Welcome to the Board of

Governors MeetingJanuary 31, 2015

Chair’s ReportJanuary 2015

Michael Mansour, MD, FACCBOG Chair

Update from December BOT

Meeting

Governance ActivitiesACC / ACCF

Nominating Committee College Officers:

Rick Chazal, MD, FACC - President-ElectM.N. Walsh, MD, FACC - Vice PresidentRobert Guyton, MD, FACC - Treasurer

College Trustees: Deepak Bhatt, MD, MPH, FACCDipti Itchhaporia, MD, FACCFred Masoudi, MD, MSPH, FACCJagat Narula, MD, MPH, MACC

Debra Ness – Public Member Trustee

Committee Appointments

• Review of Committee Appointments made by Dr. Williams

• Approved by BOT

• Nearly 200 appointments to 48 Councils, Committees, Task Forces

Board of Governors

• Supported efforts to send an additional 50 FITs to Legislative Conference

• Disseminated member benefits and advocacy accomplishments through the chapters

• Launching BOG Mentorship Program• State of the States• BOG Chair-Elect - Matthew Phillips, MD,

FACC• Elections in 23 Chapters

Newly Elected Governors• Christopher Dyke, MD – Alaska • David Mego, MD, FACC - Arkansas• Christian Breburda, MD, FACC – Arizona• Barry Rose, MD, FACC – Canada, Atlantic Province• Andrew Morris, MD, FACC – Canada, Prairie Province • John Messenger, MD, FACC – Colorado • Charles Brown, III, MD, FACC – Georgia• Kevin Kwaku, MD, FACC - Hawaii• Nathan E. Green, MD, FACC - Idaho• Raymond Dusman, Jr, MD, FACC - Indiana• Alison Bailey, MD, FACC - Kentucky• James Parker, MD, FACC - Maine

Newly Elected Governors - continued• Duane Pinto, MD, FACC - Massachusetts

• Randall Stark, MD, FACC - Minnesota• Andrew Kates, MD, FACC - Missouri• Daniel Friedman, MD, FACC – New Mexico• Edward Toggart, MD, FACC – Oregon• Jeffrey Williams, MD, FACC – Pennsylvania, Eastern • Suresh Mulukutla, MD, FACC – Pennsylvania,

Western • Juan Sotomonte, MD, FACC – Puerto Rico• David Donaldson, MD, FACC – Rhode Island• John Erwin, III, MD, FACC – Texas• Nicholas Stamato, MD, FACC – Wyoming

MembershipOperations Actvities

• Distinguished Awards

Ratified by BOT• Membership

Survey Results• Member Value

Campaign• Membership dues

Update

• Ms. Gates

• Ms. Rzeszut

• Ms. Fairbanks

• Ms. Gates

2015 Distinguished Awards• 2015 Bernadine Healy Leadership in Women’s CV Disease – Nanette K.

Wenger, MD, MACC• 2015 Distinguished Associate – Rhonda Cooper-DeHoff, PharmD, FACC• 2015 Distinguished Fellow – Gerard Martin, MD, FACC• 2015 Distinguished Mentor – Douglas L. Mann, MD, FACC• 2015 Distinguished Scientist (Basic Domain) – Cam Patterson, MD, FACC• 2015 Distinguished Scientist (Clinical Domain) – Mark Andrew Hlatky, MD, FACC• 2015 Distinguished Scientist (Translational Domain) – Jagat Narula, MD, DM,

PhD, MACC• 2015 Distinguished Service – Michael Rich, MD, FACC• 2015 Distinguished Teacher – Robert James Siegel, MD, FACC• 2015 Gifted Educator – C.A. Sivaram, MBBS, FACC• 2015 International Service – Mehdi Ali Kumar, MBBS, FACC• 2015 Lifetime Achievement – Antonio Gotto, Jr., MD, Dphil, FACC• 2015 Presidential Citation – Rick A. Nishimura, MD, MACC• 2015 Masters of the ACC (M.A.C.C.) – Greg Dehmer, MD, FACC

P.K. Shah, MD, FACC Clyde Yancy, MD, FACC

2014 Annual Member Satisfaction Study

December 2014

12Methodology

• Conducted online survey with members

• Survey live October 15 to November 12, 2014

• 9,933 email invitations sent to members on October 15 and reminders on October 22, 29, and November 5.

