State of the States 2013

The past year has been one of continuous change and adaptive transformation both within the College as well as in the broader health care arena.

In spite of the potential to add 30 million Americans to the health care coverage rolls, the implementation of the Affordable Care Act (ACA) has continued to struggle, moving forward in what can best be characterized as fits and starts. Meanwhile Congress, the Centers for Medicare and Medicaid Services (CMS) and other stakeholders have attempted, with varying degrees of success, to transition the current fee-for-service payment paradigm to one that rewards the triple aim of better care, better outcomes and lower costs. A recent ACC environmental scan showed an increasing clinical emphasis on outpatient care in addition to greater oversight and regulation of relationships with industry, impacting the way educational programs and career development awards can be funded. On the scientific front, rapid developments in health care technologies have required medical societies, government and industry to work together in innovative ways to keep up with the changes.


Organizationally, the ACC has also undergone change. Evolving member demographics due to international expansion, hospital integration, the inclusion of the cardiovascular care team, as well as a multitude of other factors, have forced the College to look closely at how best to meet these diverse and changing needs. Simultaneously, this year saw the initial implementation of the digital strategy, onboarding of a new CEO and the development of a comprehensive, five-year strategic plan focused on outcomes, patient experience, population health and the use of data and technology to make clinical decisions and connect patients to physicians.

Each year, the ACC’s Board of Governors releases a “State of the States” Report that offers a closer, first-hand look at many of these changes and their impact at the state and local level. Among the 2013 report highlights:


The roll out of the ACA remains one of the top concerns for ACC chapters. Uncertainty about the law and its impacts on the future is weighing heavily on members. The Utah Chapter summed it up best when noting that the greatest legislative and regulatory obstacles facing its chapter members next year will be “declining health care reimbursement in the face of increased expectation to provide high-quality care.” Members in Utah are “very concerned about the lack of progress in repealing the sustainable growth rate, and the lack of progress in Washington regarding formulation of a viable replacement health care payment model,”the report notes. New York had similar sentiments, saying that “reimbursement and delivery of care issues” weigh on members and “there is a good deal of concern, frustration, and disappointment with the overall state of health care.”

On the positive side, significant progress has been made on the advocacy front at the state level in terms of smoke-free legislation by working with state leaders, medical societies and other physician groups in states like Kentucky and Mississippi.

Maryland also saw major success in patient safety with efforts resulting in the 2012 establishment of a Clinical Advisory Group (CAG) to help the Maryland Health Care Commission make decisions concerning percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery issues in the state. This year, the CAG’s final report “included a recommendation that hospitals must conduct an annual external review of at least five percent of randomly selected PCI cases.”

Science and Quality

When it comes to improving quality and patient outcomes, partnerships are proving to be key. In Virginia, a collaborative effort to enhance quality and cost in the state with a multifaceted program acknowledging public reporting, the expanding heart care team and economic pressures, is proving successful. Meanwhile, many ACC chapters have joined the Million Hearts initiative and have either held their own Million Hearts meetings or participated in those in their states.

Five ACC chapters also took part in the innovative new Provider Action for Treating Congenital Hearts (PATCH) program as pilots. Michigan, California, Georgia, Massachusetts and Ohio participated in the program that fosters collaboration between cardiovascular physicians and team members caring for the nation’s two million adults and children now living with repaired and unrepaired congenital heart defects.

Purposeful Education

Annual chapter meetings are the touch point for members to learn, interact with colleagues and make a face-to-face ACC connection. Many chapters are beginning to combine their meetings, to pull in larger crowds and share knowledge across state lines. For example, this year was the first ever Midwest Regional Cardiovascular Symposium which brought together ACC chapters in North Dakota, South Dakota, Minnesota and Iowa. Chapters also continued to make a concerted effort to develop specific education courses for Fellows in Training (FITs), early career professionals and cardiovascular care team members as part of their annual meetings.

Membership Value and Engagement

Member apathy has continued to be an issue in some states, with many ACC chapters noting that finding new ways to communicate and engage with members will be a priority in 2014.

That being said, many chapters are working diligently to encourage involvement from the younger generation of cardiovascular professionals. In Alabama, ACC’s chapter president sent a personal message to each FIT at both collegiate training programs in the state to encourage their participation in the ACC. Louisiana held a “Life After Cardiology Fellowship” meeting, targeted at FITs. West Virginia has appointed council members from the both training institutions within the state, and like many other states, has supported stipends for FITs, as well as cardiovascular care team members, to attend ACC’s annual Legislative Conference.


The successes that ACC chapter leaders share in each of these reports are inspiring and the challenges are real. It is my hope that this year’s State of the States Report will serve as a learning and sharing tool across all of cardiology. View the complete report at

Article written by David May, MD, PhD, FACC. May is chair of the ACC’s Board of Governors.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Fellowships and Scholarships, Fee-for-Service Plans, Societies, Medical, Centers for Medicare and Medicaid Services (U.S.), Patient Safety, Patient Protection and Affordable Care Act, United States, Percutaneous Coronary Intervention, Cardiology Magazine, ACC Publications

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