Heart of Health Policy

In this month's Heart of Health Policy, read about the visit to the U.S. Congress by Valentin Fuster, MD, PhD, MACC, to advocate for the incorporation of recommendations from the Global Health and the Future Role of the United States report into health policy and programs. And don’t miss the Advocacy Briefs, a round-up of news that affects your practice. Learn about how the Informatics and Health Information Technology Task Force is working to build solutions to optimize the use of health information technology in your practice.

Dr. Fuster Goes to Washington, Speaks on Global Health Recommendations

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The Global Health and the Future Role of the United States report was recently published by the National Academies of Sciences, Engineering, and Medicine (NASEM). It examined the changing landscape of global health to advise the U.S. government, as well as non-governmental organizations and the private sector, so as to improve their responsiveness, coordination and efficiency.

Valentin Fuster, MD, PhD, MACC, editor-in-chief of the Journal of the American College of Cardiology, served as co-chair of the committee that produced the report. He sat down with Cardiology to share its key messages.

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Why was it important that NASEM lead the effort to produce this report to inform the U.S. government and others about global health issues?

The United States has a tremendously important role in these efforts, contributing more than $10 billion annually. The U.S. government’s dedication over the years has resulted in many successful, ongoing initiatives, including the President’s Emergency Plan for AIDS Relief and the President’s Malaria Initiative. The objective with this document was to examine the most pressing health needs globally and provide strategic direction for governmental investment over the next 20 years. It is important to remember that we cannot live in isolation, as the health and well-being of other countries both directly and indirectly affect the health, safety and economic security of Americans.

Are noncommunicable diseases a focus of this report?

This is one of four priority areas in the report. Noncommunicable diseases (NCDs), such as cardiovascular disease, chronic obstructive pulmonary disease and lung cancer, result in 40 million deaths globally each year, almost 75 percent of which are in low- and middle-income countries. The costs of managing these diseases are rising, with cardiovascular disease alone projected to cost the world $1 trillion annually for treatments and productivity losses by 2030. Many health systems in these countries are not adequately equipped to care for patients with NCDs, due to an historical focus on infectious diseases. Thus, our committee called for the United States Agency for International Development, the U.S. State Department and the Centers for Disease Control to support improved mobilization and coordination of private partners at the country level to implement strategies targeting cardiovascular disease risk factors, early detection and treatment of hypertension and cervical cancer, and immunization against cancer-causing viruses, such as human papillomavirus and hepatitis B.

The cost of health care is under tremendous scrutiny. How does the report mitigate these concerns?

To maximize the return on investment, while achieving better health outcomes, the report makes three recommendations to the U.S. Government:

  • Catalyze innovation through accelerated development of medical products and integrated digital health infrastructure
  • Employ more flexible financing mechanisms to leverage new partners and funders in global health
  • Maintain the status and influence of the U.S. as a world leader in global health while adhering to evidence-based science and economics, measurement and accountability.

What are the next steps toward implementation?

We presented the report to the U.S. Congress and our hope is that Congress and the presidential administration will incorporate our recommendations into health policy and programs going forward.

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Advocacy Brief

The Centers for Medicare and Medicaid Services (CMS) has finalized its national coverage decision (NCD) of supervised exercise therapy for symptomatic peripheral artery disease (PAD) patients with intermittent claudication (IC). IC patients will be eligible for up to 36 sessions during a 12-week period. The final coverage reflects suggestions made by the ACC and other organizations regarding supervision, site of service, session sequencing and amputation in response to the proposed NCD issued in March. The coverage is effective immediately, but it will take several months for CMS to issue guidance for providers to submit claims and guidance for Medicare Administrative Contractors to process those claims.

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Advocacy Brief
Know Your Numbers

As part of efforts to fight medical identity theft, the Medicare Access and CHIP Reauthorization Act requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. Beginning in April 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to all Medicare recipients. The new MBIs will replace the SSN-based Health Insurance Claim Numbers for transactions like billing, eligibility status and claim status after a transition period. More information on how to prepare is available in the Advocacy section of ACC.org.

Advocacy Brief
Appropriations Update

On June 2, the College submitted written testimony to the U.S. Senate Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee outlining all ACC appropriations requests for Fiscal Year 2018 (FY ‘18), including recommendations for the National Institutes of Health and Centers for Disease Control and Prevention (CDC), as well as the CDC Office on Smoking and Health, and congenital heart disease research funding. Given the budgetary climate and uncertainty surrounding the future of non-defense discretionary funding, these requests focus on programs most closely aligned with ACC’s mission. Scan the QR code for details.

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FDA Addressing Concerns Over Drug Shortages

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Over the last several weeks, cardiologists have reported increasing concerns related to ongoing shortages of sodium bicarbonate, epinephrine and dextrose.

