Tomorrow night (April 3) the ACC is holding the All-Chapter reception from 6:30-8 p.m. in the Grand Ballroom of the New Orleans Marriott. ACC President Ralph Brindis, MD, MPH, FACC, Vice President Bill Zoghbi, MD, FACC, former ACC President Fred Bove, MD, PhD, MACC, former BOG Chair and incoming VP John Harold, MD, MACC, and ACC CEO Jack Lewin, MD, and I will all be there, and there will be food, drinks, and perhaps a little bit of dancing. Don’t miss this chance to catch up with other cardiovascular professionals in your state and meet new colleagues from across the globe. Hope to see you tomorrow!

Today was my last Board of Governors’ (BOG) meeting as chair. Thad Waites, MD, FACC, governor of Mississippi, will now take the reins. It’s been a great year. I’ve met some amazing cardiovascular professionals and worked with fantastic ACC staff. I hope Thad has a similarly wonderful experience. After hearing his vision for the next year at today’s meeting – “Vision, Empowerment, Optimism and Opportunity” – I can only be excited for the direction the BOG is headed.

The keynote address at the meeting was given by Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform. Miller discussed how physicians could be successful under the health care payment and delivery reforms currently underway. According to Miller, there is a growing recognition that the structure of current health care payment systems frequently impedes efforts to improve the quality of health care and control health care costs. Because of this, a variety of different proposals to the payment system have been offered. These differ from the current fee-for-service system in one of more of the following ways:

• They pay more for certain services (such as currently unreimbursed or under-reimbursed services)
• They pay based on the quality of services
• They bundle payments for several services into one payment
• They make payment dependent on the amount and cost of services delivered by other physicians or providers (like gain-sharing or capitation)
• They pay to support specific provider structures, systems and locations

Under a new payment system, physicians would face both opportunities (i.e. being paid for desirable services not paid for today) and challenges (i.e. receiving inadequate payments for new services or bundled payments, or having performance standards set at unreasonably high levels). Successfully overcoming these challenges will require physicians to understand how to capitalize on these opportunities through improved efficiency, accessing sufficient capital, and being able to analyze their clinical and financial performance, as well as create organizational structures that support these key capabilities. 

Certainly, this is not going to be easy. The governors present at the meeting today have the challenging task of taking what they learned from Miller’s presentation back to their chapters to help their members adjust to the specific needs in their states. I’ll be doing the same in Indiana.

Thanks to all the governors today for a successful meeting!

*** Image credit: Harold Miller, from Mlive.com ***

It’s hard to believe that in roughly three weeks we will be in New Orleans for ACC.11 and i2 Summit. I hope everyone is as excited as I am for a great ACC.11 meeting. Be sure to join us for the Showcase Session on Sunday and then on Monday night at Convocation, where we welcome the first ever group of AACCs (cardiac care associate ACC member). If you arrive early, don’t miss the CardioSmart Health Fair being co-sponsored by the Louisiana and Mississippi Chapters. There’s also the All-Chapter Reception on Sunday night, which is always a great venue to come together and network with our colleagues from across the U.S. and now around the world.

The March/April issue of Cardiology should be arriving in mailboxes in the next couple weeks and provides a great preview of the many activities for the entire cardiovascular team, including FITs, CCAs. There’s also a section on BOG/Chapter activities, Advocacy and Practice Management-related sessions, and the Late-Breaking Clinical Trial schedule. Also, the ACC for the first time ever has launched an online community for attendees and others interested in the meeting to network and get access to exclusive content. 

See you in New Orleans!

The ACC has been educating members over the last year about the upcoming switch in the coding classification system for diseases from ICD-9 to ICD-10. This switch, which takes effect Oct. 1, 2013, is huge. The health care system will go from using 17,000 diagnosis and procedure codes to using over 155,000. The Health Business Blog recently featured a podcast interview between David Williams, who writes the blog and is co-founder of MedPharma Partners LLC, and Ray Desrochers, HealthEdge COO, on the upcoming switch to ICD-10 and why it’s such a big deal. Desrochers makes a good analogy of the switch to ICD-10 as the modern health care version of Y2K:

"ICD-10 has been called the Y2K of health care.  ICD-10 ... introduces a whole different level of complexity that most of the organizations out there today are not ready to deal with.  Remember that many of the technology platforms that are running today’s payer organizations are 20, 25, even 30 years old. When you start to talk about change, particularly significant change like this, they’re not able to easily accommodate that.

