Controversy surrounding changes to the American Board of Internal Medicine's (ABIM's) Maintenance of Certification (MOC) program; continued burden and costs associated with cardiovascular disease; declining cardiology reimbursement; the shift towards value-based payment; rapid adoption of information technology; significant changes in clinical risk assessment and cholesterol management; and changing workforce needs are among the top issues affecting the cardiovascular landscape, according to the ACC's 2015 Environmental Scanning Report.

The report, published Nov. 2 in the Journal of the American College of Cardiology (JACC), provides a detailed look at these and other topics with the goal of providing a comprehensive lay-of-the-land that can be used to inform strategic efforts going forward.

Overall, the report highlights a high level of member satisfaction with the College and its mission to transform cardiovascular care. Key benefits of membership include JACC journals, educational resources and access to clinical guidelines. According to the authors, led by Environmental Scanning Work Group Chair Lawrence Laslett, MD, FACC, reimbursement and certification issues, work-life balance and staying up-to-date clinically are among the top challenges facing members today.

Not surprisingly, the MOC debate and health care reform implementation figure prominently in the report. Early in 2015, the ABIM issued an apology email and subsequently announced a series of significant changes or reversals. The ACC, along with other partners in the Internal Medicine Community, continue to engage with ABIM around further changes. Also in 2015, the Affordable Care Act (ACA) marked its 5th anniversary. A mid-year Supreme Court ruling upheld a key part of the law that provides health insurance subsidies for all qualifying Americans. Efforts to transition from fee-for-service to a value-based system – largely as a result of the ACA – continue to gain traction. Passage of the Medicare Access and CHIP Reauthorization Act of 2015, which repealed the sustainable growth rate (SGR) formula, solidified this shift even more.

The report also highlights the costs and burden of cardiovascular disease around the globe as a result of aging and population growth. Efforts by the global cardiovascular community, including the ACC, to reduce non-communicable diseases are among the ways stakeholders are working to make a difference. In the U.S., cardiovascular disease is the leading cause of death and it remains the single most costly diagnostic group in the U.S., with cost expected to top $1 trillion by 2030.

On a positive note, the report shines a spotlight on team-based care as a means of addressing unpredictability in supply and demand for health care workers, as well as changes in regulatory and market factors. "In cardiology the ACC is pioneering the evolution of team-based care," the report states. Information technology and changes in clinical risk assessment and cholesterol management get mixed reviews. While progress has been made in interoperability and information sharing when it comes to information technology, insufficient infrastructure, competition between vendors, technology challenges and unresolved policy issues continue to pose barriers to use. On the risk assessment and cholesterol management side, new clinical tools have introduced broader assessment and prevention strategies and new drugs are proving to be highly effective in reducing LDL cholesterol. At the same time, concerns about costs and affordability are stirring controversy.

According to ACC President Kim Allan Williams Sr., MD, FACC, the majority of these issues will continue to be hot topics in 2016. "The College is well-positioned to help members navigate the changes in the cardiovascular landscape," he said. "Our hope is that this report can serve as a point of reference as to why we need to continue moving forward, as well as how we can best achieve success."

Keywords: Certification, Cholesterol, Cholesterol, LDL, Fee-for-Service Plans, Health Care Reform, Insurance, Health, Medicare, Patient Protection and Affordable Care Act

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