This post was authored by Jim Fasules, MD, FACC, senior vice president of Advocacy for the ACC.

Despite a rather recalcitrant Congress, last year saw very significant changes for health care and cardiology. After the swirling uncertainty surrounding the Affordable Care Act (ACA), the U.S. Supreme Court ruled the ACA, including its individual mandate, was constitutional. With the federal debate laid to rest, the action shifts to the states where for political and policy reasons a patchwork quilt of variability still leaves physicians, hospitals and patients perplexed on how to adapt to Medicaid expansion, the Exchanges and other insurance changes. Yet hidden in the rancor over the ACA were many challenges and changes effecting cardiology that the ACC tackled with a large degree of success.

For more than a decade, the sustainable growth rate (SGR) and the nearly 30 percent cuts associated with the flawed formula have threatened to impede improvements to the health care system and weaken the sustainability of practices nationwide. While a fight for permanent repeal of the SGR was unsuccessful, the last-minute “fiscal cliff” legislation delayed “the cliff” and its 27 percent cuts until 2014, at least restore a degree of financial security to physicians and ensure patients have continued access to quality care for 2013.

Besides helping achieve the SGR patch in the American Taxpayer Relief Act of 2012 (ATRA), the ACC team succeeded in helping cardiology in two other important ways.  First, last year saw an aggressive campaign waged to close the in-office ancillary services exception (IOASE), also known as the Stark exception that allows us to perform tests and imaging in our offices, mounted by radiology and others. Its inclusion in the ATRA was successfully prevented. In addition, the team’s work with the Senate Finance, Ways and Means and Energy and Commerce Committees, following the stellar testimony of ACC Past President Douglas Weaver, MD, MACC in July, resulted in the law providing that participation in qualified clinical data registries, such as the NCDR®, will count as PQRS participation in 2014. While many details still need to be worked out, this will allow greater ease of avoiding the cuts that now occur for non-participation in PQRS.

Despite our successes, 2013 has many risks. The 2 percent across-the-board sequestration cut to Medicare and the even greater cuts to public health remain a threat when the two month delay in the ATRA expires on March 1. The ACC adamantly opposes the 2 percent Medicare sequester and the approximately 8 percent sequester cut to NIH, CDC, AHRQ and other crucial agencies, and the College will continue to urge Congress to prevent the cuts from going into effect. While successfully prevented in 2012, the forces working to close the IOASE have already marshaled an even stronger campaign this year. In response, we are working with a broad coalition to demonstrate to Congress and the Administration that closure of the exception would cause great disruption to patient care and would effectively end the viability of private practice and actually result in greater expenses for Medicare and insurers. Similarly, the College remains opposed to enactment of prior authorization for imaging services under Medicare.

On the medical liability reform front for this year, the U.S. House of Representatives is expected to take action on the HEALTH Act once again, which includes MICRA-type liability reforms. The College will continue to work with other stakeholders to support this act and advance supplemental medical liability reforms. Often missed in the College’s activities is its work for public health and science.  Again this year, the College will work to support federal funding for NIH; AHRQ; the NHLBI; the Health Resources and Services Administration’s AED program; the Prevention and Public Health Fund; the Million Hearts™ initiative; CDC’s Heart Disease and Stroke Prevention Program; and congenital heart disease research and surveillance.  As Congress struggles to find spending cuts, Graduate Medical Education (GME) finds itself targeted.  Advocacy with the help of the Academic Council is working with the AAMC to prevent any disruption to fellowship training.

As you can see 2013 holds many risks to cardiovascular care.  There are many opportunities for U.S. members to get involved in ACC's advocacy efforts, including learning more about ACCPAC, and participating in legislator practice visits and Legislative Conference.

Stay tuned to CardioSource.org/Advocacy throughout the year for health policy updates. To get involved in ACCPAC, visit accpacweb.org.

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