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Welcome to the Board of Governors Meeting

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Title: Welcome to the Board of Governors Meeting


1
Welcome to the Board of Governors Meeting
  • January 31, 2015

2
Chairs ReportJanuary 2015
  • Michael Mansour, MD, FACC
  • BOG Chair

3
Update from December BOT Meeting
4
Governance ActivitiesACC / ACCF
  • Nominating Committee
  • College Officers
  • Rick Chazal, MD, FACC - President-Elect
  • M.N. Walsh, MD, FACC - Vice President
  • Robert Guyton, MD, FACC - Treasurer
  • College Trustees
  • Deepak Bhatt, MD, MPH, FACC
  • Dipti Itchhaporia, MD, FACC
  • Fred Masoudi, MD, MSPH, FACC
  • Jagat Narula, MD, MPH, MACC
  • Debra Ness Public Member Trustee

5
Committee Appointments
  • Review of Committee Appointments made by Dr.
    Williams
  • Approved by BOT
  • Nearly 200 appointments to 48 Councils,
    Committees, Task Forces

6
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

7
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

8
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

9
MembershipOperations Actvities
  • Distinguished Awards
  • Ratified by BOT
  • Membership Survey Results
  • Member Value Campaign
  • Membership dues Update
  • Ms. Gates
  • Ms. Rzeszut
  • Ms. Fairbanks
  • Ms. Gates

10
2015 Distinguished Awards
  • 2015 Bernadine Healy Leadership in Womens 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

11
2014 Annual Member Satisfaction Study
  • December 2014

12
Methodology
  • 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

13
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.

14
Biggest Challenges in CV Medicine
  • 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?
15
Change in Member Satisfaction
  • Almost two thirds (65) of members report that
    their satisfaction with the ACC has not changed
    over the past year.
  • 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

Q Please indicate the degree to which your
satisfaction with the ACC has changed within the
past year?
16
Unmet ACC Needs
16
Billing/ Coding
27 dont have any unmet needs or cant think of
any
More time
Excludes Nothing/N/A/None/Dont know
Q What specifically do you need in your daily
work that ACC does not provide?
17
ACC Chapter/Section Trended Satisfaction
18
Value of ACC Membership
18
  • 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.

Q Which of the following best describes the
value of ACC membership? Please select all that
apply.
19
How ACC Might Improve Membership Experience
19
Less inundation
Responsiveness to inquiry
Excludes N/A or None (8)
Q And lastly, please feel free to offer any
comments or suggestions on how ACC might improve
your membership experience.
20
Positive Quotes about ACC
20
  • 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 gt 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!!

Q And lastly, please feel free to offer any
comments or suggestions on how ACC might improve
your membership experience.
21
Member Value Campaign
22
A Strategic Approach to Increasing and
Communicating ACC Member Value
Personalization
Access
  • 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 ACCmobile, 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

Communication
Engagement
- Develop marketing strategies based on patterns
of engagement - Promote engagement to increase
perception of and attitudes toward value
23
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 whats in it for YOU message into
    all communications
  • Reinforcing our Value
  • Showing our members how were working for them
  • Providing easy access to information members want
    and need ACC.org, mobile apps

24
2015 National Dues Revenue Comparison Current vs
Previous YearThrough November 17, 2014
  INCOME INCOME COUNT COUNT INCOME VARIANCE TO DATE COUNT VARIANCE TO DATE
  Previous Year Current Year Previous Year Current Year INCOME VARIANCE TO DATE COUNT VARIANCE TO DATE
Fellow Master 11,198,630 11,865,847 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 12,788,980 13,530,219 23,406 22,193 741,239 (1,213)

Percentage of budget received for National Dues to date Percentage of budget received for National Dues to date Percentage of budget received for National Dues to date
Previous Year 2014 budget - through Dec. 31, 2013 73   Previous Year 2014 budget - through Dec. 31, 2013 73   Previous Year 2014 budget - through Dec. 31, 2013 73  
Current Year 2015 budget - through Dec. 31, 2014 78   Current Year 2015 budget - through Dec. 31, 2014 78   Current Year 2015 budget - through Dec. 31, 2014 78  
25
BFIC
  • 10 year review
  • Maintain fiscal policy to achieve breakeven
    budget by 2020 by combining property/operations
  • ACCF 2015 Research Awards _at_ 250,000 Panel for
    future awards
  • Dr. Valentine
  • Mr. Votaw
  • Dr. Guyton

