H.R. 1155: A Win For Team-Based Care

April 27, 2017 | Sandeep Krishnan, MD

The importance of a team approach has long been supported and advocated by the ACC, AHA, and ESC guideline writing groups. However, the adoption of a true heart team inclusive of all providers including advanced practice providers (APPs), has eluded many practices and institutions until recently as it is a fairly new concept in cardiology. One thing that I appreciate about the ACC is its longstanding emphasis on advocating for physicians, patients, and for all cardiovascular team members including nurses, APPs, and cardiovascular technologists. The ACC has led the way to help APPs practice to the highest level of their licenses with its inclusive attitude; this has allowed for improved access to patient care. A great example of this is the advocacy push for cardiac rehabilitation (rehab), which has been one of the main focuses of our visits to Capitol Hill during the past few Legislative Conferences.

During my first Legislative Conference in the fall of 2014, we advocated for a bill to help increase access to cardiac rehab. In the current system, Title XVIII of the Social Security Act mandates that cardiac and intensive cardiac rehab programs be “physician-supervised,” meaning that unless a physician is directly supervising the rehab center, it will not be eligible for Medicare disbursement. Historically, this has limited the availability of cardiac rehab services to patients across the country despite the well-established fact that cardiac rehab helps patients improve their quality of life and longevity in a safe and effective manner.

Thanks to successful lobbying from the ACC and other patient advocacy groups on February 16, 2017, Reps. Lynn Jenkins (R-KS) and John Lewis (D-GA), re-introduced H.R. 1155 in this 115th Congressional session. This House bill aims to amend the Social Security Act to allow “a physician or a physician assistant, nurse practitioner or clinical nurse specialist” to supervise both cardiac/intensive cardiac rehab programs as well as pulmonary rehab programs. This will allow more patients to access rehab programs around the country – especially in rural areas where physicians and specialists are already in short supply.

This is in line with ACC’s vision – to support a cardiovascular team in which every member of the team is practicing at the highest level of his or her license. This legislation ensures that physicians are able to spend more time with their patients and allows all health care professionals to practice to the highest level of their license. The ACC is currently advocating to get a companion bill reintroduced in the Senate. As this bill has garnered bipartisan support in the House already, hopefully it will pass through the 115th Congress’s legislative agenda without too much acrimony.

This recently re-introduced legislation provides a great reason for FITs to encourage the APPs they work with to get more engaged with ACC’s advocacy activities. The ACC and AHA recognized the importance of a team-based approach to care in a recent 2015 ACC Health Policy Statement on “Cardiovascular Team-Based Care and the Role of Advanced Practice Providers”. This publication focuses on ensuring that the team taking care of a patient is inclusive and flexible, and recognizes that the leader of the health care team may change depending on the task at hand. It emphasizes the skills each member brings to the table and helps to ensure the most efficient and highest quality of care for each individual patient.

I recently approached two of the APPs in our interventional cardiology division. They are new to cardiology and were not at all familiar with the ACC. After providing them with examples of ways that the ACC supports the cardiovascular team and improved cardiovascular healthcare delivery, they quickly saw the value in getting engaged with the ACC. I brought them to an ACC Washington Chapter meeting, and it is fair to say that they too have found a professional home in the ACC as we all have. Together we are stronger and better equipped to advocate for our patients—a win-win situation for Team Heart!

For more information regarding the College’s position on H.R. 1155, visit ACC.org.

This article was authored by Sandeep Krishnan, MD, the Fellow in Training member of ACC’s Health Affairs Committee.