• 1,042 members participated in the survey

• Response rate 10.5%

Key Findings• Reimbursement continues to be a pain point for ACC members followed by

challenges in work-life balance, MOC, and rising costs.

• Members continue to be involved in multiple professional societies – competition for share of time, talent and wallet – although the number of professional memberships is falling.

• The ACC continues to do a good job of delivering important member benefits. Access to JACC and guidelines are the most valuable member benefits. The ACC website also provides value followed by educational resources (MOC, ACC.XX, mobile apps) and professional representation. Most value messages resonate with members. The ACC is working to transform cv care and improve heart health tops the list followed closely by The ACC is here to support cv professionals from residency through retirement and The ACC is your professional home.

• Areas where members desire additional support include: advocacy (MOC and reimbursement support), personalization, and less expensive resources.

• For the majority of members, the FACC designation is very valuable to physicians and to their practice. Almost all fellows (90%) post their designation.

• Satisfaction with the College and value for price peaks in 2014. ACC is second only to ESC on key measures of satisfaction. If members could only choose one association, over half (58%) would choose to be a member of ACC.

13

Biggest Challenges in CV Medicine

1%2%3%

5%5%6%

8%8%9%10%10%11%12%12%

13%16%

18%18%

24%26%

30%40%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Not sureNA/I do not practice medicine

OtherTort reform

Access to quality tools and guidelinesMalpractice/Professional insurance

Patient treatment adherenceHospital integration

Accountable Care OrganizationClinical topics

Changing practice ownership structure - from private to hospitalQuality of care

Funding for academic/research/training programsCommunication/Information overload

Appropriate Use CriteriaGovernment regulation/Autonomy

EMR/Electronic health recordKeeping up-to-date from a clinical standpoint

Costs/ Rising costs/ Bundled paymentsCertification/ Maintenance of Certification (MOC)/Training

Work-life balance, extensive work load/work hoursReimbursement/Payment cuts/Medicare/Medicaid

• Two fifths (40%) of members identify reimbursement as the biggest issue facing CV medicine. Work-life balance (30%), certification/MOC (26%), and costs/rising costs/bundled payments (24%) are also challenges.

Q: What are the three biggest issues you will face in cardiovascular medicine over the next three years?

14

Increased23%

Has not changed65%

Decreased12%

Change in Member Satisfaction

Q: Please indicate the degree to which your satisfaction with the ACC has changed within the past year?

• Almost two thirds (65%) of members report that their satisfaction with the ACC has not changed over the past year.

15

• Advocacy (e.g., ABIM, MOC)• Conferences• ACC website• Educational

materials/programs• The new JACC• Guidelines• Focus on sub-specialty

• Advocacy (e.g., ABIM, MOC)• High dues/costs• Not enough sub-specialty

focus• Not enough international

focus

16

Unmet ACC Needs16

Billing/Coding

More time

*Excludes Nothing/N/A/None/Don’t know

Q: What specifically do you need in your daily work that ACC does not provide?

27% don’t have any unmet

needs or can’t think of any

ACC Chapter/Section Trended Satisfaction 17

Value of ACC Membership

Q: Which of the following best describes the value of ACC membership? Please select all that apply.

• Most value messages resonate with members. The ACC is working to transform cv care and improve heart health tops the list followed closely by The ACC is here to support cv professionals from residency through retirement and The ACC is your professional home.

18

How ACC Might Improve Membership Experience

19

Less inundatio

n

Responsiveness to

inquiry

Q: And lastly, please feel free to offer any comments or suggestions on how ACC might improve your membership experience.

*Excludes N/A or None (8%)

Positive Quotes about ACC

“ACC is a highly prestigious, professional, ethical organization which has an impeccable record and performance. I find myself short of words, to describe this. I feel privileged, happy and proud to be a member and a Fellow of the ACC.”