Also, similar to Y2K, you’re not only talking about a larger number of codes, you’re also, at the same time, about codes that are much longer than their ICD9 counterparts.  So you start to think about this and you go through all of the same experiences that existed in Y2K in terms of needing to analyze the databases, needing to expand fields, needing to migrate and convert data, etc. So that’s what organizations across the country are looking for as they head towards the 2013 ICD-10 standard." [The full interview transcript is available on the Health Business Blog.]

Because of the longer codes, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by Jan. 1, 2012. ICD-10 codes must be used for all health care services provided and hospital inpatient procedures performed in the U.S. on or after Oct. 1, 2013. After that, claims can’t be paid.

The ACC has resources available on our website to help members get ready for the transition, which you need to start now. Check out: What You Need to Know about ICD-10 and especially the ICD-10 Checklist.

Page one from the State Advocacy Workgroup's playbook says that if you "work with state medical societies and physician specialty groups, ... state officials will listen." Recently, joint advocacy efforts by the ACC’s Colorado Chapter and other physician groups saw just that result. The Colorado Supreme Court has been working to streamline the judicial process to ensure trials don't drag on indefinitely. While physicians have long pressed for governmental efficiency, especially in courts, the proposal was fraught with problems. It set pre-trial rules and deadlines for discovery and expert testimony, preventing physicians from responding to new arguments and evidence during trials.

One medical group raised its concerns to the state Supreme Court, and they received a form letter expressing thanks for raising the issue and a promise to consider their concerns. When the issues were raised not by one group, but by 24 physician groups, the Colorado Chapter of the ACC and the Colorado Medical Society, the results were much different. As a result of the collaboration, the CO Supreme Court panel set up a series of workgroup meetings to allow physicians to express their concerns and help re-write the policy. And because defense lawyers expressed similar concerns, the Chapter is hopeful that sensible rules of procedure will result.

This is a great example of how locking arms with friends across the House of Medicine, chapters can set the stage to protect physicians on dangerous ground either in the court room or state capitols. CO Chapter executive Lianna Collinge, former ACC CO Governor Eugene Sherman, M.D., F.A.C.C.,  and current ACC CO Governor Thomas Haffey, M.D., F.A.C.C., set a fine example for all Chapters.  

Speaking of medical liability reform, Rep. Phil Gingrey, M.D., an OB-GYN from Georgia, has introduced the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” (H.R. 5). The ACC is supporting this legislation, which would increase patient safety; ensure that injured patients are compensated quickly and fairly; improve provider-patient communications; and foster an environment for affordable and accessible medical liability insurance. The House Judiciary Committee approved the bill yesterday. The committee rejected all amendments, except one, on party line votes. The committee accepted an amendment by Cong. Scott (D-VA) removing collateral source rule reform from the legislation.  More details are available on the committee’s website. Stay tuned to “The Advocate” for updates and next steps. This issue is an ACC Advocacy priority! Read the ACC letter on the bill.   

Last weekend, nearly 150 new ACC leaders took part in the College’s annual Leadership Forum in Washington, D.C. Each year the ACC welcomes a new group of leaders, and the Leadership forum is their opportunity to learn more about their roles and responsibilities, the ACC, its policies and available resources.

Given the rapid and massive changes to the health care landscape over the last several years, the ACC has been working to transition the Leadership Forum into what essentially serves as the equivalent of pre-season training for a sports team. This year’s Leadership Forum focused on providing participants with the tools to successfully lead a team.

Some of the event’s highlights:

• ACC President Ralph Brindis, M.D., Ph.D., F.A.C.C. and CEO Jack Lewin, M.D., outlined the challenges facing the CV community and highlighted the need for leadership in changing times.
• Joseph Grenny, author of Crucial Conversations, provided a lunchtime address that focused on ways leaders/influencers “have the power to change anything.”
• Dan Reeves, former pro football player for the Cowboys and coach, talked about how his leadership experience as a winning football coach and player coupled with his ability to achieve team camaraderie has enabled him to achieve success.
• ACC Chapters were also recognized for their outstanding accomplishments in the areas of Quality, Advocacy, Education, and Membership and Community.

As chair of the BOG, I’ve seen the challenges facing cardiovascular professionals in academia, private practice, hospitals and integrated systems across the country. Incoming leaders need to know how to adeptly manage these changes, while at the same time continuing to ensure quality, appropriate cardiovascular care. The need for strong and effective leaders at all levels of the College, as well as within the CV profession in general, has never been greater. This year’s Leadership Forum is testament to the fact that there are great leaders, who are in a position to help lead the new cardiovascular team into the future.

