- Email: [email protected]
American College of Cardiology Advocacy
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 66, NO. 20, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jacc.2015.09.031
LEADERSHIP PAGE
American College of Cardiology Advocacy Ensuring Value in a Value-Based Health System Kim Allan Williams, SR, MD, FACC, ACC President
“No outcomes, no income.”
L
The reasons behind these health care costs are
—David Nash, MD,
many. We have an aging population that in no small
founding dean of Thomas Jefferson
way is a result of our successes in treatment of heart
University’s School of Population Health
disease and a nearly 50% reduction in cardiovascular
in Philadelphia, summarizing the
mortality over the past few decades (3). However, this
future of health care (1)
success in treatment, rather than reduction of dis-
ast month was unofficially “advocacy month” at the American College of Cardiology (ACC). It was the month when nearly 400 cardiovas-
cular professionals descended on Washington, DC, as part of the College’s annual Legislative Conference. For 3 days, participants heard from ACC leaders and staff, lawmakers, representatives from federal agencies like the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration, and congressional staff about the largest issues facing the cardiovascular community. More importantly, they went to Capitol Hill to meet face-to-face with their members of Congress to advocate for policies that protect patient access to quality, costeffective care. Unlike previous years, when much of the College’s advocacy efforts were focused on temporarily halting the flawed Sustainable Growth Rate and encouraging a permanent solution, the College now has an opportunity to be more forward-thinking in discussions with lawmakers. The historic passage earlier this year of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the permanent repeal of the Sustainable Growth Rate that came with it means we can focus on how best to create a value-driven health system and drive down costs that are expected to reach $4.8 trillion in 2021, constituting 19.6% of the gross domestic product or $1 of every $5 spent (2).
ease, has led to an increasing prevalence of chronic diseases and comorbidities in the face of limited funding for preventive services. The high cost of new technologies, accelerating costs of both new and generic drugs, increased administrative costs, and fragmentation of the health system also contribute to this rising tide. There is no 1 solution to counter all of these issues, but Congress, CMS, and other stakeholders have started to transition the current reimbursement system to one that rewards value over volume as a first step. How this new system will look in its final iteration remains to be seen, but we do know that reform is under way. CMS targets have 90% of payment tied to quality by 2018 (4). Since 2019 is the first payment year, 2017 will likely be the first performance year for the merit-based incentive payment system or alternative payment models (APMs) under MACRA. The merit-based incentive payment system will combine the physician quality reporting system, meaningful use, and the value-based payment modifier—all 3 of which currently have separate systems and reporting deadlines—into 1 system. Under this program, eligible professionals, including physicians, physician assistants, nurse practitioners, and clinical nurse specialists, who elect to participate will receive annual payment increases (or decreases) on the basis of their performance. In terms of APMs, clinicians choosing to participate in a private payer APM and/or who receive at least 25% of their Medicare revenue through an APM beginning in 2018 will receive a 5% payment
From the American College of Cardiology, Washington, DC.
bonus. The threshold for receiving the bonus will
Williams
JACC VOL. 66, NO. 20, 2015 NOVEMBER 17/24, 2015:2256–7
Leadership Page
increase over time as CMS and payers move toward
a comprehensive strategy, working in collaboration
value-based
with
payment
models.
Accountable
care
key
stakeholders,
to
improve
population
organizations and patient-centered medical homes
health. The ACC’s Diabetes Collaborative Registry
are current examples of APMs. Other models that
and STS/ACC TVT Registry are also great examples
incorporate quality measurement, the use of certified
of how the health care community can come
electronic health records, and the assumption of
together to track and improve care coordination
financial risk will be considered moving forward.
across specialties.
With the magnitude of these changes and the
On the patient front, the College continues to grow
importance of getting things right, the College is
its CardioSmart patient-focused efforts with the
following all of this closely and engaging with CMS,
recent launch of the “Find Your Heart a Home” hos-
lawmakers, and other stakeholders about details
pital comparison tool (FindYourHeartaHome.org), as
and time lines. The need to develop relevant and
well as an online shared decision-making tool for
reliable measures that can be used for quality
anticoagulation for nonvalvular atrial fibrillation
improvement is one of the most important ele-
(www.cardiosmart.org/SDMAFib). Through the dev-
ments, followed by ensuring that clinicians receive
elopment of these and other resources over the last
the technical assistance necessary to succeed. The
several years, the ACC can offer unique insights on
ACC’s vast experience in developing and running
how to effectively engage patients and their families
clinical data registries can play an important role
in their care.
here, given the need for reliable access to data and
Engagement in advocacy is part of our profes-
timely feedback on quality performance and varia-
sional responsibility. To paraphrase President John
tions in care. The ACC’s leadership in the develop-
F. Kennedy, I like to think of advocacy as accepting
ment of performance measures working with other
our own responsibility for the future. For those car-
societies, the Physician Consortium for Performance
diovascular professionals who attended the 2015
Improvement Foundation, and the National Quality
Legislative Conference, I thank you for taking time
Forum will inform measure selection for use going
out of your schedules to represent your patients and
forward.