“ACC Membership was of crucial importance from the very beginning in 1979 as a regular source of up-to-date professional information in the times of " iron curtain". And it has been a reliable source of these information till today.”

“ACC is a very good disciplined organization and helps in providing scientific knowledge and information.”

“As an Internist and interest in cardiology it is a privilege to be part of ACC and be guided by it in all fields of our teaching and practice.”

“Dr. Fuster has improved JACC tremendously.”

“I am pleased and satisfied to have been an FACC for > 30 years; I have learned much from the college, and been delighted to participate on Guideline panels, state ACC chapters, etc.”

“Love the conferences, access on-line and mostly everything about ACC- thank you for being such a great resource!!”

20

Q: And lastly, please feel free to offer any comments or suggestions on how ACC might improve your membership experience.

Member Value Campaign

-Provide members a personalized communications experience based on interest,

specialty, career stage

-Identify leaders/ambassadors to foster two-way communication

-Provide members a personalized communications experience based on interest,

specialty, career stage

-Identify leaders/ambassadors to foster two-way communication

- Ensure wide variety of

options for engaging with ACC—mobile, online, local chapters. Both method and

frequency.

-Ensure leadership is able to easily access tools to

communicate

- Ensure wide variety of

options for engaging with ACC—mobile, online, local chapters. Both method and

frequency.

-Ensure leadership is able to easily access tools to

communicate

- Communications should be two-way and personalized

- Peer-to-peer communication is critical, as is increased

Chapter and Section coordination

- Communications should be two-way and personalized

- Peer-to-peer communication is critical, as is increased

Chapter and Section coordination

Personalization Access Communication Engagement

- Develop marketing strategies based on patterns of

engagement

- Promote engagement to increase perception of and

attitudes toward value

A Strategic Approach to Increasing and Communicating ACC Member

Value

Key Strategic Components• Arming our Leadership

– Ensuring member leaders are engaged and informed: ACC Prezi, Coming soon leadership site. Increasing coordination with Chapters to assist in peer-to-peer communications (especially leader to member)

• Onboarding New Members– Informing new members about benefits and engagement opportunities; ensure

personalized experience from the start

• Engaging Existing Members– Connecting members with opportunities and getting them involved using

personalized, two-way communications that focus on their interests and needs

• Showing our Appreciation– Giving back and rewarding loyalty; integrate value-based ‘what’s in it for YOU’

message into all communications

• Reinforcing our Value– Showing our members how we’re working for them– Providing easy access to information members want and need: ACC.org, mobile

apps

2015 National Dues Revenue Comparison Current vs Previous

YearThrough November 17, 2014

  INCOME COUNTINCOME

VARIANCE TO DATE

COUNT VARIANCE TO DATE

  Previous Year

Current Year

Previous Year

Current Year

Fellow & Master$11,198,63

0$11,865,84

7 16,434

16,928 $667,217

494 Associate Fellow & Affiliate $1,134,988 $1,289,115 1,783

1,921 $154,127

138

International Associate $156,572 $84,096 2,579

766 -$72,476

(1,813)CV Team, Administrators & AACC $298,790 $291,161 2,610

2,578 -$7,629

(32)

             

TOTAL NATIONAL DUES$12,788,9

80$13,530,2

19 23,406 22,193 $741,239

(1,213)

Percentage of budget received for National Dues to date:

Previous Year: 2014 budget - through Dec. 31, 2013: 73% 

Current Year: 2015 budget - through Dec. 31, 2014: 78% 

BFIC

• 10 year review• Maintain fiscal

policy to achieve breakeven budget by 2020 by combining property/operations

• ACCF 2015 Research Awards @ $250,000 Panel for future awards

• Dr. Valentine• Mr. Votaw• Dr. Guyton

ACCF Debt- 2005 to 2020Commercial TL Paid Off

-10.0

10.0

30.0

50.0

70.0

90.0

($ m

illio

ns)