Take a look at the January/February issue of Cardiology magazine, which is all about leadership, and leave your thoughts in the Cardiology Discussions forum.

Here are some pictures from the event, taken by Thomas Haffey, D.O., F.A.C.C., governor of Colorado Chapter of the ACC:

	BOG Steering Committee member Margo Minissian, ACNP-BC, MSN, CNS, and ACC President Ralph Brindis, M.D., F.A.C.C.
	Brindis and former NFL Player and coach Dan Reeves
	Brindis, Dan Reeves’ cardiologist Charlie Brown, M.D., F.A.C.C., Reeves, Robert Vincent, M.D., F.A.C.C., Gov. of GA, Board of Trustees member C. Michael Valentine, M.D., F.A.C.C.

In a continuation of the tort reform theme, Health Affairs recently featured a study finding that physicians’ fear of malpractice does not appear to be correlated with their actual risk of being sued. Senior study author David Katz, MD, associate professor of medicine with University of Iowa Health Care, said:

"We found that both generalist and specialist physicians fear being sued for malpractice even in states where their risk of being sued is relatively low. One likely explanation is that physicians' concerns about malpractice are driven more by their perception that the malpractice tort process is unfair and arbitrary and less by their actual risk of getting sued.” [emphasis mine]

The study found that, in general, physicians’ concerns about malpractice were not reduced by malpractice reforms implemented in some states. They write: “States that had established caps on total damages or abolished joint-and-several liability were associated with modestly lower levels of physician malpractice concern.” Two reforms – split recovery and patient compensation funds – were actually associated with higher levels of concerns among physicians. Additionally, collateral-source rule and periodic payments reforms were not significantly associated with any change.

I think this brings up some interesting points.  If malpractice reform can’t reduce the fear of being sued, what can? Despite the article’s somewhat negative outlook (the authors conclude that the only way we can reduce costs through malpractice reform is to tie malpractice reform to bundled payments), I do think tort reform can go a long way in helping defensive medicine. The ACC has a couple of things in the works to help members reduce risk. For one, the ACC is working on tort reform legislation. Secondly, we have a new Risk Management Institute that uses both educational tools and other ways to reduce risks of suits and costs of coverage for our members.

What do you think can help to reduce defensive medicine costs?

ACC's leadership is in Chicago for AHA's meeting, and working hard for our members. We're representing ACC at international events such a the meeting of the American Association of Cardiologists of Indian Origin. When my wife and I retired from the meetings for a quiet Sunday evening dinner, Jack Lewin and former ACC President Fred Bove led into the restaurant an ACC contingent that spilled over discussions from the JACC Journals Reception earlier in the evening.

Late breaking clinical trials presented yesterday at AHA -- including ASCEND-HF, RAFT, ADVANCE and EMPHASIS-HF -- are nicely summarized on CardioSource for those not in Chicago. There were more late breaking trials today, as well as an interesting session chaired by ACC BOT Elliot Antman that will cover regulatory issues that intersect with the clinical use of clopidogrel and warfarin.

The New York Times published an op-ed piece from former OMB director Peter Orszag suggesting that physicians who follow evidence-based guidelines to care for patients should be immune from malpractice suits. Several letters to the editor the following day opposed the concept, but at least the topic of malpractice reform as a means to help “bend the curve” of medical care expense in the U.S. was raised. AMA had a letter in support of the concept. If you did not see the piece, definitely check it out and leave your thoughts below.

Jack Lewin’s blog post this week summarizes the current situation better than I could ever hope to do, but I want to reiterate that members of Congress are back in their home districts, and are listening to constituents with the acuity that comes at the time of a critical election. They need to hear from all of us about the challenges we face in providing access to quality care for our patients in the face of declining reimbursement from Medicare.

The results of the ACC’s practice census clearly show that practices are cutting staff, postponing or cancelling investments in equipment and curtailing services to Medicare beneficiaries in response to the cuts. Failure to fix the SGR will only accelerate the process. The creation of the Independent Payment Advisory Board provides additional uncertainty, and the concern that poorly thought-out payment cuts will paralyze our practices’ ability to serve our patients has never been greater.

Make sure your members of Congress hear your concerns. Learn more ways to get involved in advocacy on CardioSource.