1. ACC Advocacy Promoting Quality, Protecting Patients

2. Advocacy Priority Issues: Medicare Physician Payment Cardiovascular Imaging and Physician Ownership Quality First

3. Medicare Physician Payment The Issue: Physicians will face significant reductions in Medicare reimbursements between 2008 and 2015. At the same practice expenses are escalating and physicians are being asked to invest in necessary, but costly, overall health system improvements.

4. Medicare Physician Payment Goal: Stop the cuts and fix the problem! Stop annual cuts to Medicare physician payment. Fix the flawed Sustainable Growth Rate (SGR) formula used to calculate overall payment.

5. Medicare Physician Payment ACC Efforts:  More than 220 members visited more than 240 congressional offices during 2006 Legislative Conference. ACC’s 2007 Conference (Sept. 16-18) expected to be even bigger.  Successful grassroots campaign at end of 2006, resulted in last-minute deal to prevent 2007.  ACC Chapters continue to mobilize members to action.  Continuing to raise issue profile on Hill, stop the 10 percent cut in 2008 and pave the way for a long- term solution.

6. Cardiovascular Imaging & Physician Ownership The Issue: Imaging growth is complex and not always “black and white.” Claims of inappropriate imaging are largely unsupported and clinical benefits are often ignored in the growth debate. Patient care, access and convenience are at stake!

7. Cardiovascular Imaging & Physician Ownership The Goal: Keep Cardiologists in the Imaging Picture! Work with other organizations and key lawmakers to fight imaging cuts at the federal level. Work with ACC Chapters to stop imaging legislation at the state level. Build relationships with payers to partner on solutions to rising costs and influence how they formulate privileging programs. Develop dialogue with radiology benefit managers to understand the logic behind their preauthorization models.

8. Cardiovascular Imaging & Physician Ownership ACC Efforts: Federal Continue to meet with key lawmakers to minimize the impacts of imaging cuts included in the Deficit Reduction Act of 2005 and ensure future legislation does not include additional cuts. State Held two successful state lobby days in 2006 to fight state legislation in California and Washington. Closely monitoring state legislative activity in more than seven states.

9. Cardiovascular Imaging & Physician Ownership ACC Efforts (Continued): Payer Released model LCD for CCT, CCTA in December 2005. Annual Medical Directors’ Institute continues to bring together payers and physicians to address appropriate use of imaging. Working with UnitedHealthcare to develop pilot program using Appropriateness Criteria for SPECT-MPI.

10. Cardiovascular Imaging & Physician Ownership ACC Efforts (Continued): Education & Quality Developed Appropriateness Criteria for SPECT MPI (2005), CCT and CMR (2006), TTE/TEE (2007). Additional Appropriateness Criteria being developed. Revised COCATS training to include section on imaging. New products — EchoSAP 5 and CCTSAP Wide variety of domestic and international educational programs

11. Quality First (QCARE) The Issue: With cardiovascular services consuming more than 40% of Medicare expenditures, and with such services projected to steadily increase over the next decade,health system reform is both essential and imminent. With cardiovascular services consuming more than 40% of Medicare expenditures, and with such services projected to steadily increase over the next decade, health system reform is both essential and imminent. Physicians and health care professionals need to be at the table NOW!

12. QCARE: ACC’s Answer to Health Care Reform Q Patient Centered Care

13. An end-to-end, systems approach to continuous quality improvement that translates science into practice. QCARE An end-to-end, systems approach to continuous quality improvement that translates science into practice. –Continuous review of new science –Evidence-based guidelines and standards –Comprehensive education –Appropriateness Criteria –Data reporting and collection through registries (NCDR) –Specific quality initiatives (D2B) –Adoption and appropriate use of new technology –Evaluation through self-assessment tools, performance testing and longitudinal studies

14. QCARE Puts Quality First Moving Forward the ACC Must:  Continue to lead in the quality arena and move beyond process measures to focus on outcomes.  Imbed quality in everything we do.  Honor our individual and collective responsibility to provide care that is patient-centered, evidence-based and cost-effective.

15. Get Involved Join the ACC’s CardioAdvocacy (CAN) Network (www.acc.org/can) and stay up to date on critical issues facing the cardiovascular community.www.acc.org/can Contribute to the ACC’s Political Action Committee (PAC) and support candidates who understand the importance of cardiovascular care. Attend the ACC’s Legislative Conference in Washington, D.C. Learn about the key issues of the day and make your voice heard. Get involved with your local chapter!