across
colleagues on Capitol Hill and for sharing the many
federal, state, and private payers is of the utmost
ways the cardiovascular community can continue to
priority, as is ensuring that electronic health re-
lead the way as we transition to a value-based
cords,
information
system. For those who could not make it but have
technology networks are using the same datasets
written letters or called your members of Congress;
and terminology.
hosted lawmakers at your practice as part of our
Alignment
registries,
and
of
measures
other
health
used
Care coordination both among clinicians and with
legislative practice visit efforts; provided expertise
patients is another critical element that needs to be
and feedback to ACC Advocacy staff on policy pro-
considered as we move from a volume- to value-
posals; contributed to the ACC’s Political Action
based system. This is also an area where the ACC
Committee; and/or filled in for colleagues to partici-
can play a role. Just this past May, the ACC released
pate in advocacy efforts, thank you as well. Let us
a health policy statement focused on cardiovascular
grab hold of our future and make sure we and our
team-based care and the role of advanced practice
patients get the most value out of a value-based
providers. The basic premise: building teams that
system.
include advanced practice providers can help meet the challenges of cardiovascular workforce short-
ADDRESS CORRESPONDENCE TO: Kim Allan Williams,
ages, an aging patient population with growing
Sr., MD, FACC, American College of Cardiology,
complexities in cardiovascular care, and a payment
2400 N Street NW, Washington, DC 20037. E-mail:
system in transition. The College is also developing
[email protected].
REFERENCES 1. Versel N. Population health expert: health reform
Available
http://www.cnbc.com/2015/
4. U.S. Department of Health & Human Services.
as simple as changing incentives. Forbes August 15, 2014. Available at: http://www.forbes.com/sites/ neilversel/2014/08/15/population-health-experthealth-reform-as-simple-as-changing-incentives/. Accessed September 24, 2015.
07/28/1-of-every-5-spent-in-us-will-be-on-healthcare.html. Accessed September 24, 2015.
Better, smarter, healthier: in historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. Press release. January 26, 2015. Available at: http://www.hhs.gov/news/press/2015pres/ 01/20150126a.html. Accessed September 24,
2. Mangan D. $1 of every $5 spent in US will be on health care. CNBC July 28, 2015.
at:
3. Weisfeldt ML, Zieman SJ. Advances in the prevention and treatment of cardiovascular disease. Health Aff (Millwood) 2007; 26:25–37.
2015.
2257
VOL. 66, NO. 20, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jacc.2015.09.031
LEADERSHIP PAGE
American College of Cardiology Advocacy Ensuring Value in a Value-Based Health System Kim Allan Williams, SR, MD, FACC, ACC President
“No outcomes, no income.”
L
The reasons behind these health care costs are
—David Nash, MD,
many. We have an aging population that in no small
founding dean of Thomas Jefferson
way is a result of our successes in treatment of heart
University’s School of Population Health
disease and a nearly 50% reduction in cardiovascular
in Philadelphia, summarizing the
mortality over the past few decades (3). However, this
future of health care (1)
success in treatment, rather than reduction of dis-
ast month was unofficially “advocacy month” at the American College of Cardiology (ACC). It was the month when nearly 400 cardiovas-
cular professionals descended on Washington, DC, as part of the College’s annual Legislative Conference. For 3 days, participants heard from ACC leaders and staff, lawmakers, representatives from federal agencies like the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration, and congressional staff about the largest issues facing the cardiovascular community. More importantly, they went to Capitol Hill to meet face-to-face with their members of Congress to advocate for policies that protect patient access to quality, costeffective care. Unlike previous years, when much of the College’s advocacy efforts were focused on temporarily halting the flawed Sustainable Growth Rate and encouraging a permanent solution, the College now has an opportunity to be more forward-thinking in discussions with lawmakers. The historic passage earlier this year of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the permanent repeal of the Sustainable Growth Rate that came with it means we can focus on how best to create a value-driven health system and drive down costs that are expected to reach $4.8 trillion in 2021, constituting 19.6% of the gross domestic product or $1 of every $5 spent (2).
ease, has led to an increasing prevalence of chronic diseases and comorbidities in the face of limited funding for preventive services. The high cost of new technologies, accelerating costs of both new and generic drugs, increased administrative costs, and fragmentation of the health system also contribute to this rising tide. There is no 1 solution to counter all of these issues, but Congress, CMS, and other stakeholders have started to transition the current reimbursement system to one that rewards value over volume as a first step. How this new system will look in its final iteration remains to be seen, but we do know that reform is under way. CMS targets have 90% of payment tied to quality by 2018 (4). Since 2019 is the first payment year, 2017 will likely be the first performance year for the merit-based incentive payment system or alternative payment models (APMs) under MACRA. The merit-based incentive payment system will combine the physician quality reporting system, meaningful use, and the value-based payment modifier—all 3 of which currently have separate systems and reporting deadlines—into 1 system. Under this program, eligible professionals, including physicians, physician assistants, nurse practitioners, and clinical nurse specialists, who elect to participate will receive annual payment increases (or decreases) on the basis of their performance. In terms of APMs, clinicians choosing to participate in a private payer APM and/or who receive at least 25% of their Medicare revenue through an APM beginning in 2018 will receive a 5% payment
From the American College of Cardiology, Washington, DC.
bonus. The threshold for receiving the bonus will
Williams
JACC VOL. 66, NO. 20, 2015 NOVEMBER 17/24, 2015:2256–7
Leadership Page
increase over time as CMS and payers move toward
a comprehensive strategy, working in collaboration
value-based
with
payment
models.