T/E Bonds Commerical T L Commerical TL -Bridge

2nd Bond Issue/ Reduced CTL & 

Bridge

Paid Down Bridge Loan by $7.6M/ Increased LOC

Paid Off Bridge Loan- proceeds from 

HH-Bethesda Sale

Commercial Term Loan Will Be Paid 

Off- 2020

Principal Repayment on 

CTL Begins- $1.8 M/ year

Team-Based Care: Team-Based Care: CV Nursing Scope of CV Nursing Scope of Practice DocumentPractice Document

((ACCFACCF))Dr. Brush

Dr. Handberg

Team-Based CareTeam-Based Care

• Background– ACC’s history with APPs (CCA membership, AACC)– Relevance of TBC (Workforce needs, payment reform)– Document is about APPs, but also about RNs– Process: Think Tank meeting and writing committee

• Informational– Education, training, licensing, credentialing, of APPs– Qualities of good teams.– “Shared goals, clear roles.”– Laws and regulations on scope of practice, payment– Examples of TBC in practice

IssuesIssues

• Leadership– More flexible than AMA position

• Accountability• Regulatory

– Autonomy versus Independence (IOM FON report)– Prescriptive authority, variability

• Payment issues– “incident to,” shared services, no NPI for

pharmacists– Future payment models

• Legal issues

OpportunitiesOpportunities

• Education– COCATS criteria for APP training– Inter-professional education– Improved educational content for APPs

• Advocacy– Start a discussion about regulatory and

payment reform.

• Connection to the ACC Strategic Plan– Transition to the future– Triple Aim (quality, access, cost)

ConclusionsConclusions

• Good TBC is good for patient care.– Access, efficiency, patient satisfaction.

• There are opportunities to make TBC better.– Greater awareness, education, reforms.

• ACC’s member value for APPs.• TBC is key for implementing the

Strategic Plan.

CEO Report

BOG Meeting 2015

Shal Jacobovitz

ACC CEO

2014 Strategic Plan - Highlights

Rollout•Established and maintained a clear set of metrics and initiatives to evaluate and strengthen the College’s activities and services

•Performed monthly and annual reviews to measure progress in achieving ACC’s strategic goals and objectives

•Completed 90% of the initiatives and met or exceeded over 85% of the targets established for 2014

Highlights•Membership Value & Engagement

– Launched Leadership Academy

– Digital Strategy - rolled out acc.org website on January 14, 2015

•Advocacy

– Completed draft publication for white paper on optimal CV team-based care/scope of practice

2014 Strategic Plan - Highlights

• Purposeful Education – Annual Meeting Attendance- Professional attendees: 13,507 in 2014

vs. 12,378 target

– Completed Purposeful Education 5-Year Product/Research Business Plan, including outcomes of the International Strategy Study

• Data, Information & Knowledge– NCDR’s New Research & Analytics Engagements Signed: $19.10M

new contracts signed vs. $7.5M target

• Transformation of Care – Completed a Health System's Strategy Business Plan

– ACC total revenue for institutions (3Q) - $19.7M vs $18.7M target

– ACC % of total revenue for institutions (3Q) - 23.8% vs 22.9% target

Registry participation exceeded Targets

©1997-2014 Balanced Scorecard Institute.

Members /Stakeholders

Stewardship

Internal Processes

OrganizationalCapacity

36Enterprise-level Strategy Map

Improve CV competency

Increase member

engagement and value

Increase adoption of clinical policy

and best practice

Protect brand and reputation

Improve development & delivery of CV

standards

Enhance member

experience and communications

Increase governance effectiveness

Increase staff and member

knowledge and skills

Improve shared services and

tools

Improve organization

al health

Improve education

development & delivery

Membership Value & Engagement: Cardiovascular specialists choose ACC as their professional homePurposeful Education: Build a more competent CV workforce by developing a personalized, competency-based Educational experience; producing a curriculum that addresses clinical, administrative, and leadership skills; and engaging & expanding the community of learners.Transformation of Care: Patients receive the highest quality, patient-centered, cost-effective CV care with improved outcomes.Population Health: Improve heart health.

