Heart of Health Policy | The U.S. health care system has undergone radical change over the last decade resulting in a drastic shift in how medicine in practiced. Regardless of the countless hurdles and threats cardiology has faced, the ACC remains focused on the ultimate wellbeing of patients, both in the U.S. and around the world. Through its advocacy efforts, the ACC builds relationships with Congress, federal government agencies, state legislative and regulatory bodies, private insurers, and other policy making groups to advance the College’s mission of improving heart health.

Last year saw a number of significant wins for providers, patients and practices, thanks to the ACC’s advocacy efforts. The ACC tackled the Sustainable Growth Rate, facilitated alternative payment model participation, testified during congressional committee hearings, advanced crucial legislation in the states and connected a record number of ACC members with lawmakers.

The New Year welcomed a new Congress and a new set of challenges and opportunities for health care organizations. Given the change in congressional leadership and a shift in power in the Senate, it’s a crucial time for the ACC and its members to educate policymakers, old and new, about the impact their decisions have on cardiology. At a time when the future of medicine is being debated, clinicians are able to offer unique, patient-provider expertise that can truly influence health policy.

The ACC started the year out strong by hosting briefings in February for House and Senate leaders on how the NCDR is fostering innovation and improving care. This was a high-profile opportunity for the College to highlight how its registries work with thousands of hospitals and outpatient providers across the country to ensure evidence-based cardiovascular care, improve patient outcomes and lower health care costs. During the briefings, Ralph G. Brindis, MD, MPH, MACC, educated congressional leaders about how the NCDR is leading the way for clinical data and discussed the critical role registries play in the ever-changing health care landscape.

The ACC will continue to seek out opportunities to educate lawmakers and shape health policy during the coming year.

ACC’s Advocacy Agenda

There is a long list of challenges and opportunities in health care. In order to remain strategic and achieve success, the ACC refined its advocacy priorities to ensure the College is addressing the issues most crucial to members and patients. In 2015, the ACC will:

• Create a value-driven health care system
• Strengthen the U.S. health care system by improving the care experience, enhancing the health of populations, and reducing health care costs. The ACC will also advocate for cardiovascular care interests in the development of alternative payment models.
• Ensure patient access to care and cardiovascular practice stability
• Advocate for patient access to a comprehensive array of services at the hospital or in the office, adequate resources for practices to support patient care, and reduced administrative burdens.
• Promote the use of clinical data to improve care
• Encourage use of clinical data registries for quality improvement and research, recognition of clinical practice guidelines and appropriate use criteria, and improvements in health information technology.
• Foster research and innovation in cardiovascular care
• Advocate for the adoption and tracking of new drugs and medical devices, funding for clinical research, improvements to the clinical research infrastructure, and access to new technology.
• Improve population health and prevent cardiovascular disease
• Advance policies that address risk factors for cardiovascular disease, reduce the global burden of cardiovascular disease, decrease disparities in care and outcomes, improve access to care for special need populations, and support ACC members in their increased accountability for the health of populations.

Opportunities and Challenges For 2015

There is more movement in the health care space than ever before. By strengthening the ACC’s advocacy goals for 2015, the College is well-positioned to tackle impending developments and issues impacting cardiovascular medicine. Here’s a look at what is anticipated for the coming year:

21st Century Cures

Last spring, the House Energy and Commerce Committee launched 21st Century Cures, an initiative focused on exploring and streamlining the process for bringing new treatments from research and development to approval. During one of many hearings the Committee held last year to understand medical innovation and the gaps that exist, ACC President Patrick T. O’Gara, MD, FACC, shared his perspective on personalized medicine and its impact on cardiology. The Committee has already released a discussion draft of the legislation this year and the ACC looks forward to working with Congress to propel health care into the future.

SGR Repeal

Medicare payment will be another hot topic, yet again, as the current Sustainable Growth Rate (SGR) patch will expire on March 31. If Congress fails to act, physicians will face double-digit Medicare payment cuts. While permanent repeal wasn’t in the cards in 2014, we came closer than ever to doing away with the flawed formula. The ACC will continue to work with the medical community and Congress to find a permanent fix that ensures provider and practice stability. Additionally, the Protecting Access to Medicare Act of 2014, which delayed payment cuts associated with the SGR in 2014, also requires consultation with appropriate use criteria (AUC) and clinical decision support for advanced diagnostic imaging, beginning in 2017. In preparation for the AUC program, the Centers for Medicare and Medicaid Services (CMS) must specify applicable AUC for advanced imaging services by Nov. 15, 2015. The ACC is working with CMS on a regulatory framework and will be engaged every step of the way to ensure that the use of AUC in Medicare works to improve patient care and creates the minimum possible burden for physicians.

