The ACC continues to champion innovation and recognizes the growing potential of AI to streamline workflows and optimize care delivery in cardiology. AI oversight within the current federal landscape is segmented with no singular governing body managing the regulation of AI-enabled tools. The ACC has developed guiding policy principles to ensure the responsible and effective use of AI within cardiovascular care.

The following is an abbreviated list of the College's policy principles for AI-enabled tools:

• AI-enabled tools should remain ancillary in a clinical setting and should augment the clinician's work and decision-making responsibilities, not replace it.
• Liability related to an AI-enabled tool's output should be clearly assigned, ensuring clinicians are not held responsible for system-level failures.
• No two AI-enabled tools are equal in capability and use.
• Data privacy and cybersecurity regulations and guidance are imperative to preserve the safety of the clinician and patient when using AI-enabled tools.
• Payment policies should support appropriate, evidence-based adoption of AI while avoiding incentives that encourage overuse, underuse, care denial or the replacement of clinician judgment.
• Public trust in AI-enabled tools requires transparency, accountability, equity and demonstrated benefit.
• AI-enabled tools require continuous monitoring, revalidation and post-deployment feedback loops.
• Procurement of AI-enabled tools should be evidence-based and support clinician choice.

Digital health encompasses a broad scope of tools that engage patients for clinical purposes; collect, organize, interpret and use clinical data; and manage outcomes and other measures of care quality. The ACC is an advocate for the responsible development of innovative digital health solutions and tools that improve the patient experience and support clinicians.

The following principles guide the College's support of digital health initiatives:

• Enable patient engagement and shared-decision making in care delivery by providing clinicians and patients with improved access to personalized health information.
• Conduct research into appropriate use and integration of digital health into cardiovascular care to ensure patient safety, care quality and positive health outcomes.
• Improve the patient experience, care quality, patient safety, and outcomes without hampering clinical workflow.
• Foster the development, adoption and evolution of practices that optimize data security, privacy, use and sharing, as well as device security and safety.
• Adopt and utilize standardized approaches for seamless data transmission, integration, aggregation and analysis.
• Ensure clinicians and health systems are compensated appropriately for the integration of digital solutions into patient care.
• Require clinicians to provide services as authorized by state licensure boards.

To further commitment to and address responsibility for increasing access and value, the ACC, under the guidance of the Health Affairs Committee, has put forth principles pertaining to site neutral payments within Medicare:

• Changes to Medicare payment should prioritize patient access, quality and value of care.
• Approaches to remove unnecessary and/or unexpected cost to patients and the health care system, including equity across outpatient ambulatory settings, should be discussed.
• Significant changes to address payment disparities between sites of service must be phased in over time to safeguard the stability of the health care system.
• Proposals must consider the financial impact of changes on the stability of the health care system, particularly those providing care to underserved populations.
• Site of service payment policies must be aligned with programmatic and systemic changes to avoid unnecessary complexity and promote the successful transition to a value-based payment system.
• Any payment differences across sites should be related to documented differences in the resources needed to ensure patient access and high-quality care.
• Medicare payments for all sites of care should account for costs related to emergency capacity, compliance with regulatory requirements, geographic differences, quality improvement activities, higher need populations, or other factors relevant to a site of service.

In 2016, 91.4 million people – more than one-quarter of the U.S. population – were enrolled in either Medicaid or the Children's Health Insurance Program. The ACC supports expanded access to and the prevention of loss of health care coverage through public and private programs, especially access to affordable coverage options for the treatment of cardiovascular disease.

The following principles guide the College's efforts regarding Medicaid:

• Support the expansion of health care coverage through public and private programs, including working with stakeholders and ACC chapters to support Medicaid expansion where feasible.
• Promote patient access to high-quality care through appropriate payment for services provided under Medicaid.
• Promote patient-centered coverage that provides appropriate access to clinicians and services, including primary, preventive, rehabilitative and specialty care.
• Discourage the imposition of undue burden on access to coverage, such as lifetime limits and per capita caps.