Earlier today, I co-chaired a panel with ACC President Ralph Brindis, MD, FACC, discussing what health care reform means to cardiovascular practice. A panel of ACC leaders – BOG Chair Dick Kovacs, MD, FACC, ACC SVP of Advocacy Jim Fasules, MD, FACC, and Brindis – spoke about their views on health care reform. I talked about the types of delivery system reform that we should expect to see in the near future, with or without the Affordable Care Act (ACA): more integration of hospitals, physicians, and insurers, possibly through accountable care organizations (ACOs), but also via medical homes, team practice models, major payment reforms and improved coordination of care at all levels. Fasules provided an overview of the College’s advocacy efforts, citing payment reform, self-referral, tort reform and health care reform implementation as the four “mountains” facing the practice of cardiovascular medicine from a health policy perspective.

Brindis said we need to overhaul the current care delivery and payment models and lead the profession toward systematic and measured reductions in cardiovascular morbidity and mortality, as well as toward ongoing improvements in personal and population-based prevention and health care outcomes. To do this the College needs to continue promoting its registries, as well as develop point-of-care decision support tools that put guidelines directly in the hands of cardiovascular professionals. Kovacs agreed, while also noting that health reform implementation will largely take place at the state level. He said its important for ACC members to build relationships with their state and federal lawmakers and mentioned potential opportunities to bring patients to the Hill with cardiologists.

Afterwards, there was a Q&A for session attendees. Not surprisingly, there were a lot of questions about what health care reform means for ACC members. Unfortunately, while we all had our opinions of what the answers were, there aren’t a lot of definitive responses that we could offer. We know what ACA requires, and what provisions have already been implemented, but it’s looking less and less clear how far the implementation of the ACA will proceed. Will it be funded, even it survives its legal challenges? This leaves ACC leaders and members in a tricky spot of trying to prepare for an uncertain future with thousands of moving parts. Despite the ever-increasing and miraculous abilities of health care to better diagnose,  treat, and prevent  medical problems, the economic imperatives related to the relationship between the national debt and rising health care costs, and the growing inabilities of families, businesses, and states to fund their own share of the costs, represents a growing fiscal emergency that cannot be ignored. This is going to be tough on physicians, unless we help find a way out of the mess.

What has your practice done to prepare for any of the changes in the ACA?

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