President's Message
John S. Strobel, MD, FACC |
Dear Colleague,
Are you familiar with the Million Hearts Campaign? As the Million Hearts website explains, "Preventing 1 million heart attacks and strokes in five years will require the work and commitment to change from all of us. There are steps that each of us can take to reach this goal as a nation. Be one in a Million Hearts™ and see how your actions can make a positive difference. A Million Hearts™ begins with you."
I hope that you will commit to this important initiative by visiting this link.
As a health care professional, you play a key role in helping patients reduce their risk for heart disease and stroke and lead longer and healthier lives.
Focus on the "ABCs" with your patients:
- Emphasize that controlling blood pressure and managing cholesterol reduces your patients' risk of heart attack and stroke.
- Ask your patients about what makes it hard for them to take their medications and help them find ways to make it easier.
- Ask your patients about their smoking habits and provide smoking cessation counseling and tools to help current smokers quit.
- Prescribe appropriate aspirin therapy for those who would benefit from it.
- Promote heart-healthy habits to your patients, such as regular physical activity and a diet rich in fresh fruits and vegetables.
- Reduce out-of-pocket costs for smoking cessation, blood pressure and cholesterol medications and services.
Use health information technology and quality improvement tools to:
- Track and improve ABCS performance.
- Report on the ABCS-related Cardiovascular Prevention Measures Group in the CMS Physician Quality Reporting System.
- Use electronic health records with clinical decision support tools and patient registries.
Connect with other health care professionals in your community to improve ABCs in your patients:
- Support team-based approaches to care to improve coordination and quality of care for patients.
- Implement innovative care models (patient-centered medical homes, Accountable Care Organizations) that include a focus on the ABCS.
- Recognize and reward health care providers who address and promote the ABCS in their patients.
- Align provider education and quality improvement initiatives to focus on and improve the ABCS.
Decrease health disparities - use culturally appropriate education materials, patient navigators, community health workers to address barriers to care. Connect at-risk patients with community resources for self-management and resources to address barriers to adherence, addressing any inequities in treatment and diagnosis detected by your registries.
Some of the existing investments in cardiovascular health that can be leveraged include:
Again, please commit to this important initiative!
Sincerely,
John S. Strobel, MD, FACC
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Mission:Lifeline Update
Edward T.A. Fry, MD, FACC |  Mission Lifeline (ML) is a national initiative of the American Heart Association (AHA) chartered to improve the quality of MI care across the country. Patterned after the delivery of trauma care by regional trauma centers, ML has encouraged the development of statewide systems of STEMI care with a coordination between patients, first responders, local emergency department staff, and PCI centers. In Indiana and across the country, ACC members have been integral contributors to the organization, execution, and staffing of programs participating in ML. Unfortunately, early efforts had been hampered by organizational changes and funding challenges within ML. Nevertheless, ML in Indiana has been able to create criteria to designate "sending" and "receiving" institutions, describe qualifications of PCI centers, conduct surveys of EMS providers regarding existing protocols for STEMI care, and has started work on establishing consensus best practices for pre-hospital treatment plans.
Even prior to ML, cardiologists and their institutions in Indiana have been well ahead of the curve nationally in constructing and operating regional networks of early STEMI care. There are many examples throughout the state where health care systems have worked with referring facilities to streamline MI care. ML strives to build on these existing relationships to create standardized treatment protocols, empower first responders and ER staff with early activation of PCI teams, facilitate direct transfer of patients with STEMI from the field to PCI centers for timely primary reperfusion, and to collect data for process improvement. MI mortality in IN is already better than the national average, but gaps in availability of prompt and state-of-the-art MI care still exist, especially in rural communities that may not be covered by current networks of MI care. ML, working with IN-ACC, can help close these gaps and can further improve MI care throughout the state.
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| RUC Surveys for June - Pay Attention If You Receive One! | 
RUC Surveys Affect You! Surveys will be distributed this June related to four different code families: EKGs, extracranial duplex studies, transitional care management, and complex chronic care management. If you are randomly selected and receive a survey, please take 10-20 minutes to thoughtfully complete it. Contact James Vavricek at 202-375-6421 or jvavricek@acc.org if you have questions.
Annual updates to physician work relative values are based on recommendations from a committee involving the AMA and national medical specialty societies-the RUC. The RUC is an expert panel of the AMA and specialty societies charged with developing relative value recommendations to Medicare. A key part of the RUC process is the completion of relative value surveys. Data from these surveys are used to establish the physician work that determines Medicare reimbursement.
What Is the RUC?
Dr. Edward T.A. Fry explains that many IN-ACC members have been contacted to complete practice surveys for the "RUC". Although many are familiar with the process that translates a detailed survey of what we do clinically every day into reimbursement, it remains a mystery to many. Active and broad participation in these surveys is key to protecting physician and facility payment. A better understanding of what the RUC is and how it works may encourage greater participation and a more accurate reflection of care delivered.
Rather than trying to reiterate the entire history and workings of the "RUC", there is an excellent review of the "Relative Value Scale Update Committee" process from the American Academy of Family Practice website (see it here). It details the background, composition, purpose, function, and outcomes of the RUC and how physician time and work are translated into recommendations to CMS for payment. CMS has final approval of any payment schedule but follows the RUC's recommendations 90% of the time. In turn, the vast majority of commercial payers tie their reimbursement structure to the RUC's recommendations.
As Yogi Berra said, "It is difficult to make predictions, especially about the future", but it is predicted that a process similar to the RUC may be used internally within large health care systems in the future to value physician work in ACO's. So, even with anticipated changes in payment models, an understanding of the RUC process will serve us well going forward. |
Hospital Payment Rates Likely to Increase
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Under the recently released 2013 Hospital Inpatient Prospective Payment System proposed rule, which covers payment and quality issues for services provided to patients admitted into the hospital, payment rates to hospitals will increase by 2.3 percent. The rule states that the introduction of surgical site infections following cardiac implantable device procedures will be classified as a "hospital-acquired condition" and the hospital will not be eligible for higher payments resulting from the complication in conditions. As part of the Affordable Care Act, the rule establishes penalties for hospitals with high readmission rates for patients with acute myocardial infarction, heart failure and pneumonia. A performance measure for statins prescribed at discharge has also been added as part of the hospital value based payment program that adjusts payment based on the quality of care provided in the hospital setting. Stay tuned for ACC's comments on the proposal after additional analysis is completed.
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Provider Enrollment Update
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Under CMS' recent final provider enrollment rule, specialists are exempt from recent changes to provider enrollment standards. The rule calls for providers and suppliers to include their National Provider Identifier (NPI) on all Medicare and Medicaid enrollment applications, but exempts specialists since Medicare beneficiaries are not required to have a referral to see a specialist. Additionally, the rule says that residents can enroll in Medicare in states where they are licensed to practice and order treatments; however, teaching physicians will be required to include an NPI in states where residents are not licensed. To learn more about the changes, click here. Meanwhile, to accommodate the new requirements for tracking NPIs of referring and ordering physicians, the ACC anticipates changes to the CMS-1500 form within the next year. The College is monitoring these developments, but urges providers to consult with their practice management system vendors to ensure systems are up-to-date. Also of important note, the Internet-based PECOS (Provider Enrollment, Chain, and Ownership System) now allows providers to sign Medicare enrollment applications electronically. Once an application is submitted, providers will receive an email from "customerservice-donotreply@cms.hhs.gov" with additional instructions.
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| Quick Hits | | |
Attention CV Team Members & Fellows-in-Training! Apply for a $750 travel stipend to attend the ACC Legislative Conference.
Meaningful Use Series. |
Connect with
Indiana-ACC |
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