Advocacy Update. Current environment is not sustainable –47 million uninsured –Millions underinsured –More than 16% of economy spent on health care –Varied.

Advocacy Update

• Current environment is not sustainable– 47 million uninsured– Millions underinsured– More than 16% of economy spent on

health care– Varied health care quality and outcomes

Health Care Reform

Health Care Reform

• Delivery System Reform buzz words: – Accountable care organizations– Medical home– Bundling– Hospital readmissions– Value based purchasing– Gainsharing or shared savings

Health Care Reform

• There is no silver bullet to fix the problems with the U.S. health care system

• The cardiovascular community needs to be at the table, not on the menu

ACC Quality First

• Health Reform Summit 2008 and 2009

• “Blueprint for Reform”

• Principles

• Action Plans

• Website: qualityfirst.acc.org

ACC Principles for Reform

1. Provides universal coverage2. Provides coverage through an expansion

of public and private programs3. Focuses on patient value (transparent,

high quality, cost-effective, continuous care)

4. Emphasizes professionalism5. Ensures coordination across sources

and sites of care6. Includes payment reforms that reward

quality and ensure value

ACC Action Plans for Reform

1. Reduce CV hospital readmission rates

2. Increase appropriate imaging

decision support at point of care

3. Reduce geographic variations in care

4. Test payment models that reward quality

5. Increase adherence to guidelines

6. Make quality operational

ACC Action Plans for Reform

7. Partner on patient-centered medical home models

8. Increase primary and secondary prevention through medication adherence and lifestyle

9. Ensure transparency

10. Empower patients

11. Ensure professional competence

12. Seek opportunities to promote tort reform

• Share best practices• Learn and teach• Deploy QI initiatives based on practice needs• Implement Appropriate Use Criteria• Use interoperable electronic systems to:

– exchange data – deliver decision support – reduce errors and waste

Quality First Network

Hospital to Home

• ACC and Institute for Healthcare Improvement (IHI) quality improvement initiative

• Goal: “excellence in transitions”

• Reduce 30-day hospital readmission rates for HF or AMI by 20%

• For more info: www.acc.org/h2h/enrollment

Physician Payment

• MIPPA provided 1.1% payment increase for 2009 in place of cuts; no long term solution to flawed SGR formula

• Physicians face 21.5% Medicare pay cut on Jan. 1, 2010; 40% in cuts in next decade

• Congressional action necessary to stop cuts and replace flawed formula

Physician Payment

•Congress intervened since 2003

•Bipartisan consensus that formula needs to be replaced

•Long term reform held up by increasing cost and lack of consensus

•Action expected as part of health reform bills in June/July

Physician Payment

• Replace flawed formula with more sustainable system that reflects increases in practice costs and accounts for appropriate growth in services

• Test models that seek to reduce variations in spending and ensure patients receive evidence-based care

Imaging

•MIPPA requires accreditation of providers for MRI, CT, and nuclear medicine/PET by Jan. 1, 2012

•MIPPA establishes 2-year, demonstration program to test appropriate use criteria by Jan. 1, 2010

Imaging

• HHS to designate accrediting bodies by end of 2009; IAC, ACR should be named

• CMS will announce appropriateness pilot in next few months

• Stay tuned for more information from ACC

Imaging

• Imaging under attack again– GAO Report– CBO Report– Baucus White Paper– Obama budget blueprint

Imaging

• RBM Threat:– Obama budget and CBO report include use

of RBMs to ensure “appropriate imaging payments” for advanced imaging

– Budget savings estimate: $300 million

– CBO savings estimate: $1.9 billion

– Under discussion on Capitol Hill

Imaging

• Self Referral Scrutiny:– Baucus White Paper– MedPAC discussing whether physician

ownership of imaging equipment influences use of imaging

– Found that physicians who owned equipment had 5-104% higher spending on imaging than those that did not

– June report will include self referral chapter

Imaging

• New data– Since 2005, rate of imaging growth slowing– 2006-2007, imaging spending dropped 13%

• UHC/ACC pilot– Results of SPECT-MPI appropriateness

criteria pilot released at ACC.09– One practice reduced inappropriate tests from

22% to 13% through feedback and education

Imaging

• ACC advocates for responsible approach to imaging, continued emphasis on improving quality with health plans and state and federal policymakers

• Development and implementation of appropriate use criteria offers alternative to prior authorization/pre-certification

PQRI

• MIPPA increased PQRI incentive to 2% for 2009 and 2010

• Problems with 2007 feedback reports and payment

• ACC/CMS Mar 18 Open Door Forum for cardiovascular professionals

• Resources: http://www.acc.org or http://www.cms.hhs.gov/PQRI

HIT

• MIPPA e-Rx incentives: 2009-2011

• ARRA HIT incentives: 2011-2015

• ACC Resources: www.acc.org/healthIT

• E-Rx Initiative: CMS e-Rx program info, minimum functional criteria

• EHR Toolkit: ARRA FAQs, helpful hints, contract negotiation advice, selection tools, educational resources

Specialty Hospitals

• ACC continues to be active on physician ownership issues

• Fought several attempts to attach specialty hospital language to legislation in 2008 and 2009

Physician Resource Reports

• MIPPA authorized Medicare confidential physician resource use reports

• CMS sent test reports to some physicians in early 2009

• Contact ACC with feedback if your practice is involved in the test

• Nationwide distribution in late 2009

ACE Demo

• Medicare Acute Care Episode (ACE) Demo

started this year

• Bundled payments for select cardiovascular

inpatient procedures

• Goals: improve quality; produce savings for

providers, beneficiaries, and Medicare; improve

price and quality transparency; and increase

collaboration among providers

Get Involved

• Get involved in ACC Advocacy

• Grassroots: www.acc.org/can

• PAC: www.accpacweb.org

Contact ACC

• ACC Website: www.acc.org

• ACC Phone Number: 800-253-4636