ACC positions quality at center of health-care reform

The American College of Cardiology (ACC) — long at the forefront of quality initiatives — is taking a leading role in health care reform. In partnership with patients, lawmakers and payers, the ACC is setting a new standard for health care delivery, one that centers on increasing the quality of care and ensuring greater patient access and value.

A paper published in the August 4, 2009, issue of the Journal of the American College of Cardiology (JACC) lays out the College’s vision, describing both existing initiatives and plans for the future. It calls for cardiologists to step forward and play an active role in shaping health care reform.

“Under the organizing principle of ‘Quality First,’ the ACC is encouraging health care providers to act on their professional responsibility and transform health care from the inside out,” write the editorial’s authors, James T. Dove, M.D., and W. Douglas Weaver, M.D., both past presidents of the ACC, and Jack Lewin, M.D., the ACC’s chief executive officer.

Over the last 60 years, the ACC has become a recognized leader in physician education and quality. Through clinical guidelines, appropriate use criteria, performance measures, process measures and the National Cardiovascular Data Registry (NCDR), the ACC provides powerful tools for guiding clinical decision-making and improving patient care. Now it is helping to define the physician’s role on the front lines of health care reform.

“We must remain focused, involved, and prepared to lead,” the authors write. “It is our responsibility to ensure any reforms are practical and appropriate for cardiovascular patients and practices.”

Death rates from cardiac disease and stroke have plummeted by 60 percent and 70 percent, respectively, over the past 30 years, thanks to public awareness and new medications, devices and treatment strategies. But not everyone has access to high-quality health care in this country. In fact, more than 46 million Americans have no health insurance, and at least as many are under-insured. In addition, there are wide variations across the country in outcomes, quality and the use of medical resources.

As a result, the momentum for health care reform is rapidly growing. The ACC, in its commitment to high-quality cardiovascular care for all patients, has endorsed six principles necessary for health care reform, including:

  • Universal coverage
  • Coverage through an expansion of public and private (pluralistic) programs
  • Focus on patient value — transparent, high-quality, cost-effective, continuous care
  • Emphasis on professionalism, the foundation of an effective partnership with empowered patients
  • Coordination across sources and sites of care
  • Payment reforms that reward quality and ensure value

Several steps must be taken to put these principles into action. For example, to be effective, health care reform must foster not only a renewed focus on measurable health outcomes but also a reduction in legal and defensive medicine costs. Health information technology is also key to improving quality, enhancing coordination of care, reducing duplication and improving efficiency. To be successful, however, information systems must be interoperable and provide decision support tools at the point of care.

Similarly, payment systems must be redesigned with the patients’ interests in mind, rewarding quality of care and best practices, rather than simply the number of patient contacts. The ACC favors payment reform that rewards those who focus on total patient care and prevention, supports team-based care, and encourages the appropriate use of tests and procedures.

The ACC has developed a series of action plans aimed at making major contributions in both cardiovascular care and overall health system reform. The plans focus on reducing cardiovascular-related hospital readmission rates, limiting inappropriate imaging, reducing geographic variations in care, encouraging adherence to guidelines, partnering on patient-centered medical home models, ensuring transparency and professionalism, testing payment models that reward quality, and increasing prevention of cardiovascular disease.

“We must take responsibility for reducing the high costs that we can control such as those associated with duplication, overuse, and a lack of coordination of care,” the authors write. “We must also address the underuse and failure to adhere to proven medical regimens. We can do better and must become good stewards in the use of health care resources.”

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