Strategic

Themes &

Results:

Increase financial

sustainability

Improve heart health

Advocacy Update and Forecast

Rebecca KellyVice President, Advocacy

January 31, 2015

Overview

• Outlook for ACC advocacy priorities in 2015

• Preview of 2015 state legislative session

• Deep dive: AUC, Guidelines and Coverage: Can We Bridge the Gap

Creating a Value-Driven Health Care System

Key 2015 Priorities

•Ongoing implementation of Medicare quality incentive

programs

•Educate ACC members on value-based payment environment

•Facilitate chapter involvement in state/local payment model

activity

•Implement ACC-preferred cost and quality measures for CV

care

•Develop specialty payment models

Ensuring Access to Care and CV Practice Stability

Key 2015 Priorities

•Permanent SGR repeal

•Site of service payment differential

•GME funding and CV workforce support

•Protection of IOASE at state and federal level

•Appropriate payer policies for use of CV services

•Medical liability reform

•Narrow networks

Promoting Use of Clinical Data to Improve Care

Key 2015 Priorities

•Implementation of AUC mandate

•Federal legislative initiatives to support use of

registries

•Ongoing implementation of QCDR program

•EHR Incentive Program Stage 3; EHR standards and

certification

•Access to claims data

Fostering Research and Innovation in CV Care

Key 2015 Priorities

•Drug safety

•Drug and device approval

•21st Century Cures Initiative

•Informed consent

•Post-market surveillance

Improving Population Health

and Preventing CVDKey 2015 Priorities

•Appropriations for public health and prevention activities

•Initiatives to reduce and regulate tobacco use and

products

•Chronic disease management and prevention

•Support for CHD; Implementation of pulse ox screening

for CCHD

•State initiatives for prevention of sudden cardiac death

Prospects for SGR Repeal

• Current SGR patch expires March 31.• Consensus on policy for permanent

SGR repeal and physician payment reform remains solid.

• No apparent progress on necessary payment offsets.

Site Neutral Payment

• Targets payment differences between Medicare’s fee schedules for different sites of care.

• Cardiac imaging services prominent example of opportunity for savings. MedPAC recommended lowering hospital outpatient payments to physician fee schedule levels.

• Growing Congressional interest.

Medicare Payment Incentive Programs

• Penalty phase is underway in 2015 for 2013 reporting period– 1.5% cut for PQRS non-participants– 1.0% cut for EHR Incentive program

non-participants– Additional 1% cut for groups >100 that

did not participate in PQRS (VB modifier)

• Penalties and reporting requirements get more severe.

Payer and Value Solutions Issues

• Policy expertise for chapters engaging in alternative payment models.

• Alignment of quality measures across federal and commercial payers.

• Keep ACC-preferred measures in the marketplace.

• Problem solving and conflict resolution with health plans.

• Value-based payment resources for members.

Member Engagement

Advocacy Ambassadors

• The member face of ACC Advocacy.• Peer-to-peer communication to

educate members about advocacy.• Reinforce the member-driven nature

of ACC’s advocacy program.• Eight ambassadors available to

speak at chapter meetings, other chapter activities.

Preview and Priorities for 2015 State Legislative

SessionsFrank Ryan

Director, State Government Relations

“Member Engagement in State Capitols”

ACC STATE GOVERNMENT RELATIONS

2015 STATE LEGISLATIVE SESSIONS

New threats, new opportunities, new politics, new strategies

NEW POLITICS

Republicans posted historic gains on election day. In state capitols, they have the numbers to advance major changes. --Historic to the Modern Era: Of 98 chambers, they control 67 --Historic to the Modern Era: They now have supermajorities in 16 legislative chambers --They hold the governor’s mansion in 28 states --In 24 states, they hold governor’s mansion and both chambers --Democrats control the house, senate and governorship in only six states. --Republicans hold 31 Lieutenant Governors seats

The Tea Party: Coalition partners or dream killers? --Help win elections but have been known to derail legislation: Some have supported repealing all medical licensure laws so that anyone may treat anyone at any time for whatever reason they choose. They have opposed funding for regional STEMI and trauma systems and newborn screening for CCHD…but…--A Force in Elections: Flush with cash and continue to build armies of enthusiastic volunteers

ACC/ACC Chapters Issues 2015Perennial Battles: Tort Reform -- new allies: doctors insurance plansPublic Health - ACC and Chapters continue to work on newborn screening for CCHD - 9 more states to go; CPR/AED as a high school grad reqt;

New Battle: Protecting heart health of scholastic athletes via on-site rescue resources, volunteer training, enhanced collection of medical history; uniform pre-participation forms  

State Regulatory Agencies: Over 400 agencies in 50 state governments have some level of authority over cv services, practice. Close eye on PCI oversight, AUC manipulation, certificate of need, data analysis.

