March 10, 2017

What works best in your Chapter for member/patient benefit?

This week's BOG Update is brought to you by BOG Chair A. Allen Seals, MD, FACC. This is Seals' last BOG Update as Chair, and is presented here as:

BOG YEAR IN REVIEW

It has been my honor and a privilege to serve as Chair of the Board of Governors (BOG) this past year. The BOG functions in a central role that is critical to the function of the College, and I have gratefully accepted the commission as your Chair to provide leadership and support to ACC governors in our mutual and unwavering commitment to the College. It has been my responsibility and pride to support the inherent value and tireless efforts of the ACC governors as they led their respective chapters to further the mission and the strategic plan of the College.

INNOVATION
The basic theme of this past year, in my opinion, has been innovation. The BOG serves as a testing ground for the development of novel initiatives and projects. In a previous BOG Update, past BOG Chair Robert Shor, MD, FACC stated: "ACC chapters are incubators of ideas and instruments for action". Innovation comes in many different forms – with some innovation originating from the ACC chapters while other innovations come from ACC national. Whether the initiatives are driven from either a state chapter or national, the driving force is the development of novel programs and initiatives which will assist our members in delivering high quality cardiovascular care to our patients.

BOG ACCOMPLISHMENTS
This BOG Update will serve both as a "Year in Review" as well as a vehicle to highlight and emphasize the innumerable achievements of the BOG and the chapters. This list is by no means complete, but is a small sampling of some of the exemplary accomplishments of the BOG. Let me be quick to acknowledge that this list should not be credited to any single individual, but rather speaks to the collaborative strength of the BOG and our chapters to pull together efforts from a diverse collective of efforts and individuals from other "silos" of the College as well as outside stakeholders. In addition, it should be noted that many of these projects and initiatives took multiple years in development to reach operational readiness. So, MAJOR KUDOS to our governors and chapters for the vision, the strength, and the tenacity to accomplish excellence in a vast array of projects and initiatives that all contribute to the ACC's mission and Strategic Plan.

