In 2016 the ACC identified five main advocacy priorities: create a value-driven health care system; ensure patient access to care and cardiovascular practice stability; promote the use of clinical data to improve care; foster research and innovation in cardiovascular care; and support efforts to prevent cardiovascular disease. These priorities were used to guide the College’s advocacy efforts in a number of areas, including Medicare payment, health information technology (IT), prevention and public health, cardiovascular research and more. The following provides a snapshot of ACC’s advocacy successes in each of these areas over the past year.

Medicare Payment

• Created a member-driven Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Task Force and provided implementation recommendations to the Centers for Medicare and Medicaid Services (CMS), leading to the inclusion of many of the College’s requests reflected in the final MACRA rule.
• Offered expertise and guidance to key congressional committees and offices, including a briefing for staffers on MACRA and its various implications on clinicians.
• Conducted MACRA member outreach and education efforts via various webinars and live educational programs, including ACC.16 and Legislative Conference.
• Submitted significant and substantive comments on annual Medicare payment regulations resulting in changes to the Quality Payment Program (created by MACRA), the 2017 Physician Fee Schedule and the 2017 Hospital Outpatient Prospective Payment System.
• Provided legislative recommendations on the enactment of a site-neutral Medicare payment policy for provider-based off-campus hospital outpatient departments.

Coding, Billing and Coverage

• Secured a nomination for Robert Piana, MD, FACC to a highly coveted seat on the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel and presented multiple CPT code change proposals.
• Obtained approval of the LAAO Registry to meet requirements of a Left Atrial Appendage Closure (LAAC) national coverage decision and successfully advocated for Medicare coverage for LAAC.
• Advocated for revisions to myocardial infarction coding in ICD-10 and the development of new ICD-10-CM codes for pulmonary hypertension.
• Conducted AMA RUC surveys to substantiate values for LAA closure, paravalvular leak, transthoracic echocardiogram, stress echo, electrophysiology device monitoring and 3-D mapping.

Quality Measures

• Developed and released a cardiovascular core quality measure set that ultimately served as the basis for the MACRA cardiovascular quality measure set.

Payment Models

• Submitted substantive comments on a proposed rule for Advancing Care Coordination: Cardiac Episode and Cardiac Rehab Incentive Payment.
• Conducted a biannual survey to gauge member awareness and participation in value-based payment/alternative payment models.

Prior Authorization and Accreditation

• Advocated against arbitrary denials and delays resulting from insurance company prior authorization practices; legislation passed in OH, DE, NH and WA.
• Convened a prior authorization workgroup and developed a Prior Authorization Reporting Tool to collect data for advocacy efforts. (Scan the QR code to access the tool.)

Team-Based Care

• Promoted the value of team-based care in comments on the proposed expansion of advanced practice registered nurse capabilities at Veterans Affairs facilities.
• Promoted legislation to allow nurse practitioners, physician assistants and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs.

Self-Referrals

• Advocated to congressional committees on the Stark Law and the need for simplification, reduction of exorbitant fees and burdens, and differentiation between willful and inadvertent violations.

Health IT

• Provided expertise on the evolution of health IT adoption from the Electronic Health Record (EHR) Incentive Program to the Advancing Care Information component of the Quality Payment Program.
• Led promotion of the Flexibility in EHR Reporting Act and commented to CMS on the need to reduce the Meaningful Use reporting period, initiatives that ultimately pressured CMS into taking action.

Prevention and Public Health

• Led state stakeholder effort to advocate for the mandatory use of pulse oximetry screening for newborns in Idaho and Kansas and adopted regulations in Vermont and Wyoming.
• Successfully advocated for state-level adoption of a high school cardiopulmonary resuscitation graduation requirement, and legislation to provide resources for student athletes, coaches and volunteers to learn signs of cardiac arrest in 34 states.
• Promoted tobacco tax increase initiatives in cooperation with various stakeholders.
• Secured a pre-recorded ACC.16 welcome and endorsement of the prevention agenda from former First Lady Michelle Obama.
• Developed prevention-focused goals for state and federal advocacy efforts.

Evaluation of Medical Products, Research and Innovation

• Helped shape the reauthorization of the Medical Device and Prescription Drug User Fee Agreements; promoted provisions addressing the use of real-world evidence in device evaluation and monitoring.
• Engaged with lawmakers in the development and passage of the 21st Century Cures Act and advocated in support of key provisions.
• Engaged in ongoing dialogue with the Food and Drug Administration and served as a key resource regarding the use of clinical data registries in the regulatory decision-making process for medical devices.

Looking Ahead: 2017 Advocacy Priorities

The health policy environment remains unsettled as the new Administration, the new Congress, and newly elected governors and state legislators take office. The ACC will remain focused on a core set of Advocacy priorities in 2017 and will monitor the health policy landscape and make any necessary changes to its Advocacy agenda.

This year, MACRA and the Quality Payment Program will continue to be a key focus of ACC’s Advocacy efforts. The College will work to ensure successful implementation of MACRA/the Quality Payment Program and the mandatory Cardiac Episode Payment Model/Cardiac Rehabilitation Incentive Payment initiative. The ACC also will continue to implement its Population Health Management initiative.

Another key priority is ensuring optimal coverage policies for cardiovascular services and drugs in Medicare, Medicaid and private health plans, especially given anticipated changes to the Affordable Care Act (ACA). The College’s overarching message in the ACA debate is that health reform legislation must maintain or improve patient access to quality, affordable insurance; strengthen the health system to foster innovation and quality; and improve patient and clinician satisfaction. To that end, College leaders have developed a set of principles to provide a lens through which to shape and evaluate proposals as they emerge.

In addition, the ACC will work to reform prior authorization policies for imaging, therapeutic services and pharmaceuticals, and continue its support for team-based cardiovascular care.

The College also will be embarking on its next phase of its research and innovation policy initiative and will focus on funding and implementation of the 21st Century Cures Act that passed in 2016.

Electronic health record interoperability and standards, ACC registry sustainability and the appropriate use criteria for advanced diagnostic images services in Medicare requirement remain priorities in 2017.

Regardless of the health policy changes that are likely to take place this year, ACC Advocacy will continue to advocate for cardiovascular professionals and their patients to ensure access to quality, affordable care.

Keywords: ACC Publications, Cardiology Magazine, Accreditation, American Medical Association, Atrial Appendage, Athletes, Rehabilitation, Cardiopulmonary Resuscitation, Cardiovascular Diseases, Centers for Medicare and Medicaid Services, U.S., Electronic Health Records, Electrophysiology, Fee Schedules, Health Care Reform, Hypertension, Pulmonary, International Classification of Diseases, Meaningful Use, Medicaid, Medicare, Medicare Access and CHIP Reauthorization Act of 2015, Myocardial Infarction, Nurse Clinicians, Nurse Practitioners, Outpatients, Oximetry, Patient Protection and Affordable Care Act, Pharmaceutical Preparations, Physician Assistants, Prospective Payment System, Public Health, Referral and Consultation, Registries, Tobacco, United States Food and Drug Administration, Veterans