Medicaid Expansion - Deference to ACC Chapters--Thus far, four chapters have actively petitioned their state to accept federal funding for Medicaid expansion. --Each state has unique access challenges; ACC believes it should support chapters’ efforts to increase access be it through Medicaid expansion or other policy initiatives 

New, Trending State Issues --Telemedicine: sharp increase in bills as states grapple with costs; 46 states

have some form of Medicaid coverage (14 cover remote patient monitoring); 22 states have laws mandating private health plan coverage

--In 2014, AMA announced support for coverage, reimbursement . State Medical and specialties are monitoring closely as are we

--HIT Meaningful Use (MA is first states)--E-Cigarettes--Energy Drinks: more research required before youth has open access; data

from ER reveal substance abuse issues

Team Based Care: No Longer “Scope”Threat: naturopaths, alternative med, supplement lobby. --17 states regulate. Scope varies. Prescriptive authority for some. Board

ofmedicineoversight works. --Productive relationships where naturopaths focus exclusively onwellness under authority of physician or nurse; however many naturopath orgs advocate for imaging, other diagnostic authorityOpportunity re Team-Based Care bills: educate others on Chapters’ vision ofphysician-led, cv team-based care. Other specialties are willing to open dialogue

so that they can preserve their visions for team-based care

Consultants and contract lobbyists to address legislation, raise cardiology’s profile in state capitol and position cv specialists to with key lawmakers by positioning members

Customized staff service: Each member of the State Team has been assigned chapters to provide extra support for needs specific to their states

Expanded roster of partners to support key legislative initiatives

Later this week…

Member Engagement in State CapitolsPilot Program

New Resources, Strategies and Tactics to raise Cardiology’s Standing in State Capitols

AUC, Guidelines and Coverage

Can We Bridge the Gap?

The context

• Medicare LCDs and NCDs.• Medicare AUC mandate for advanced

imaging (CT, MR, Nuclear) begins in 2017.

• Uptick in RBM activity.• State Medicaid waivers. • High deductible insurance plans.

Chapter Case Studies: AUC in the Real World

• New York: Smadar Kort, MD, FACC• Oregon: Ed Toggart, MD, FACC • Delaware: George Moutsatsos, MD

FACC

Board of Governors andSection Steering

Committee Joint SessionJanuary 31, 2015

Park HyattWashington, DC

• Section - Members who actively align themselves around an area of clinical or professional interest. Typically pay $35/year to join a member community.

• Sections are governed by a corresponding Section Leadership Council. A section leadership council is a leadership group comprised of members appointed by the president.

Section/Council Definitions

• Academic Cardiology

• Adult Congenital and Pediatric Cardiology

• Cardiovascular Care Team

• Cardiovascular Imaging

• Cardiovascular Management

• Early Career Professionals

• Electrophysiology

• Federal Cardiology

• Fellows in Training

Current ACC Sections• Geriatric Cardiology• Heart Failure and

Transplant • Interventional• Peripheral Vascular Disease • Prevention • Sports and Exercise

Cardiology • Surgeons’ Scientific • Women in Cardiology

Chapters are:• Representative of the US and Puerto

Rico• Separate

Legal entitiesBudgetStaff

• ShareMembersACC mission, goals, support of Strategic PlanLogo/branding

• Vary by size

Separate Organizations,

Shared Mission

Puerto Rico Chapter Meeting San Juan, PR

ACC.08, Chicago

Opportunities for Collaboration

• Consider including Section representative members on Chapter Councils

• Connect Section Chairs with engaged/interested Chapter members

TVU: Time Value Based Units

ACC Board of Governors MeetingJanuary 2015

Robert Shor, MD, FACCMatthew Phillips, MD, FACC

• Private Non-Integrated Single Specialty Practice

• Shared equity, non-productivity based compensation

10docs in 1996

38 docs today!

