Today is the first day of the College’s 2009 Health System Reform Summit. Over 100 leaders from within the College have gathered to talk health care reform, brainstorm solutions, and find ways to get our voice heard. Over lunch, economist Len Nichols, Ph.D., director of the health policy program at the New America Foundation, gave a presentation titled, “The Cost of Health Reform (and of Doing Nothing).” Nichols made some great points right on target with the points the ACC has been trying to make with its Quality First campaign.

Nichols gave these as the underlying realities of the health care system:

• The system’s incentive structure is “deeply flawed” – and some profit from the flawed structure
• Behavioral choices affect health and health costs
• The system cannot afford “business as usual” trajectories
• Change is impossible but necessary (he intended you to smile here)

The incentive structure is deeply flawed. I’ve been talking about payment reform on this blog since it launched – since I started as CEO at ACC -- and I can assure you, it’s the top thing on the minds of our members. Physicians are NOT compensated for providing the right care the first time -- they are compensated for the VOLUME and COMPLEXITY of tests they perform. This has to change. Changing the payment structure to reward high performance could have a dramatic impact on controlling costs and improving care.

Payment reform was one of three investments Nichols said we could use to create efficiencies to pay for reform. The remaining two: health IT and comparative effectiveness research. The ACC is highly supportive of health IT. We think it can improve efficiencies and reduce medical errors. Cardiology has one of the higher rates of health IT adoption of any of the specialties, but it’s not nearly high enough. We need to use the stimulus dollars to implement INTEROPERABLE health IT. Because we need to use it to adhere to guidelines, outcomes effectiveness and value. Comparative effectiveness is a little trickier – it must be done right to truly work.

Here’s what he says are solutions to “breaking the chain” of inaction: pursue bi-partisan reform and reform ourselves. Cardiologists can do this. We already are – look at our registries (National Cardiovascular Data Registry and its many sub-registries); look at our guidelines, appropriate use criteria, performance measures and other clinical documents, helping CV professionals translate science into everyday practice. We need other specialties to follow, and we need Congress and the President to listen.

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