working closely with partner cardiovascular societies both in the U.S. and around the globe, is featuring numerous co-sponsored sessions each day with societies like the Society of Vascular Surgery, The Society of Thoracic Surgeons, the International Society for Cardiovascular Translational Research, the Heart Rhythm Society, the Heart Failure Society of America, the American Society of Echocardiography, the American Heart Association, and others. On a global scale, the record 18 International Lunch Symposia, which are jointly sponsored by ACC and international cardiology societies, will cover topics ranging from using registries for quality improvement; best practices for treating adult congenital cardiology; improving outcomes for patients with acute coronary syndromes; and more.

All of these education sessions are vital for professionals to earn Maintenance of Certification (MOC) credits, an increased point of emphasis at ACC.12. For example, entire afternoons will be dedicated to a review the fundamentals, such as MOC and clinical interpretations, with an increased number of MOC sessions from past meetings so attendees can complete much of their required elements and core content. This is something not offered to attendees at European meetings, but is vital for professional development.

Of course, networking is something else that can’t be done behind a desk and in front of a computer. ACC.12 provides many unique opportunities for cardiologists, nurses, nurse practitioners, practice administrators, pharmacists, training directors, fellows in training and others to come together in a forum not seen anywhere else. Only at ACC.12 will there be opportunities to meet and ask questions of cardiovascular legends credited for making the delivery of cardiovascular care what it is today. whenever 20,000 people who love cardiovascular science, clinical research, and health policy get together to describe the future, it has to both a very special and unique experience.

As the needs of cardiovascular professionals are changing, the ACC’s meeting is changing with them. The need for cutting edge cardiology science, education and innovation to better benefit patients and save lives will never diminish. ACC.12 shows just how far we’ve come in ensuring the meeting remains relevant and continues to benefit all cardiovascular professionals in terms of their learning and scientific needs.

Whenever 20,000 people who love cardiovascular science, clinical research, and health policy get together to describe the future, it has to be a very special and unique experience.

Geisinger Health Plan recently announced that a telehealth-based remote monitoring program for heart failure patients has significantly cut the readmission rate for those patients by 44 percent. The program uses interactive telemonitoring tools to supplement case management. Over 1,000 patients are enrolled in the program. The majority of patients use the tool to input symptomatic information on a regular basis, allowing care managers real-time access to the patient's condition. Based on its success, Geisinger plans to extend the program to diabetes and hypertension patients. This, my friends, is the future for all cardiology chronic disease outpatient care.

Don’t miss these sessions at ACC.12 and ACC-i2 with TCT in Chicago that focus on remote disease management, H2H and readmissions:

• Can Remote Disease Management Improve Clinical Outcomes?
  Saturday, March 24, 2 – 3:30 p.m. (McCormick Place South, S406a)
• Tools to Improve the Care Transition: The Hospital to Home (H2H) Experience
  Sunday, March 25, 8 – 9:30 a.m. (McCormick Place South, S501a)
• Improving Outcomes and Reducing Heart Failure Readmissions
  Monday, March 26, 3:45 – 5:15 p.m. (McCormick Place South, S406b)

New survey data released by the ACC provides an important first-look at cardiology from the viewpoint of hospital administrators, reflecting responses of 300 hospital executives and cardiovascular professionals representing 291 hospitals and medical facilities. 40 percent of these CEO-administrators say their facility had either acquired or had considered acquiring a cardiology practice in the last two years.  Roughly 20 percent indicated they are considering an acquisition in the near future.

Recruitment of cardiologists and other cardiovascular professionals is the top priority in terms of the biggest challenges facing hospital administrators in successfully running a cardiovascular service. The FACC designation was viewed as an important factor when it comes to hiring. According to the survey, 72 percent of administrators said they were somewhat more likely or much more likely to hire a cardiologist with an FACC designation, with more than three-quarters (77 percent) of the administrators indicated that it was extremely or very important for cardiologists to have earned the FACC in general.

The FACC distinction symbolizes a dedication and commitment to the highest quality of cardiovascular care. Fellows are elected to the college based on their credentials, achievements, and contribution to cardiovascular medicine as recommended by faculty and members, and it’s good to see that this distinction is recognized as important in the hospital environment.