BOG YEAR IN REVIEW

• BEST PRACTICES: The BOG Portal is the official website of the BOG, and functions as one of the principal internal methods for communication and, for individuals not familiar with the ACC, the BOG Portal often becomes the initial impression of the BOG. This year, we have highlighted some of the "award winning" initiatives and projects with a new section on the BOG Portal entitled "Best Practices." These vignettes from ACC Governors clearly illustrate the strength of the ACC chapters in development of truly innovative concepts.
• CHAPTER HEALTH INDEX (CHI): The CHI – not to be confused with any beverage from Starbucks, is a new initiative this year which asks ACC chapters to engage in an introspective review of the functions, operations and strategy of the chapter. These self-assessments are structured around six chapter functionalities: operational capacity, aspirations, strategy, organizational skills, leadership, and programmatic capacity. The purpose of the CHI is to encourage chapter leadership – governors and council, as well as chapter executive – to do a functional 360 and explore action steps to improve chapter functionality.
• CHAPTER eREPORTS: Launched in July 2016, the National Cardiovascular Data Registry (NCDR) introduced a new initiative to allow chapters to review statewide reports of key metrics from selected registries. These NCDR based reports, known as eREPORTS, allow ACC chapters the opportunity to review data on quality of cardiovascular care on a statewide basis. The ICD Registry™ was chosen as the initial NCDR product available for statewide reporting, with the CathPCI Registry™ dashboard coming online last month. Importantly, these reports are created for statewide analysis only and have strict safeguards to protect the confidentiality of any single clinic or hospital reporting data. The NCDR looks to expand the number of registries offered to chapters for eREPORTS in the near future.
• GOVERNANCE: The College's governance transformation directly involved the BOG. BOG leadership is expected to submit competencies which support inclusion on multiple policy making committees that support the new ACC governance doctrine: "centralized authority and decentralized decision making." In addition, the new governance plan created the Membership Committee (MC), with the BOG as a central component. As stated in the MC charter, the BOG Chair and Chair-Elect serve to directly represent and amplify the voice of ALL domestic members. Specifically, the BOG leadership views their role on the MC as important to promote effective collaboration and to grow the professional home by improving member value, engagement and relevance. To represent effectively, the Chair of the BOG continuously strives to engage in multiple communication channels with all members of the MC to maintain a pulse on the concerns and needs of the broad and diverse ACC membership. As directed by the governance transformation of the College, the BOG Chair serves on both the MC and the BOT, and takes this role and responsibility of representing all ACC members very seriously.
• INTERNATIONAL: This year, the BOG supported the introduction of three additional chapters into the ACC family of domestic-international partnerships. Formerly known as "twinning," the newest iteration of the international collaboration program is known as "International Chapter Exchange" (ICE). Three chapters pioneered these programs and have continuing international programs: California/Israel, Florida/Spain, and Pennsylvania/Italy. The newest ICE programs, which started this year, are Arizona/Mexico, New Jersey/Greece, and New York/Argentina. The BOG strongly supports and engages these chapters and in addition continues to look for methods to work more closely with the Assembly of International Governors.
• CHAPTER QUALITY INITIATIVES: As stated above, the ACC chapters have long been recognized as one of the principal drivers of innovation in the College. This has especially been the case when it comes to programs and initiatives that improve quality of cardiovascular care. This was highlighted in detail in a recent issue of JACC (Promoting Initiatives in Quality of Cardiovascular Care: The Complementary Role of ACC National and State Chapters. Seals and Chazal, JACC vol 69, No. 6, Feb 14, 2017, 745-9). The wealth and diversity of quality programs from the College is impressive, including the following examples: multistate, comprehensive, large Center for Medicare & Medicaid Innovation (CMMI) grants like SMARTCare; single statewide NCDR registry based projects including the Virginia Cardiac Services Quality Initiative, the Florida Cardiovascular Quality Network as well as statewide PCI appropriateness projects such as the Maryland Academic Consortium on PCI Appropriateness and Quality. These examples represent only a very small sampling of the extraordinary work that is being done by chapters to document significant improvements in quality of cardiovascular care.
• LEADERSHIP FORUM / LEADERSHIP ACADEMY: What can a retired Army Lt. General teach cardiovascular specialists about leadership? What can the entire ACC presidential team teach cardiovascular specialists about professionalism? What can newly elected "rookie" governors-elects learn from the BOG "old guard"? These questions were definitively answered over five days in Orlando at the Leadership Forum/Board of Governors Meeting/CV Summit marathon of meetings. From Lt. General Mark Hertling, attendees learned that there are parallels between the military training of officers and the process of developing physician leaders. These concepts have been field tested with Hertling's current role as senior vice president of Global Partnering, Leadership Development and Health Performance Strategies at Florida Hospital where he instructs organized groups of physicians from their 28-hospital system. The lessons learned from his role in physician leadership development were shared and discussed by an engaged audience with the aid of an advanced audience response system to structure questions and responses into an interactive session. Importantly, this session was directed by current and former BOG leadership, and illustrated the ongoing alignment of the BOG with the Leadership Forum.
• MENTOR – MENTEE PROGRAM: The importance of leadership development also extends to the BOG in the form of direct instruction from senior governors to first year governors. The BOG mentorship program has proven to be a successful addition to the singular governor orientation by offering first year governors ready access to experienced leadership. In addition, many senior current and past BOG members have been asked to participate in a parallel program offered through the ACC Leadership Academy. This has also proven to be an effective method for up-and-coming future leaders to develop detailed knowledge and perspective on the inner functions and workings of the College.
• SUPPORT OF FIT AND EARLY CAREER PROFESSIONALS: All governors have expressed interest in our training institutions in each of our respective chapters. It is clear that as an organization, we can do a great deal to assist with the objectives of the FIT and EC Sections. Perhaps two of the most tangible efforts on the part of many governors to support FIT/EC physicians are: (1) BOG support of the FIT JEOPARDY competition through efforts at the state and regional chapter levels, and (2) funding of FIT/EC members to attend major ACC meetings (for example, Leadership Forum, CV Summit, and Legislative Conference). Past and present governors have also included many FIT and EC physicians as full representative members on their chapter councils. At this year's Annual Scientific Session, BOG leadership and governors will participate in an informal session at the FIT/EC lounge demonstrating support for the objectives of the FIT and EC Sections (Sunday, March 19, 11 a.m. – 12 p.m., FIT/Early Career Lounge). Finally, a recent JACC article highlighted the importance of FIT training to include "non-clinical competencies" including leadership training, legislative and advocacy awareness, as well as organizational knowledge of the College. (Fellowship Training in Cardiology; Seals. Journal of the American College of Cardiology Nov 2016, 68 (21) 2376-2378; DOI: 10.1016/j.jacc.2016.10.006)