(plus 10-15 CCAs)

TVUs are used to ensure parity of work in this

shared compensation model

Work is Work

All Work is Assigned to TVUs

• Revenue generating

• Approved non-revenue generating– Wind shield time– Meetings– Marketing– Etc.

Inequalities Exist in Type of Work

• More RVUs in the office, less down time

• Hospital work is inherently less efficient

• Outreach clinics need special dispensation– Lower TVU generating for the good of the

practice

Inaccuracies in the TVU System

• We do not use it to strictly dictate compensation

• We use an 85% level of the average FEP (full economic partner) as the minimum

How Does It Work?

• Mark down everything everyone does for the practice

• Decide what non-revenue generating work you are going to track

How Does It Work?

• Decide how you are going to measure the associated time

Travel time was an issue for us.

Initially, some wrote down as much time as they could including time in the hospital before working.

We used Map Quest time – standardizes, but probably underestimates.

How Does It Work?

• Everyone was assigned time they thought it took to perform a given task

• The time was averaged and analyzed

• The list was sent to everyone for another round of adjustments

every six monthsWe monitor TVUs

• Anyone who falls below our threshold has an opportunity to bring them up

• We look at the reasons; work opportunity (remote clinic) vs. work style

We review every few years for new procedures or updates

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedcrephysFeeSchedfctsht.pdf

One example:EVU (education value units)

Paid by:• by time slot and type of work• min work in clinic to get credit

AcademiaUncommon

Time Value Unit (TVU)Compensation ProgramIntegrated Governance

at Austin Heart

Practice Profile• 58 cardiologists

–28 in Austin, 19 outside of Austin–30 non-interventional, 11 interventional,

4 EP• 24 MLPs, 300+ non-provider employees• 13 full time offices, 19 outreach clinics• 18 Counties covering 16,561 square

miles (the size of Maryland)• Purchased by HCA in January 2010

Reality Check• There is only one “best” compensation

program – it is solo practice– Fairness will always be in the eye of the

beholders • All compensation programs can be gamed

and have flaws• There must be a balance between fairness

and complexity

Reality Check

• Incentives drive behavior• In the absence of other incentives the

compensation model can and usually does drive group direction

• The change in compensation (RVU) can alter groups direction negatively

Compensation Program History

• TVU model has been in place since 1999• Program phased in over two years• 100% productivity and incentive based• Compensation manual – 53 pages• Minor modifications over the years

– Time unit value changes– New carrots, new sticks

Program Overview

Three main components

– Day time units• Work done from 7 am to 6 pm• Standard rate of pay

– On call time units• Work done from 6pm to 7 am• Premium rate of pay – about 50% higher than the standard rate of

pay

– Call points• Availability pay when on call

Patient care time units

• Most CPT codes are assigned a time unit value based on time motion studies

• Complex procedures have special codes as CPT correlation did not provide accurate time unit

• Time studies have been done over the years–1,400 interventional cases in 2009 – cath went up, and

PTCA went down–200 EP cases – in general, the time unit values went

down.

Non-patient care time units

• Administrative time• Marketing time• Travel time• Meeting time• Clinical leadership and committee time• Work done after 6pm is paid at the on call time unit

rate• Represent 5% of the time units generated by the

physicians

Call points

• Pay per call point – to be available

• Weekday call – one point per day

• Weekend call – two points per day

• Less significant holidays – 2 points per day

• Significant holiday – 3 points per day

Cost Allocation

• Transcription

• MLPS

• Personal business expenses– CME– Insurance– Dues and Memberships

Secondary components

• Disincentives (sticks/fines)– Late hospital charges, Late dictation,

Unsigned chart notes, Required education programs – starts at $50 and increases to $5,000

– Professional standards violations – up to $5,000

Challenges• Time unit changes

–New services - Vein Center, New procedures–Improving technology - Mapping systems,