On the quality front, the survey found that almost all hospitals participate in cardiovascular quality initiatives, with 83 percent participating in ACC sponsored quality activities like the ICD and CathPCI Registries, and the Door to Balloon (D2B) Alliance.

Bottom line, the data from this survey are extremely important as we move forward with meeting the needs of cardiovascular professionals and administrators in the constantly evolving health care environment. It’s good to know that the College is moving in the right direction with its quality efforts.

The ACC’s 61st Annual Scientific Session and Expo is officially 2 weeks away. Here at Heart House we’ve been busy loading up the truck with all of the meeting materials to ship to Chicago. I know all of those involved in the meeting have been tirelessly working on all of the last minute details.

If you haven’t heard, meeting attendees can already start planning Chicago activities using the new ACC.12 eMeeting Planner App, available for the iPad, iPhone and Android. The app is focused on helping attendees plan ahead in how to make best use of all the educational content and offerings at this really spectacular meeting -- the educational content, organized by the ACC.12 Co-Chairs Rick Nishimura, Pat O’Gara and many others, is better than we’ve ever produced in my view.

The app lets you easily search and browse sessions and exhibits and create a schedule. There are also animated maps to help navigate the convention center once you get there and easy access to local Chicago tourism information. Plus, the app provides links to the ACC.12 Twitter feed and eBooks of the Final Program, Program-At-A-Glance, JACC Abstract Supplement and the daily CardioSourceNews at ACC.12 newspaper. Search “ACC.12” in the app marketplace or browse http://ativ.me/acc to download the app.

In addition, the ACC.12 Online Community is up and running and provides opportunities for ACC members to network with colleagues and stay on top of late-breaking ACC.12 news before, during and after the meeting. You can also stay up to date on ACC.12 through the College’s Facebook page and via Twitter by following @ACC_2012 and using the hashtag #ACC12.

Per usual here on the ACCinTouch blog we will be providing you with daily articles and updates from Dr. Holmes, Dr. Waites and myself, including several guest bloggers this year. Also be sure to check out the Fellows in Training blog on CardioSource.org/FIT. They have a roving reporter team lined up for coverage from the meeting so check out their blog throughout the meeting.

View all of the ways to stay connected at ACC.12 here. See you soon at ACC.12 in ChicaGO!

Innovation is the topic du jour among lawmakers and others lately. Recently the co-chairs of the House Medical Technology Caucus, Rep. Erik Paulsen (R-MN) and Rep. Anna Eshoo (D-CA), held a briefing on Treating Cardiovascular Disease: Advancements in Medical Technology Innovation. A panel of experts shared examples of many ways in which cardiovascular technology innovation is changing the industry and the way health care is delivered.

Mayo Clinic was featured for being on the cutting edge of education and research, spending $421 million in these areas in 2011 alone. Mayo’s 2020 vision, “Mayo Everywhere,” involves engaging technology to impact patient care globally.  For example, instead of bringing patients to Rochester, MN for treatment, Mayo is focused on delivering affordable health care to their patients wherever they live using home monitoring and other technological approaches that foster mobility and independence.

Industry representatives were also on hand to describe the latest innovations stemming from extensive cardiovascular research and development. The Edwards Lifesciences’ SAPIEN Transcatheter Heart Valve, which recently received FDA approval, was an obvious example (read more about transcatheter valve therapy here). The MitraClip, a Mitral Valve Repair System that EVEREST II deemed safe for patients with moderate to severe mitral regurgitation, was touted as another impactful innovation that is currently in FDA review.

Meanwhile, it was noted that while the U.S. has been a strong force in medical technology, China, Brazil, India and other countries are surpassing us in the innovation arena due to the structure of current U.S. policies.  Rep. Eshoo, a long-time champion for technology and innovation, stressed the need for the U.S. to regain its status as the leader in medical advancement and set the gold standard for the world. She echoed the need for transforming the FDA and other agencies into innovation drivers, versus hindrances, and encouraged her congressional colleagues to visit technology companies in order to gain a first-hand perspective of the impact they have on the medical system.

This focus on innovation provides a great opportunity for the College to showcase our leadership and expertise when it comes to cardiovascular advances both in the past and moving forward.  Our work on TAVR is the most recent example. Hopefully this will be the new paradigm moving forward working with the FDA, CMS and our fellow specialty societies.