• SUPPORT OF CV TEAM (CVT): BOG leadership have demonstrated strong support of the CVT Section – through collaborations on issues at the chapter level, speaking at CVT Section meetings, and especially through the recent successes of the CVT membership recruitment campaign. Additionally, CVT leadership serves on the BOG Steering Committee. The Governors are on record supporting including each chapter's CVT state liaison – the only other elected position in the College – as a full member of each chapter's council. Recently, as documented in the State of the State reports, there are numerous examples of how CVT members have served as integral participants in critical chapter programs. These effective collaborations between governors and CVT state liaisons have promoted recruitment of an ever-increasing number of CVT professionals to become active ACC chapter members. The BOG Update has frequently included content from the national CVT Section leadership to discuss CVT issues and roles for effective involvement in the College, and has helped reinforce this message between BOG meetings. All of these efforts by BOG leadership, as well as current BOG governors, demonstrate strong support of the goals and objectives of the CVT Section.
• MACRA EDUCATION: There is arguably no more transformative change in health care law than the Medicare Access and CHIP Authorization (MACRA) Act of 2015. Now in the first year of operation, the governors of each of our chapters are committed to assisting their chapter members with MACRA implementation. While not necessarily a "MACRA expert", all governors recognize the importance of their position to facilitate MACRA education in their chapters. To assist governors, and members in general, the College has developed the "MACRA Hub" on ACC.org. This highly informative educational section of the College website, containing an impressive collection of graphs and other learning aids as well as excellent teaching slides. The BOG meetings have invested significant time to the presentation on information on the MACRA, and BOG members have formally provided feedback on these ACC developed MACRA education tool. Now, in the upcoming years, it will be even more critical for the governors to be in tune with their members as they attempt to successfully attest to meeting MACRA benchmarks. The BOG has a history of strongly supporting our general membership in challenging times, and now is certainly a challenging time in medicine.
• PRIOR AUTHORIZATION REPORTING TOOL (PAR Tool): The prior authorization process has been widely recognized to be out of control. A byproduct of what the insurance industry claims was an effort to maintain quality, prior authorization has now devolved into an overburdensome system to deny patient's access to care. In response, the BOG initiated an effort to study means to assist our ACC members with a tool to report prior authorization activity. This effort led to the creation of a work group and after a long effort (with occasional setbacks), the Prior Auth Work Group has very recently introduced the PAR Tool as a means of collecting detailed information directly from ACC members on denial of access to care. It is anticipated that high volume utilization of the PAR Tool will deliver significant documentation to chapters to approach other stakeholders (for example, state insurance commissioners) on the potential for abuse of the prior authorization process. The key factor is organized physician utilization of the PAR Tool. This is where the BOG will likely play an important role in galvanizing the general membership to organizing means to make the utilization of the PAR Tool a mandatory effort in multiple practices, thereby promoting a larger cohort of patients into this important effort.
• CHOOSING WISELY: Choosing Wisely (CW) aims to promote conversations between clinicians and patients by promoting care that is supported by evidence, not duplicative of other tests or procedures, free from harm, and truly necessary. The BOG has formally joined other national organizations to assist with the development of the next set of Choosing Wisely tenets for cardiovascular professionals. Led by Dick Kovacs, MD, FACC, chair of the ACC Science and Quality Committee and former BOG chair, a new strategy is developing to engage volunteer governors to form a work group to directly advice the CW effort. Clearly, governors with their close ties to the "real world" of clinical cardiology are in a unique position to advise and direct the CW process into areas that have real relevance to clinical practice.
• COLLABORATION WITH SECTIONS: The ACC chapters recognize a special collaborative relationship with the 19 member sections. Governors have enhanced chapter meetings by including section leaders, including one of the newest sections – Cardio-Oncology, with presence in multiple chapter meetings. Another example is the Geriatric Section's Essentials of Cardiovascular Care in Older Adults (ECCOA) program, highlighted in multiple chapters through a grant with the Retirement Research Foundation. At the most recent BOG meeting, the Section Steering Committee met with all ACC governors in an informal and highly interactive session designed to provide an opportunity for BOG and section leadership to make personal connections. To enhance this BOG-Sections collaboration, the following questions were raised: What do ACC sections have to offer governors/chapters and vice versa, what do governors/chapters have to offer sections? Importantly, the College is now witnessing meaningful integration of chapters and sections fueled by BOG leaders who continue to actively seek out more effective methods of involving specific sections into the work and objectives of their chapters.
• CHAPTER GRANTS: Chapter funding requests were solicited by the BOG, and with the approval of the BOT, funding was provided for special projects that were consistent with the ACC's Strategic Plan. While the number of requests exceeded funds available, a "chapter grants" peer review ad hoc committee was named from disinterested members of the BOG. These fellow governors developed a carefully considered grant scoring system to objectively review all grant requests in detail. The BOT approved funding of the BOG selection of two grants: Pennsylvania and Kansas. With lessons learned from this past year, the BOG anticipates the continuation of chapter grants with a more specific request for proposal (RFP) and a better defined timeline for submission/approvals. In addition, the BOG should look forward to interim reports on the success of these two awarded chapters in meeting their ACC Strategic Plan-based objectives.

As illustrated in this Update, the BOG ("the heart of the ACC") is clearly working on all cylinders and functions in a manner that is critical and necessary to the optimum functionality of the College. This year, in the face of unprecedented changes in the health care system, the BOG has once again risen to the challenges of our times, and demonstrated its historical value and critical core position in the College. Ultimately, the collective success of the BOG, as well as our individual governors and their respective chapters, significantly benefits our members and most importantly, our patients.

A trusted and respected senior ACC leader (and also past BOG Chair) once told me, "the year of BOG Chair will be the most challenging and at the same time, the most FUN year you will ever have with the College." I can attest to the truth of that statement. As your Chair, it has been my mission to function as your advocate and to actively work to facilitate the exemplary work that is accomplished by you, our ACC governors and ACC chapters on a daily basis.

Finally, let me repeat that it has been my singular honor and high privilege to serve as your Chair and work alongside you as governors and leaders of the ACC. You have my utmost respect. I also owe a deep sense of gratitude to the unquestionable best staff of any medical organization – they have kept me organized and focused. Finally, as I leave the Chair position, let me clearly state that the future of the College has never been so positive – entrusted to an impressive pipeline of current and future leadership, all dedicated to the transformation of cardiovascular care.