Digital echo

• Administrative costs–1.0 additional FTE to manage program

New Programs Aided by Vision, Compact and TVU System

• Incentivized Research- Partner; Simplicity;OCT for CTO;Stem Cell for MI; SQ Antibody for Lipids

• TAVR• Vein Center• Sleep Centers• Cryoballoon; Lariat• Physicians Subspecialize - gave up Cath• Over 500 physician to physician marketing Visirs

Quality Programs at Austin Heart

General CardiologyA.Chart Audits of All CardiologistB.Medical Director in place

ImagingAll Imaging programs are accredited with functional over read procedures All imaging modalities have a section head

Procedural SubspecialtyEP and Interventional Groups have defined ongoing peer review (i.e. appropriateness review of pts getting cath/stentsSection Heads in place

Quality Programs at Austin Heart

QA NurseFull time job to monitor the programs and provide admin support

Peer Review CommitteeA.Headed by Medical DirectorB.Several physicians on CommitteeC.QA NurseD.A formal legal description is the Austin Heart Bylaws. Allows access to the database and the hospital

Credentials CommitteeAustin Heart internal credentialing- overrides the hospital and is more strict ( i.e. board certification in Intervention and EP required)

Quality Programs at Austin Heart

Yearly Physician ReviewPhysicians are scored based on their performance per the compact

Yearly Organization ReviewThe Organization is scored based on the performance per the compact

Professional Standards PolicyFormal Written guidelines for compact violations that can include fines and or terminationViolations are investigated and reviewed by physician administrative directors and then brought to the board for approval

Questions?

Jan. 31, 2015BOG Meeting

Michael Mansour, MD, FACCBoard of Governors Chair

State of States

State of the States Highlights –

To Align with ACC’s Strategic Plan Focus Areas Member Value and Engagement +

Advocacy

Data, Information and Knowledge + Transformation of Care

Purposeful Education

Population Health

State of the States:Member Value and Engagement +

Advocacy

• All domestic chapters are engaging in activities to support FITs

• Kentucky created an early career professionals committee

• Missouri awarded early career cardiology grants

• Puerto Rico and Missouri created chapter histories

• Collaborations with Member Sections

• Collaboration with state medical societies

State of the States:Data, Information and Knowledge +

Transformation of Care• North Carolina:

– With the NC Medical Society and task force Toward Accountable Care Consortium – co-sponsored, approved and made available a manual for setting up an ACO

• Puerto Rico:– Held a transformation of care workshop for hospital administrators, which

laid the ground for PR’s NCDR launch (early 2015)

• Virginia: – Virginia Cardiac Services Quality Initiative invited the VA Chapter to

become a partner in changing its focus from one measuring surgical outcomes to one that measures overall quality. CathPCI data will be merged with STS data.

• Wisconsin and Florida:received $15.8M CMMI grant for SMARTCare

• Mississippi: NCDR with STEMI network and MSDH

State of the States:Purposeful Education

• Kansas and Colorado held first educational meetings

• Rhode Island:

– Held “Fellows Night Out” – gathering for FITs to present interesting cases to FACCs

• Washington:

– Held two well attended events for CV Team members, and an FIT and ECP meeting

• Alabama:

– Offered ABIM MOC Part 2 credit at winter meeting

• Connecticut:

– Expanded Chapter meeting to include programming for FITs and AACCs

• Illinois:

– Offered a dual track at meeting – general cardiology and CHD• Regional meetings growing in popularity

– MT/WY/ID and ND/SD/IA/MN

State of the States:Population Health

• A number of chapters supported legislation requiring high school coaches and trainers to be instructed in risks and early signs of Sudden Cardiac Death in early athletes

• Kansas:– Working on the planning and implementation of the “One Million Pounds and Ten

Million Miles” initiative, a collaboration to help Kansas lose 1 million lbs and walk 10M miles in one year

• Michigan:– Surveyed members regarding whether MI’s Certificate of Need policy should be

changed to allow elective PCI at hospitals w/o surgery on-site • New Jersey:

– developing Student Athlete Cardiac Assessment Professional Development Module in collaboration with Commissioner of Health, an online course for physicians, PAs and NPs who provide physicals to student athletes