In addition innovative programs like Hospital to Home and D2B are already contributing to major gains in reducing cardiovascular hospital readmissions and D2B times, respectively. Other programs like PINNACLE, FOCUS and SMARTCare are well on their way.

We have a lot to be proud of. We’ll be showcasing a lot of this innovation and exploring what cardiovascular care might look like in a number of sessions and activities at ACC.12 for those of you headed to Chicago this month. Definitely plan to check out the Heart of Innovation Featured Learning Destination during the Expo, which is specifically designed to showcase the continuum of advances in cardiovascular innovation and provide a unique glimpse of what the future can be. It’s truly amazing.

Common Good and the Bipartisan Policy Center teamed up for an eye-opening Forum on Obsolete Law recently. Speakers hailing from across the spectrum weighed in on government’s desperate need for a spring cleaning. After decades of laws piling up—there are a reported 160,000 pages of regulations—the system has become an immobile beast and common sense has been thrown out the window.

Let’s face it, laws are destined to become obsolete, especially in today’s society where human knowledge is growing, globalization is booming, politics are polarized and economic, technological and social change is evolving faster than we can keep up with. Operating on rules that were put in place in the 60’s and 70’s— when health care regulation was primarily formulated—doesn’t make any sense. As Phillip Howard from Common Good put it, “government is run by dead people.”

A common topic of discussion was the need to move away from incentivizing regulators to add more and more policies regardless of how they perform, and instead implement a “look back” element that evaluates the effectiveness of laws and eliminates legal build-up. Sen. Mark Warner (D-VA) believes the British government is on to something with their “one in one out” model, which requires an outdated bill to be removed from the books whenever a new bill is enacted.

Health care was injected throughout the forum to demonstrate how too much regulation can inhibit innovation. The SGR was mentioned as a prime example of Congress kicking the can down the road for the past decade instead of overhauling the flawed formula in order to protect reimbursement rates. The panel also discussed how physicians’ omnipresent fear of being sued coupled with a straight fee-for-service system has resulted in unnecessary testing that contributes to rising health care costs. What option do we have as physicians? We’ve been backed into a corner and will be stuck there until something is done that allows us to practice without fear.

So what is the solution to the issue of obsolete law? In a room full of lawmakers, CEOs, political scientists and professors, no one had the magic formula for tackling this mess, of course. While the panel had a wide range of suggestions, the resounding theme was the need for spring-cleaning and simplification, restoring a nimble, user- friendly government in these rapidly changing times.

A study published earlier this week in The Lancet shows that treating heart attack patients with an infusion of their own heart-derived cells helps damaged hearts re-grow healthy muscle. The study results are from the Cedars-Sinai Heart Institute clinical trial CADECEUS and is the first-of-its-kind stem cell procedure.

As it has shown that cardiosphere-derived cells (CDCs) reduce scarring after myocardial infarction, increase viable myocardium, and boost cardiac function in preclinical models, the authors aimed to assess safety of such an approach in patients with left ventricular dysfunction after myocardial infarction.

The study involved 25 patients who had suffered a myocardial infarction that left them with damaged heart muscle. Eight patients received standard care, and the remaining 17 received the stem cell treatment. The results showed that one year later, scar size was reduced from 24 percent to 12 percent of the heart in patients with cells. Patients also experienced sizable increase in healthy heart muscle following the experimental stem cell treatments. Patients in the control group who did not receive stem cells did not experience a reduction in their heart scars.

Eduardo Marban, MD, PhD, director of the Cedars-Sinai Heart Institute who invented the procedures and technology involved in the study noted, “While the primary goal of our study was to verify safety, we also looked for evidence that the treatment might dissolve scar and regrow lost heart muscle... this has never been accomplished before, despite a decade of cell therapy trials for patients with heart attacks.”

While the grim concerns about the alarming contributions of health care costs to the national deficit seem to dominate the conversation, who could deny that this is an unprecedented and exciting time for the cv community! Science is moving fast. The ACC wants more medical research and NIH funding to pursue innovative, life-saving therapies. Although funding of stem cell research is often a topic of controversy, we need to publicly educate how life-saving therapies like these are exactly what innovators in medicine and science strive to achieve.

