ACCA: Cracking the crystal ball--What health reform means for CV practices
Jack Lewin, MD, CEO of the American College of Cardiology (ACC)
CHICAGO—To help increase the viability of cardiovascular practices, "We must clean up priorities and focus on getting involved in CV registries like PINNACLE, and focus on improving processes of care," said Jack Lewin, MD, CEO of the American College of Cardiology (ACC) April 14 at this year’s annual leadership conference of the American College of Cardiovascular Administrators (ACCA).

In terms of fighting for health reform, Lewin said two years ago the ACC put forth six health reform priorities. These included: universal access to care, public and private systems, quality value definitions, measurement and coordination of care systems and payment reform evolution and professionalism. And while he said universal healthcare may sit in Congress’ hands, the rest is in the hands of the physician.

“It’s our job to improve the coordination of care and our job to come up with payment reforms that actually move the system towards better patient care,” Lewin offered. “The patient comes first. Everything we do should be focused around improving the lives of patients.”

Lewin offered that there are many opportunities to reduce healthcare costs including improving inpatient care processes, use of lower cost treatments, reductions in adverse events, preventing hospital readmissions and improving the management of complex patients. Using tactics like these and others can lower overall healthcare costs.

Everyone working together can get sicker patients and manage them better and this will lead to better practice management, which could eventually lower costs.

The pressure for cost containment from those in Washington, D.C. have caused small practices to integrate and consolidate with hospitals, and have spawned the idea of accountable care organizations (ACOs). However, Lewin said ACOs are similar to "Bigfoot” because "no one really knows exactly what the ACO entails but we think we would recognize one if we saw it."

And while Lewin said that leaders have thought that the inauguration of the Patient Protection & Affordable Care Act would lower costs, systematically improve quality and reinvigorate primary care, he said “the Affordable Care Act will not do any of those three things by itself.”

Currently, more than 50 percent of cardiologists in small practices or solo practices have already moved over to the hospital, and economic pressures will make solo cardiology practices a thing of the past.  In fact, the response to CMS cuts was that 52 percent of cardiologists moved towards hospital integration within one-year.

Lewin said that various pressures across the system--pressure for delivery system reform (EHRs/meaningful use) and pressures to measure and report quality improvement--pull the industry in multiple different directions.

So, how can we find better ways to increase the viability of CV practices?

Lewin offered that "taking the $25 million spent in the ACC registry this year and extrapolating that across all specialties. For about $500 million, we could have an interoperable registry system between various specialties focusing on science and guidelines.

"That is less than 1 percent of the estimated sustainable growth rate physician payment that Congress estimates to cost $55 billion. So imagine for such a small amount of money the federal government and insurance companies could be investing in this infrastructure for data that we need," said Lewin. "This registry data is so in reach, yet we are not lobbying together with this type of action," Lewin said.

He said that outpatient registries such as PINNACLE present a huge opportunity; however, practices may be hesitant because of the little incentive given ($8,000-$9,000). Lewin said that “while it’s not a huge incentive, we now can harmonize the data through EHRs and can help improve outcomes and increase patient value while also reducing costs.

"We must constructively come up with solutions that will systematically reduce costs," Lewin concluded. Hospitals and specialists can work together to apply science and use registries to translate science into clinical tools to improve care that will ultimately decrease costs.