State Advocacy

It’s expected to be a busy year in the states where perennial issues such as tort reform, tobacco cessation, newborn screening for critical congenital heart disease, and attempts to restrict in-office imaging will again receive strong consideration. Emerging issues such as team-based care and regulation of energy drinks are also likely to be hot topics this year.

Electronic Health Records

The Electronic Health Record (EHR) Incentive Program requires a full year reporting period for 2015. Citing difficulties cardiologists and others have experienced obtaining EHRs that are certified to meet the 2014 standards and certification criteria, the ACC urged CMS and the Office of the National Coordinator for Health Information Technology to reduce the 2015 reporting period from one year to 90 days. Regardless of whether the reporting period is reduced, physicians and hospitals who do not meet the requirements in 2015 will not only be ineligible for any incentive payments, but they will also face penalties in 2016 or 2017, depending on when they started participating in the program.

Sunshine Act

Last year, reports of industry payments made to physicians were made public for the first time as required by the Physician Payments Sunshine Act, also known as the Open Payments Program. Due to data consistency concerns, about one-third of reports were withheld from the initial 2014 release. The problematic data was returned to industry for correction and resubmission. Physicians and teaching hospitals will have the opportunity to review and dispute the data in 2015 at the same time they are reviewing their pre-publication reports based on 2014 data. The 2015 reports are expected to be released at the end of June.

U.S. Food and Drug Administration

This could be the year that the U.S. Food and Drug Administration approves the WATCHMAN System. The ACC will work with stakeholders to secure appropriate coverage of left atrial appendage closure, should the device be approved.

ICD-10

On Oct. 1, 2015, the long-awaited transition from ICD-9 to ICD-10 will take place. At this time, ICD-10-CM will be used for diagnosis coding in all settings and ICD-10 Procedural Code Set (ICD-10-PCS) will be used for inpatient procedures (for hospitals only).

Physician Quality Reporting System

There are several key Physician Quality Reporting System (PQRS) dates to keep in mind this year. On Jan. 1, eligible professionals (EPs) and group practices that did not successfully report through PQRS in 2013 began receiving a -1.5 percent payment adjustment applied to Part B services. EPs and group practices that do not successfully participate in PQRS in the 2015 reporting year will be subject to a two percent penalty on Part B payments in 2017, along with additional penalties under the Value-Based Modifier. Feb. 27 is the last day to submit 2014 claims for PQRS reporting under the claims-based reporting option to determine the 2016 payment adjustment. On April 1, Group Practice Reporting Option registration for 2015 reporting begins. No pre-registration with CMS is required for EPs participating as individuals or as individuals in a group practice through the following reporting options: claims-based, qualified registry, certified EHR technology, or qualified clinical data registry (i.e. PINNACLE Registry). In November, CMS will notify eligible professionals and practices receiving the 2 percent payment adjustment based on unsuccessful 2014 PQRS reporting for the 2016 payment year.

Get Involved With ACC Advocacy

Successful pursuit of the ACC’s Advocacy agenda demands that we continually strengthen and enhance cardiology’s voice in health policy at all levels. Get involved by:

• Hosting a legislator practice visit: Invite your members of Congress or state lawmakers to your practice so you can provide a first-hand account of how policies created in Washington, DC, impact cardiovascular providers, patients and practices
• Become a member of ACCPAC: Invest in the future and preservation of cardiology by contributing to ACC Political Action Committee (U.S. members only)
• Download the ACC Advocacy Action App: Communicate with lawmakers on the go using the ACC’s grassroots alert system
• Attend ACC’s Legislative Conference: Get up-to-speed on the hot button issues in cardiology and meet directly with members of Congress on Capitol Hill during the 2015 Legislative Conference, held Oct. 18 – 20

Keywords: ACC Publications, Cardiology Magazine

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