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Physician Accountabilities in
Health System Reform:
A View from the ACC
Jack Lewin, M.D., CEO
The American College of Cardiology
Jack Lewin MD
 I have no disclosures to note.
"It's tough to make predictions,
especially about the future.“
~Yogi Berra
“It is not the strongest of the species
that survives, nor the most intelligent
that survives.
It is the one that is the most adaptable
to change.”
~ Charles Darwin
“You can lead a man to Congress,
but you can’t make him think!”
~ Milton Berle
ACC Health Reform Priorities
• Universal Access
• Public and private system
• Quality (value) definition, measurement
• Coordination of care systems
• Payment reform evolution
• Professionalism
The Bullish Forces
ACA
The beginning or result of
health reform?
Percent of median family income required to
purchase family health insurance
Source: Author’s calculations, using KFF and AHRQ premium data, CPS income data, plus projections from Carpenter and Axeen, The Cost of
Doing Nothing, 2008.
Medicare is unsustainable now
(percent of GDP, projected)
8
7.3
7
6
4.5
5
4
3.2
3
2
1
0
2008
Source: Medicare Trustees Report:, 2009.
2020
2035
The pressure for cost
containment and fair
competition in a global
economy
The pressure for integration
and consolidation
•
•
•
•
Physicians, hospitals and insurers
ACOs
Employer and consumer groups
Vertical vs. horizontal integration
The pressure for physician
employment
• AMA, ACC estimates
• Lifestyle preferences of young physicians
• Vertical vs. horizontal integration
Changing Cardiology Practice Landscape
14%
The ACC’s 2010 Practice Census was conducted from May 5 through August 9 by e-mail and telephone. A total of 2,413
unique practices from 49 states and Puerto Rico participated in the study. The response rate was 31 percent.
The pressure to move away
from fee-for-service
reimbursement
•
•
•
•
Payment reforms
PCMH (patient centered medical home)
HOPPS
Government strategy
The pressure for delivery
system reform
•
•
•
•
•
•
EHRs and Meaningful Use
Team care
PCMH vs. minute clinics
Specialty hospitals
Prevention and disease management
Care coordination, H2H, etc.
The pressure to measure and
report on quality
improvement
•
•
•
•
•
Public reporting expectations
Who measures Q in payment reform?
Claims vs. clinical data
The importance of registries
Measurement at the point of care
The pressure to create patient
financial incentives related to
health care costs
•
•
•
•
Employer actions
Government actions
Co-pay incentives
Preferred networks, Centers of Excellence
and CV Practice Improvement Program
(CPIP)
The pressure to improve
population health
ACC 2011
Top Advocacy Priorities
Feedback from CCO, Leadership Forum and BOG
Likely 2011 Top Priorities
1.
2.
3.
4.
5.
6.
7.
ACA and HSR issues
Payment reform issues
Private practice protections
State advocacy issues
Innovation and science
Meaningful use and HIT
Public reporting
The Most Important?
• Payment reform
• Tort reform
• The ongoing nuts and bolts: SGR, RUC,
CMS regulations, insurers, state
legislatures
Other Key Issues
• Reducing disparities (and expanding access)
• Public reporting (& clinical data vs.claims data)
•Medicaid reform issues (especially peds cardiology)
• Workforce and changing demographics and
generational influences
• Team practice and delivery system models
• Public health and prevention
• Technology and ability to share social tools
• Monitoring self referral protections under Stark,
including CV hospital employed contract issues
ACA Clean Up Priorities
1. Payment Reform and ACOs
•
•
•
Anti-trust relief
Value-based reimbursement
Level playing field?
2. Physician regulation and the IPAC (HR 452)
•
Major risk for physicians – hospitals, too?
3. Tort reform (Gingrey)
4. Medicare/Medicaid reimbursement issues
•
HOPPS assault?
ACA Opportunities
•
•
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CMS innovation center grants -- $10 billion
Workforce transitions
Graduate medical education issues
PCORI
Accountable Care Organizations
• ACOs
– What are they?
– Who governs them?
– Will payment incentives be real?
– A unified policy position for medicine?
– Hospital and physician alignment
Risks and Opportunities
Accountabilities
Uniting a fragmented
profession
Train wreck at Montparnasse Station, Paris, 1895. Studio Lévy & fils.
Who will save us?