26
ACCF Debt- 2005 to 2020Commercial TL Paid Off
Paid Off Bridge Loan- proceeds from HH-Bethesda
Sale
Principal Repayment on CTL Begins- 1.8 M/ year
Commercial Term Loan Will Be Paid Off- 2020
2nd Bond Issue/ Reduced CTL Bridge
Paid Down Bridge Loan by 7.6M/ Increased LOC
27
Team-Based Care CV Nursing Scope of Practice
Document(ACCF)
  • Dr. Brush
  • Dr. Handberg

28
Team-Based Care
  • Background
  • ACCs 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

29
Issues
  • 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

30
Opportunities
  • 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)

31
Conclusions
  • Good TBC is good for patient care.
  • Access, efficiency, patient satisfaction.
  • There are opportunities to make TBC better.
  • Greater awareness, education, reforms.
  • ACCs member value for APPs.
  • TBC is key for implementing the Strategic Plan.

32
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33
CEO Report
  • BOG Meeting 2015
  • Shal Jacobovitz
  • ACC CEO

34
2014 Strategic Plan - Highlights
  • Rollout
  • Established and maintained a clear set of metrics
    and initiatives to evaluate and strengthen the
    Colleges activities and services
  • Performed monthly and annual reviews to measure
    progress in achieving ACCs 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

35
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
  • NCDRs 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
36
  • Enterprise-level Strategy Map

Strategic Themes Results
Membership Value Engagement Cardiovascular
specialists choose ACC as their professional
home Purposeful 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.
Improve heart health
Members / Stakeholders
Stewardship
Internal Processes
Organizational Capacity
Increase member engagement and value
Increase adoption of clinical policy and best
practice
Improve CV competency
Protect brand and reputation
Increase financial sustainability
Enhance member experience and communications
Improve development delivery of CV standards
Improve education development delivery
Improve organizational health
37
(No Transcript)
38
Advocacy Update and Forecast
  • Rebecca Kelly
  • Vice President, Advocacy
  • January 31, 2015

39
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

40
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

41
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

42
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

43
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

44
Improving Population Healthand Preventing CVD
  • Key 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

45
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.

46
Site Neutral Payment
  • Targets payment differences between Medicares
    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.

47
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 gt100 that did not
    participate in PQRS (VB modifier)
  • Penalties and reporting requirements get more
    severe.

48
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.

49
Member Engagement
50
Advocacy Ambassadors
  • The member face of ACC Advocacy.
  • Peer-to-peer communication to educate members
    about advocacy.
  • Reinforce the member-driven nature of ACCs
    advocacy program.
  • Eight ambassadors available to speak at chapter
    meetings, other chapter activities.

51
Preview and Priorities for 2015 State Legislative
Sessions
  • Frank Ryan
  • Director, State Government Relations

52
Member Engagement in State Capitols ACC
STATE GOVERNMENT RELATIONS 2015 STATE LEGISLATIVE
SESSIONS New threats, new opportunities, new
politics, new strategies
53
NEW POLITICSRepublicans 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 governors mansion in 28 states
--In 24 states, they hold governors mansion and
both chambers --Democrats control the house,
senate and governorship in only six states.
--Republicans hold 31 Lieutenant Governors
seatsThe 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 CCHDbut--A Force in Elections
Flush with cash and continue to build armies of
enthusiastic volunteers
54
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 
55
  • 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 ofmedicine
  • oversight works.
  • --Productive relationships where naturopaths
    focus exclusively on
  • wellness under authority of physician or nurse
    however many naturopath orgs
  • advocate for imaging, other diagnostic authority
  • Opportunity re Team-Based Care bills educate
    others on Chapters vision of
  • physician-led, cv team-based care. Other
    specialties are willing to open dialogue so
  • that they can preserve their visions for
    team-based care

56
Consultants and contract lobbyists to address
legislation, raise cardiologys 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 statesExpanded
roster of partners to support key legislative
initiatives
  • Later this week
  • Member Engagement in State CapitolsPilot Program
  • New Resources, Strategies and Tactics to raise
    Cardiologys Standing in State Capitols

57
AUC, Guidelines and Coverage
  • Can We Bridge the Gap?

58
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.