Let’s not forget that this type of innovation requires funding and support, and it’s not looking good for those of us in the U.S. folks. President Obama’s Fiscal Year 2013 Budget Proposal freezes funding for NIH, and many in Congress advocate for significantly slashing funding for innovation and research.  Nonetheless, innovators like Marban are paving the wave of the future. Let’s have at it!

In a recent issue of Nature magazine, an article entitled “The Toxic Truth About Sugar” (subscription required), authored by three academics, one of whom is Claire Brindis, PhD, wife of ACC Past President Ralph Brindis, MD, MPH, MACC, is causing quite a stir.

Brindis and her co-authors highlight the growing body of evidence about the adverse effects of ubiquitous added sweeteners in the U.S. and global diet, particularly high fructose additives, which contribute immensely to non-communicable diseases, including diabetes and obesity. The United Nations recently declared that we must combat non-communicable diseases (NCDs), which represent a global threat killing over 35 million a year, and far exceeding the toll from communicable diseases now. (Read a previous blog post here). These problems now affect every country that has adopted the western diet of low-cost, highly processed food -- which is most of the world. The UN targets tobacco, alcohol, and diet as the three priority areas -- and diet issues are dominated by the metabolic syndrome-fostering impacts of added sweeteners to foods.

Brindis and her co-authors noted that tobacco and alcohol controls and social costs are typically mediated by government regulation and taxation, but that sugar addiction and its related toxicity escape this kind of regulation. The U.S. still leads the world in the average calories per day from added sweeteners in the diet (over 600 per day), but the rest of the world is catching up. These authors suggest -- despite the political hurdles anticipated -- that regulation and taxation of added sweeteners could have an enormous impact on reducing NCDs (including heart disease!), as well as health care and productivity loss costs. A courageous position!

Of course, you might imagine how much threatening opposition mail the authors have also been barraged with.  Nonetheless, my hat is off to the ‘other’ Dr. Brindis. The food industry is not going to give in easily here, even though this week we also saw that the transfat labeling requirements on foods (in combination with the restaurant transfat bans in some cities) have had a real impact in reducing consumption.

Last week I had the pleasure of testifying on behalf of the ACC at the House Ways and Means Subcommittee on Health during a special hearing to explore how private sector payers are rewarding physicians who deliver high quality and efficient care. I was joined by other panelists: Lewis G. Sandy, MD, senior vice president, Clinical Advancement, UnitedHealth Group; David Share, MD, MPH, vice president, Value Partnerships, Blue Cross Blue Shield Michigan; John L. Bender, MD president and CEO, Miramont Family Medicine; and Len Nichols, PhD, director, Center for Health Policy Research and Ethics and editor-in-chief of the ACC’s online Community on Payment Innovations.

During my testimony I discussed several of the quality improvement collaborations underway in cardiology and what lessons can be applied across the health care system to simultaneously reduce unnecessary readmissions, complications, testing, and ineffective spending. My testimony also focused on the power of data as exemplified by our experience with the NCDR and the importance of decision support tools in helping care providers actually use evidence-based guidelines and appropriate use criteria to “get science to the point of care” to ensure not only the right therapy and/or test, but also engage patients in the decision making process. I also focused on the ways the ACC is currently working to “put the data to work” through programs like Hospital to Home, Imaging in FOCUS and PINNACLE. I also expressed the need for payment reforms linked to these tools.

A big part of my testimony was also the “SMARTCare” projects currently underway in Wisconsin and Florida that combine data collection, decision support and quality improvement initiatives into a focused project that documents clinical quality, resource use and cost variation in the treatment of stable ischemic heart disease. The projects are driven by the ACC’s state chapters and the ACC in collaboration with integrated health care systems, payers and multi-stakeholder collaborative groups.

The ACC was absolutely a vital part of this conversation. The development of innovative new programs and payment models that reward physicians who deliver high quality and efficient care has been a College priority over the last several years in light of health care reform and the need to curb out-of-control health care costs. I also told the Subcommittee that one of the key points to keep in mind about new systems is the time it takes to implement -- so the faster they are established the faster we can move forward with implementing these new payment reforms!

I invite you to share your “big ideas" on how to reward providers for quality care and cost savings in the comment section below.

Read the complete testimony and learn more about the hearing here.