2015 State Successes

In 2015, ACC chapters dealt with a broad range of issues and met personally with lawmakers early in the legislative process to educate them of the effect of proposals on patients. The 2015 successes can also be attributed to a focused effort on stakeholder collaborations, including partnerships with state and specialty medical societies, and patient advocacy groups such as the Sports Safety Coalition. ACC member participation in groups such as the National Conference of State Legislators and the National Lieutenant Governors Association also provided an excellent platform to not only discuss key issues, but showcase ACC's patient-focused efforts. Some highlights of 2015 successes include:

Sudden Cardiac Arrest
Legislation was defeated in Texas and North Carolina that would have required all scholastic athletes to take electrocardiogram tests as a condition of participation.

Team-Based Care
Legislation was defeated in North Carolina that would have required cardiovascular interventional technicians to meet the requirements of radiological technologists in order to work in cath labs.

Medical Malpractice
In Illinois, legislation was defeated that would have lifted the exception that prohibits peer review deliberations from being admitted into evidence in medical malpractice lawsuits.

Key Issues For 2016

Several challenging issues in 2016 will open doors for state advocacy efforts. Most state legislatures started their sessions in early January and lawmakers have been busy drafting proposals to address spiraling pharmaceutical costs, increasing access to care in rural areas, establishing clear rules for telemedicine licensure services, updating emergency care policies and addressing insurers' prior authorization policies. Some issues of note for this year include:

Pulse oximetry screening
Four states have not acted on pulse oximetry legislation, including Vermont, Kansas, Wyoming and Idaho. The ACC Northern New England Chapter supports a Department of Health proposed rule to mandate this screening to detect congenital heart disease.

Medical Malpractice
Several states have defeated ill-advised proposals to scrap the current state litigation system and replace it with a workers compensation model that would create new regulatory and quasi-judicial "expert panels" with authority to determine which claims are valid and the amounts patients should be compensated.

Insurance Coverage
ACC's Ohio and Pennsylvania Chapters are working closely with medical societies to reform prior authorization in order to ensure that clinical judgment guides coverage regulations.

Population Health
In response to ACC's increased population health initiatives, the ACC State Advocacy team has further developed its resources for state chapters to get involved. Key 2016 population health issues include:

• Sale of Tobacco Products: Currently, six states permit the sale of e-cigarettes to minors. Several other states treat e-cigarettes as tobacco products in their smoke-free laws. ACC State Advocacy objectives include enacting smoke-free laws, increasing cigarette taxes and increasing funding for smoking cessation.
• CPR: A majority of states require cardiopulmonary resuscitation as a high school graduation requirement. Adding additional states is a high priority.
• Physical Education: Major efforts are needed in fighting childhood obesity by requiring physical education in grades K – 12 and recess in grades K – 6. Three states meet this standard: Illinois, Missouri and Louisiana. Fourteen require either physical education or recess. Thirty-three states have no requirements.
• Sudden Cardiac Arrest: The ACC State Advocacy team has developed resource materials for legislators and advocates that outline policies to prevent sudden cardiac arrest in scholastic athletes through training, education and on-site resources.

Emergency Care
The ACC Illinois Chapter is working with a coalition comprised of health department representatives, American Heart Association officials, emergency medical technicians (EMTs) and health system interests to update the state's ST-elevated myocardial infarction (STEMI) program. A key challenge will be to ensure EMT agencies have up-to-date information on hospital capabilities and are in constant contact with all stakeholders so that STEMI patients are transported to appropriate facilities.

Pharmaceutical Costs
Synchronization of refills, transparency and prior authorization will be a primary focus for ACC State Advocacy this year. The ACC has met with pharmaceutical stakeholders and payers to find common ground, and the next step is to position chapter leaders to deliver cardiology's message to lawmakers. In addition, medical societies nationwide have expressed newfound interest in this area and the ACC convenes with them regularly to evaluate proposals and share intelligence.