ACC President C. Michael Valentine on the College’s top advocacy priorities for 2019

With the American College of Cardiology’s annual congress fast approaching in March and two new JACC medical journals slated to launch later this year, the ACC is lining up its priorities for 2019.

Among those priorities, according to ACC President C. Michael Valentine, MD, are growing the College’s relationships with other cardiovascular organizations, finding a solution to burnout and advocating for physicians and their patients in the U.S. government.

Valentine took the reins of the ACC last March. This is what he told Cardiovascular Business the organization is most focused on this year:

Strengthening ties with sister societies

Starting in 2018, the ACC started trying to collaborate more with subspecialty sister societies like the Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Heart Rhythm Society and American Society of Echocardiography, Valentine said. The idea was to pool the organizations’ assets and advocacy programs and present a united front to policymakers and administrators.

“We had noted that cardiovascular organizations such as our electrophysiologists and our interventionalists, heart failure doctors ... everybody was kind of advocating on their own, and that makes problems,” Valentine said. “Congress and regulators really don’t know who’s speaking.”

He said the cardiology societies were stronger speaking together on some issues, like administrative burden and clinician burnout.

Addressing administrative burden and clinician burnout

In 2019, nobody’s a stranger to the conversation on physician burnout, Valentine said. He himself testified twice last year before the U.S. House Ways and Means Subcommittee on Health, and he’s had to hire a scribe for his practice to keep up with the dual daily demand of quality care and careful documentation.

“Anyone who spends time with a physician knows how much they’re buried in the computer and how distracting it is as a patient,” he said. “And how concerning when the doctor doesn’t look at you or engage with you very well. Losing the subtle communication is very difficult for our patient-physician relationships.”

A 2017 study found cardiologists spend an average 27 percent of their time face-to-face with their patients—a sliver compared to the hours they dedicate to data entry, which reportedly consume more than half of their work days. Other research has linked that digital burden to more disengagement from patients and, as a result, burnout itself.

Valentine said the ACC is largely focused on electronic health records (EHRs) and optimizing EHR workflow, which is presently a “huge burden” to health systems. He said software companies are making an effort to mitigate the problem with innovative programs that enable scribeless systems to complete EHRs and take patient notes simply through a phone app.

“The EHRs that we use now were really created as data entry systems or as billing systems, but they’re not effective communication tools between physicians,” he said. “Nor, in many instances, are they very adequate records for patient care. So they were not created with that in mind, and they’re not very physician- or clinician-friendly.”

The ACC is also attempting to simplify coding guidelines and better streamline documentation requirements to ease burnout, especially in the case of prior authorization, which can set patient care back weeks at a time.

Leading the conversation on alternative payment models

Alternative payment models—particularly value-based models—are going to be a “major area of push for the government” in 2019, Valentine said, and the ACC wants to be on top of the effort.

“Alternative payment models are clearly on CMS’ mind, and I think that it’s going to be up to us to make sure that we’re engaged in that and that if we’re going to help lead this we have to have the physician leadership involved that will actually make a difference,” he said.

Valentine said without physician input, legislation might ignore the delicate balance between keeping quality of care as high as possible and clinical costs as low as possible. He said it’s hard to say whether value-based payment will become mandatory in the future or whether it will remain voluntary, but the ACC’s recent acquisition of MedAxiom Feb. 4 will help the organization adapt regardless.

According to Valentine, MedAxiom will help the ACC lead the charge on improving quality and efficiency and minimizing costs across difference practice settings and situations.

“Alternative payment models are going to grow—we just have to see now how far and how wide they go,” he said. “But we don’t want to be left sitting on the sidelines if they develop. We want to be in the middle to make sure that physician input is part of the answer.”

Taking the fight to Capitol Hill

One of the ACC’s goals in pooling its resources with those of sister societies is to strengthen cardiologists’ voice in the government, Valentine said. Recently, the College was involved in “extensive” discussions with the Senate Committee for Health, Education, Labor and Pensions after the committee’s chair, Lamar Alexander, requested the ACC send in recommendations to assist in reducing healthcare costs both for whole healthcare systems and individual patients. Alexander, who’s been the senior U.S. senator for Tennessee since 2003, announced last year he won’t be running for re-election in 2020.

“We’re really proud,” he said. “Lamar Alexander is trying to get something done before he leaves office, and that would be a great way to do something. To advocate, to get the societies in the middle of helping lower healthcare costs together.”

Valentine said that politically, the ACC is looking for the most change in the areas of EHR and documentation burden. Other contributors to burnout—individual resilience, workplace environment, efficiencies of care—are harder to legislate. Long work hours, for example, won’t be a priority to policymakers when it’s an issue healthcare systems are working to ameliorate themselves.

“We’re obviously always looking for a solutions-oriented public policy to reduce the burden of CV disease,” Valentine said. “We always want to deliver effective, efficient care and improve the healthcare system. We are trying to get much more involved with healthcare systems because they now employ about 75 percent of our global members, and we think that having the ability to work with healthcare systems to empower our members in those systems to improve cardiovascular care and outcomes is going to be critical.”

Engaging more with healthcare systems

This is another area where the MedAxiom partnership will be a boon, Valentine said. In 2019 the College started to develop an entire health systems strategy that reportedly will revolve around working directly with systems and trying to engage their leaders.

“We think that healthcare systems are looking for solutions, they’re looking for answers to the value equation,” Valentine said. “They don’t know how to engage some of their physicians, and we think that cardiovascular physicians are the most likely to engage and to be able to work efficiently and effectively, so we hope to be able to do this.”

Working more closely with healthcare systems might also be a way to reduce burnout, since some physicians cite feeling like a cog in a machine as a contributor to their own stress and dissatisfaction.

“So many times when physicians are employed, they feel that they’ve lost any control and any input into the outcome of quality systems,” Valentine said. “And we feel that exactly the opposite should occur—that health systems should be engaging their employed leaders and helping them be effective dyads in improving quality and lowering cost.”