To address the shortage of sodium bicarbonate, the U.S. Food and Drug Administration (FDA) has approved importation of the drug from an Australian supplier for as long as necessary. To ensure patient safety, providers are encouraged to review manufacturer information highlighting the differences between the U.S. registered product and the imported version posted on FDA.gov.

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On the epinephrine front, the FDA says the emergency epinephrine syringe shortage is the result of a problem in the supply chain for one of the two domestic manufacturers of the drug. Because one domestic manufacturer does not have the capacity to replace the production capacity of the other and the FDA has not been able to identify a foreign source of the product, the agency is working with the manufacturer to identify solutions. At present, the FDA is advising providers to:

  • Consider drawing epinephrine from vials. While this is not an ideal solution, there are existing supplies of epinephrine in vials that should assist in alleviating the shortage.
  • Maintain supplies of expired emergency epinephrine syringes. The FDA is working with the manufacturer to determine if the expiration dates can be extended. Information will be posted online if such a determination is made.

Additionally, the FDA is working with the dextrose manufacturer to determine whether those expiration dates can be extended as well.

In both the epinephrine and dextrose situations, tables will be made available that identify affected product lot numbers, original expiration dates and new expiration dates to address any compliance issues that may arise from retaining expired lots.

ACC will continue communications with the FDA on this important issue until the shortages are resolved.

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The Informatics and Health Information Technology Task Force: Building Solutions

Long before the Affordable Care Act, and even before President George W. Bush’s 2004 pledge for widespread implementation of the electronic health record, a group of cardiologists within the ACC were concerned about the impact of health information technology (IT) on cardiovascular professionals. First, under the leadership and guidance of James Dove, MD, MACC, then Michael Mirro, MD, FACC, and more recently James Tcheng, MD, FACC, the Informatics and Health Information Technology Task Force has been advising ACC leadership on navigating the treacherous currents of health IT that today affects all members. John Windle MD, FACC, and Jeff Westcott MD, FACC, are the current chair and co-chair of the Task Force.

"Stated simply, the role of the Task Force is to help determine how to use health IT to make clinical care, quality, education and research easier for ACC members."

Health informatics is the interdisciplinary study of the design, development, adoption and application of IT-based innovations in health care services delivery, management and planning. Stated simply, the role of the Task Force is to help determine how to use health IT to make clinical care, quality, education and research easier for ACC members.

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It begins with advocacy. The Task Force works with government agencies such as the Centers for Medicare and Medicaid Services, Office of the National Coordinator and National Quality Forum, and other standards organizations such as the Cardiology Domain of Integrating the Healthcare Enterprise and medical societies to build bridges and identify and solve common health IT problems.

The Task Force also serves a critical function working within the ACC to break down silos. A major challenge being addressed is registry reporting. Under exploration: How can data be captured at the point of care and transmitted to NCDR registries without needing a person to manually “abstract” the data from sources like EHRs?

The Task Force is working with the Digital Steering Committee and the Guidelines Committee to leverage NCDR data when developing quality measures, appropriate use criteria and clinical guidelines. The Task Force is also looking at ways to support and enhance patient-centered care through its work with appropriate ACC committees.

The implementation of health IT has created pain points. It is cited as a major cause of physician burn out by increasing administrative data collection and documentation, decreasing clinical efficiency for providers and creating new barriers to patient and team communications. Health IT is affecting the whole cardiology team. Nursing documentation is perhaps even more rigorous than physicians. A cadre of data abstraction specialists is now required to move digital data from one site to the next. Documentation tasks have taken precious time away from all providers, impacting the direct patient care experience and provider satisfaction. Thankfully, the ACC has a well-earned reputation as a leader and innovator in health IT. The Informatics and Health Information Task Force can see the light at the end of the tunnel, and is committed to minimizing health IT obstacles that separate cardiovascular professionals from their patients.

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Clinical Topics: Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise, Hypertension, Smoking

Keywords: ACC Publications, Cardiology Magazine, Simian Acquired Immunodeficiency Syndrome, Acquired Immunodeficiency Syndrome, Amputation, Anniversaries and Special Events, Centers for Disease Control and Prevention (U.S.), Centers for Medicare and Medicaid Services (U.S.), Electronic Health Records, Epinephrine, Exercise Therapy, Global Health, Glucose, Health Care Costs, Health Policy, Heart Diseases, Hepatitis B, Hypertension, Immunization, Interdisciplinary Studies, Intermittent Claudication, Leadership, Lung Neoplasms, Malaria, Medicaid, Medical Identity Theft, Medical Informatics, Medicare, National Institutes of Health (U.S.), Papillomaviridae, Patient Care, Patient Protection and Affordable Care Act, Patient Safety, Patient-Centered Care, Peripheral Arterial Disease, Point-of-Care Systems, Private Sector, Pulmonary Disease, Chronic Obstructive, Registries, Risk Factors, Smoking, United States Food and Drug Administration

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