A View into ACC’s Advocacy: An Interview With Karthikeyan Ananthasubramaniam, MBBS, FACC

Akash Rusia, MDAkash Rusia, MD

Karthikeyan Ananthasubramaniam, MBBS, FACC is president-elect of the ACC Michigan Chapter and will begin his three-year term in spring 2022. He is the Director of Nuclear Cardiology and Cardiac PET at Henry Ford Hospital, Professor of Medicine at Wayne State University, and previously served as the Director of Echocardiography and Program Director of Advanced Imaging Fellowship at Henry Ford. In 2012, he served as president of the Michigan Society of Echocardiography. Currently, he is the Education Committee Chair for the American Society of Nuclear Cardiology and sits on the Board of Directors. He was kind enough to chat with me about ACC's work in advocacy.

Tell me about yourself and your path to leadership.

I'm originally from south India, from the city of Chennai. I completed my medical school at MGR Medical University (Madras Medical College) and came to the U.S. in 1992. I completed my internal medicine residency and cardiology and echocardiography fellowships at Henry Ford and received my advanced imaging training at the University of Ottawa (nuclear cardiology/PET) and Beaumont Hospital (cardiac CT and MRI). I've been lucky to have excellent colleagues and mentors throughout my training and practice. My father, who is an internist and cardiologist, was my inspiration to go into medicine. Howard Rosman, MD, FACC, who was the cardiology program director at Henry Ford, served as my role model and mentor during my training. Although I initially envisioned myself as an interventionalist, the physiology and pathology insights offered by cardiac imaging (mainly echocardiography) inspired me to change my career path. It was the best decision I've made!

In terms of pursuing leadership, the Henry Ford Leadership Development Program and ACC Emerging Faculty Workshop were key programs that molded me. The ACC's program started in 2005 and is organized by Elizabeth Klodas, MD, FACC; Rick Nishimura, MD, MACC; and Patrick O'Gara, MD, MACC. The goal is to understand how to become an effective teacher, master presentation skills, and keep your audience engaged. This is valuable training to become an effective educator and foster positive leadership skills. My chief of cardiology, Douglas Weaver, MD, MACC, encouraged and nominated me to participate in the workshop. It is a great tool for those interested in leadership opportunities and looking to get involved with ACC. I am fortunate to be an alumnus of this program. The program continues to build bridges with the Emerging Faculty Alumni reception held during the ACC's Annual Scientific Session, where you can meet and mingle with younger faculty looking for mentorship and direction and reconnect with colleagues who were part of this program.

As president of the ACC Michigan Chapter, you will play a central role in advocacy – what are some ways that state-level and national-level advocacy align?

The chapter largely follows the path laid by the College, but it also has unique local issues it tries to impact. There are two issues that are a common focus for state chapters across the country. The first hurts most practices: persistent uncertainty regarding Medicare payment stability. Many physicians, nurses, CV team members and support staff are going into premature retirement because of burnout in the past year due to the pandemic. On top of that, there were multiple looming payment cuts which were going to go into effect Jan. 1, 2022. This was a top priority for the College and state chapters at the 2021 ACC Legislative Conference, where we lobbied our representatives to stop and/or delay the cuts.  Think of all the small practices and physicians who have been struggling during COVID and what these cuts would mean to them! But we just received good news: Congress passed legislation that gives a temporary reprieve from these cuts. This is a big, albeit temporary, win and we will continue to advocate against the cuts.

The second issue is telehealth, and it is a big focus for us in Michigan. The pandemic's silver lining was the rapid adoption of telehealth capabilities. This was great to connect patients and providers during the pandemic and will be great to continue, but there are several roadblocks. First, there are restrictions in some states to provide telehealth care across state lines. Second, there are looming cuts that will dramatically reduce reimbursement for telehealth care once the pandemic ends. Third, we will need to help maintain interstate licensure flexibility for physicians to better deliver this care. We will continue to advocate for policy that enables physicians and patients to utilize telehealth, even across state lines.

How does ACC establish legislative priorities and advocate for them? What is the timeline like for these initiatives?

The ACC's overall mission is four-fold: Providing high quality education, ensuring members' wellness, promoting cardiovascular research, and advocating for legislation that is not detrimental to its members. The ACC is able to feel the pulse of the membership through the Board of Governors (BOG), which is composed of the elected leader (i.e. president) of each chapter. The Executive Committee, Board of Trustees, and President base their decisions on input from the BOG because the chapter presidents are a direct link to the members. ACC's mission is to transform cardiovascular care and improve heart health and all leaders and committees work to further that mission. Delivering care during the pandemic has been a main priority. Incorporation of information technology and digital transformation has been a high priority of our current ACC President, Dipti Itchhaporia, MD, FACC. Legislative priorities are set by the Health Advocacy Committee with support from the College's very knowledgeable advocacy staff.

Additionally, HeartPAC is a strong piece of ACC's advocacy efforts.  HeartPAC is a non-partisan Political Action Committee, funded voluntarily by members. It is a platform to educate and support legislators who are aligned with ACC's legislative priorities. For example, apart from the Medicare cuts, we asked Congress to support the Cardiovascular Advances in Research and Opportunities Legacy Act (CAROL Act).  This was a piece of legislation that was crafted by a congressman whose wife unfortunately passed away from sudden cardiac death.  He wanted to focus on research in valve disease and sudden cardiac death, so he introduced this bill to authorize funding for that research. The CAROL Act just passed the House and now goes to the Senate. This was a key issue for us at the last ACC Legislative Conference, so it is gratifying to see it one step closer to becoming law. The timeline for initiatives like this varies dramatically based on the impact of and support for the bill. The ACC is adept at prioritizing issues that have immediate impact. For example, the Medicare cuts were a top priority because they were set to begin Jan. 1, 2022 and would have had a detrimental impact.

What state-level priorities do you have in Michigan?

We will continue the great work of the current chapter president, David Wohns, MD, FACC, on ongoing long-term chapter initiatives, but I have a few new priorities in mind. One area I'd like to focus on is enhancing the quality of cardiac imaging in Michigan. My hope is to create a collaborative group across Michigan with the goal of achieving some basic standardization of quality metrics in cardiac imaging. For example, Beaumont led the Cardiovascular CT Consortium in Michigan which was sponsored by Blue Cross Blue Shield, something I was fortunate to be a part of. This consortium and its work received national attention because of data generated and feedback provided to institutions on use of cardiac imaging. Along the same lines, I'd like to expand into echocardiography and nuclear cardiology where quality is so different across institutions. We would create an Imaging Quality Consortium and hopefully garner similar support. A second focus for me is clinician wellness and avoiding burnout. The ACC has put a tremendous number of resources toward this and ACC.org is a great source for information. We need to add to those resources and make them widely available so the entire care team will remain engaged in the workforce.

For fellows interested in advocacy, what avenues do they have to participate or learn more?

The ACC's website and advocacy hub are great resources. Attending the annual ACC Legislative Conference is also eye opening. But the best way to participate is to get involved in your local chapter. Our chapter includes fellows on our Advocacy Committee and the co-chairs of our FIT Council sit on our chapter's Board. They see policy development and the impact of grassroots advocacy firsthand. I'd recommend that fellows get involved in their chapter, attend the ACC Legislative Conference, choose a mentor who is involved in and drives advocacy, and dive right into making an impact on the future of cardiology.



Akash Rusia, MD

This article was authored by Akash Rusia, MD, chief fellow at Beaumont Hospital, Royal Oak. Twitter: @akashrusia.

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