59
Chapter Case Studies AUC in the Real World
  • New York Smadar Kort, MD, FACC
  • Oregon Ed Toggart, MD, FACC
  • Delaware George Moutsatsos, MD FACC

60
(No Transcript)
61
Board of Governors andSection Steering Committee
Joint Session
  • January 31, 2015
  • Park Hyatt
  • Washington, DC

62
Section/Council Definitions
  • 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.

63
Current ACC Sections
  • Academic Cardiology
  • Adult Congenital and Pediatric Cardiology
  • Cardiovascular Care Team
  • Cardiovascular Imaging
  • Cardiovascular Management
  • Early Career Professionals
  • Electrophysiology
  • Federal Cardiology
  • Fellows in Training
  • Geriatric Cardiology
  • Heart Failure and Transplant
  • Interventional
  • Peripheral Vascular Disease
  • Prevention
  • Sports and Exercise Cardiology
  • Surgeons Scientific
  • Women in Cardiology

64
Chapters are
  • Representative of the US and Puerto Rico
  • Separate
  • Legal entities
  • Budget
  • Staff
  • Share
  • Members
  • ACC mission, goals, support of Strategic Plan
  • Logo/branding
  • Vary by size

65
Separate Organizations, Shared
Mission
ACC.08, Chicago
Puerto Rico Chapter Meeting San Juan, PR
66
Opportunities for Collaboration
  • Consider including Section representative
    members on Chapter Councils
  • Connect Section Chairs with engaged/interested
    Chapter members

67
(No Transcript)
68
TVU Time Value Based Units
  • ACC Board of Governors Meeting
  • January 2015
  • Robert Shor, MD, FACC
  • Matthew Phillips, MD, FACC

69
  • Private Non-Integrated Single Specialty Practice
  • Shared equity, non-productivity based compensation

10
38
(plus 10-15 CCAs)
docs today!
docs in 1996
70
TVUs are used to ensure parity of work in this
shared compensation model
Work is Work
71
All Work is Assigned to TVUs
  • Revenue generating
  • Approved non-revenue generating
  • Wind shield time
  • Meetings
  • Marketing
  • Etc.

72
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

73
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

74
How Does It Work?
  • Mark down everything everyone does for the
    practice
  • Decide what non-revenue generating work you are
    going to track

75
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.
76
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

77
every six months
We 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

78
We review every few years for new procedures or
updates
79
http//www.cms.gov/Outreach-and-Education/Medicare
-Learning-Network-MLN/MLNProducts/downloads/Medcre
physFeeSchedfctsht.pdf
80
(No Transcript)
81
Academia Uncommon
  • One example
  • EVU (education value units)
  • Paid by
  • by time slot and type of work
  • min work in clinic to get credit

82
  • Time Value Unit (TVU)
  • Compensation Program
  • Integrated Governance
  • at Austin Heart

83
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

84
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

85
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

86
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

87
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

88
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.

89
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

90
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

91
Cost Allocation
  • Transcription
  • MLPS
  • Personal business expenses
  • CME
  • Insurance
  • Dues and Memberships

92
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

93
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

94
New Programs Aided by Vision, Compact and TVU
System
  • Incentivized Research- Partner SimplicityOCT
    for CTOStem 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

95
Quality Programs at Austin Heart
  • General Cardiology
  • Chart Audits of All Cardiologist
  • Medical Director in place
  • Imaging
  • All Imaging programs are accredited with
    functional over read procedures
  • All imaging modalities have a section head
  • Procedural Subspecialty
  • EP and Interventional Groups have defined ongoing
    peer review (i.e. appropriateness review of pts
    getting cath/stents
  • Section Heads in place

96
Quality Programs at Austin Heart
  • QA Nurse
  • Full time job to monitor the programs and provide
    admin support
  • Peer Review Committee
  • Headed by Medical Director
  • Several physicians on Committee
  • QA Nurse
  • A formal legal description is the Austin Heart
    Bylaws. Allows access to the database and the
    hospital
  • Credentials Committee
  • Austin Heart internal credentialing- overrides
    the hospital and is more strict ( i.e. board
    certification in Intervention and EP required)

97
Quality Programs at Austin Heart
  • Yearly Physician Review
  • Physicians are scored based on their performance
    per the compact
  • Yearly Organization Review
  • The Organization is scored based on the
    performance per the compact
  • Professional Standards Policy
  • Formal Written guidelines for compact violations
    that can include fines and or termination
  • Violations are investigated and reviewed by
    physician administrative directors and then
    brought to the board for approval

98
Questions?
99
State of States
  • Jan. 31, 2015
  • BOG Meeting
  • Michael Mansour, MD, FACC
  • Board of Governors Chair

100
State of the States Highlights To Align with
ACCs Strategic Plan Focus Areas
  • Member Value and Engagement Advocacy
  • Data, Information and Knowledge
    Transformation of Care
  • Purposeful Education
  • Population Health

101
State of the StatesMember 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

102
State of the StatesData, 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 PRs 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 Floridareceived 15.8M CMMI grant
    for SMARTCare
  • Mississippi NCDR with STEMI network and MSDH

103
State of the StatesPurposeful 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

104
State of the StatesPopulation 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 MIs
    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

105
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