Accountable
care
key
stakeholders,
to
improve
population
organizations and patient-centered medical homes
health. The ACC’s Diabetes Collaborative Registry
are current examples of APMs. Other models that
and STS/ACC TVT Registry are also great examples
incorporate quality measurement, the use of certified
of how the health care community can come
electronic health records, and the assumption of
together to track and improve care coordination
financial risk will be considered moving forward.
across specialties.
With the magnitude of these changes and the
On the patient front, the College continues to grow
importance of getting things right, the College is
its CardioSmart patient-focused efforts with the
following all of this closely and engaging with CMS,
recent launch of the “Find Your Heart a Home” hos-
lawmakers, and other stakeholders about details
pital comparison tool (FindYourHeartaHome.org), as
and time lines. The need to develop relevant and
well as an online shared decision-making tool for
reliable measures that can be used for quality
anticoagulation for nonvalvular atrial fibrillation
improvement is one of the most important ele-
(www.cardiosmart.org/SDMAFib). Through the dev-
ments, followed by ensuring that clinicians receive
elopment of these and other resources over the last
the technical assistance necessary to succeed. The
several years, the ACC can offer unique insights on
ACC’s vast experience in developing and running
how to effectively engage patients and their families
clinical data registries can play an important role
in their care.
here, given the need for reliable access to data and
Engagement in advocacy is part of our profes-
timely feedback on quality performance and varia-
sional responsibility. To paraphrase President John
tions in care. The ACC’s leadership in the develop-
F. Kennedy, I like to think of advocacy as accepting
ment of performance measures working with other
our own responsibility for the future. For those car-
societies, the Physician Consortium for Performance
diovascular professionals who attended the 2015
Improvement Foundation, and the National Quality
Legislative Conference, I thank you for taking time
Forum will inform measure selection for use going
out of your schedules to represent your patients and
forward.
across
colleagues on Capitol Hill and for sharing the many
federal, state, and private payers is of the utmost
ways the cardiovascular community can continue to
priority, as is ensuring that electronic health re-
lead the way as we transition to a value-based
cords,
information
system. For those who could not make it but have
technology networks are using the same datasets
written letters or called your members of Congress;
and terminology.
hosted lawmakers at your practice as part of our
Alignment
registries,
and
of
measures
other
health
used
Care coordination both among clinicians and with
legislative practice visit efforts; provided expertise
patients is another critical element that needs to be
and feedback to ACC Advocacy staff on policy pro-
considered as we move from a volume- to value-
posals; contributed to the ACC’s Political Action
based system. This is also an area where the ACC
Committee; and/or filled in for colleagues to partici-
can play a role. Just this past May, the ACC released
pate in advocacy efforts, thank you as well. Let us
a health policy statement focused on cardiovascular
grab hold of our future and make sure we and our
team-based care and the role of advanced practice
patients get the most value out of a value-based
providers. The basic premise: building teams that
system.
include advanced practice providers can help meet the challenges of cardiovascular workforce short-
ADDRESS CORRESPONDENCE TO: Kim Allan Williams,
ages, an aging patient population with growing
Sr., MD, FACC, American College of Cardiology,
complexities in cardiovascular care, and a payment
2400 N Street NW, Washington, DC 20037. E-mail:
system in transition. The College is also developing
[email protected].
REFERENCES 1. Versel N. Population health expert: health reform
Available
http://www.cnbc.com/2015/
4. U.S. Department of Health & Human Services.
as simple as changing incentives. Forbes August 15, 2014. Available at: http://www.forbes.com/sites/ neilversel/2014/08/15/population-health-experthealth-reform-as-simple-as-changing-incentives/. Accessed September 24, 2015.
07/28/1-of-every-5-spent-in-us-will-be-on-healthcare.html. Accessed September 24, 2015.
Better, smarter, healthier: in historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. Press release. January 26, 2015. Available at: http://www.hhs.gov/news/press/2015pres/ 01/20150126a.html. Accessed September 24,
2. Mangan D. $1 of every $5 spent in US will be on health care. CNBC July 28, 2015.
at:
3. Weisfeldt ML, Zieman SJ. Advances in the prevention and treatment of cardiovascular disease. Health Aff (Millwood) 2007; 26:25–37.
2015.
2257