News from the Ohio Chapter of the American College of Cardiology
Ohio-ACC Newsletter, April 2018
President's Message
Sanjay Gandhi, MD, MBA, FACC
Sanjay Gandhi, MD
Dear Ohio-ACC Colleague,

As I write my first newsletter to you, I want to begin by thanking my predecessor Laxmi Mehta, MD, FACC for her outstanding leadership of the Ohio-ACC over the last three years . Special thanks to Sandra Smith, RN, MSN, CNP, AACC  who served as the Ohio-ACC cardiovascular team liaison and Kelly J. Scheiderer, RHIA, MHA  who was our cardiovascular administrator committee chair the past three years. Please join me in welcoming Jennifer Dicken, BSN, RN-BC, AACC  who will take over the CV team liaison role and Heather Sedlacek, ACSM-CES, M.S. as the chair of the cardiovascular administrator committee. I look forward to working with the Ohio-ACC board but most importantly with all of you as members. Your engagement is crucial to the success of Ohio-ACC, and I certainly welcome your comments and feedback.  

Your Input for QI Project
I would like to share some information about a QI project that the Ohio-ACC is undertaking. Please make sure to share this with all of your electrophysiology colleagues, including EPs, EP & Cath Lab leadership, and CV service line administrators.
 
The Good News
The Indiana, Michigan, and Ohio Chapters of the American College of Cardiology were awarded an ACC grant to support an innovative collaborative quality improvement initiative that utilizes de-identified data from the ICD registry to improve outcomes for patients undergoing ICD implantations. The project will catalyze development and sharing of best practices to improve care.

CMS Issues a Change
However, as you probably know, CMS (with considerable input from the Heart Rhythm Society (HRS) and the ACC) issued an updated ICD National Coverage Determination (NCD) on February 13, 2018. The details can be found on the CMS website: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=288. Included in the CMS NCD memo was the news that institutional participation in an ICD registry is no longer mandated.  We believe it is in the absolute best interest of our patients and our institutions for facilities to continue collecting and reporting data to the ICD Registry.
 
Your Reply Requested by April 30
Please deliberate carefully on the rationale presented below, and let us know how your hospital plans to proceed with ICD registry participation via our survey: https://goo.gl/forms/zxAqjViUN4OzwuTy2 .

Rationale for Continued Participation in the ICD Registry. 
  1. The data that is sent to the registry is reported back to our hospitals systematically and is always benchmarked to our region and the nation. It allows each hospital and each EP section to analyze and discuss the data from which QI can be tailored in a facility-specific fashion.
  2. It is, after all, the data from the registry that allows identification of potential areas for improvement state-wide and any assessment of improvement over time is best made by using the same registry-based methodology.
  3. Many of us have vivid recall of the events of circa 2012 when many institutions across the country faced significant financial penalties based on ICD implants which upon review were deemed to have had insufficiently supported indications. The hard-wiring of decision support followed by systematic analysis of registry data has appeared to be the absolute best way to mitigate that risk and assure our patients are being well-served by evidence-based decision-making.
  4. When, as a profession, we embrace QI through the collection and analysis of clinically-derived performance data, we advance our mission. Examples, including the Door-to-Balloon Initiative, the Blue-Cross Blue-Shield Consortium based state-wide efforts in interventional cardiology, cardiac surgery and peripheral vascular intervention, amongst others all were made possible by these methods. It is this moment in time when the state’s Electrophysiology Community can make a similar difference. Participation in the ICD Registry is, in our opinion, a critical part of the process.

Contact Us
If Gwen Goldfarb, our chapter executive, or I can be of assistance to you, please let us know.

Sincerely,

Sanjay

Congratulations to Our New FACCs & AACC
We would like to congratulate our members who recently attained their FACC & AACC designations:
Saad Ahmad, MBBS, FACC
Haitham Ahmed, MD, MPH, FACC
Sinan Alo, DO, FACC
Chadi Ayoub, MBBS, FACC
Brian Boe, MD, FACC
Saneka Chakravarty, MBBS, FACC
Jason Evanchan, DO, FACC
Chete Eze-Nliam, MD, FACC
Farshad Forouzandeh, MD, PhD, FACC
Jonathan Hassel, MD, FACC
Suzanne S. Inglis, RN, MSN, AACC
Saima Karim, DO, FACC
Prasanth Lingam, MD, FACC
Jim Liu, MD, FACC
Chris Manhart, DO, FACC
Hossam Mustafa, MD, FACC
Sandeep Patel, MD, FACC
Virenkumar Patel, MD, FACC
Kyle Pfahl, MD, FACC
Kevin Stiver, MD, FACC
Matthew Tong, DO, FACC
Akira Wada, MD, FACC
Seeking Your Involvement
Call for Board Nominations 
As our Board of Trustees election approaches, we would like to ask for your involvement. 

The board is seeking nominations in the following districts:
  1. Columbus: Practicing community physician nominee
  2. Cleveland: CWRU/MetroHealth physician nominee
  3. Toledo: University of Toledo physician nominee
  4. Cincinnati: University of Cincinnati physician nominee
  5. Cardiovascular Surgeon: at-large physician nominee

A nominee must be a Fellow, Associate Fellow, Affiliate, Distinguished Fellow or Honorary Fellow of the American College of Cardiology in Ohio. The responsibilities of a trustee include attending all meetings of the Board (on average, there are two per year), attending meetings of the membership, and helping to carry on the business and affairs of the Chapter. Feel free to visit www.ohioacc.org. Primarily we are seeking individuals whose counsel and service would be of great benefit as we work to build a strong voice for cardiology in Ohio. 

If you are interested in being considered, please complete this form by May 31. If you would like to recommend a colleague, please email ohioacc@gmail.com.

Fellows in Training: Apply to Serve on the Ohio-ACC FIT Council
Represent your training institution as a member of the Ohio-ACC Fellow in Training Council. Share your ideas, network with colleagues, and get involved with the Ohio-ACC. Applications are now being accepted. The deadline is April 30.

Steps:
2. Have your program director or an Ohio-ACC Board Member send a letter of support to ohioacc@gmail.com by April 30.
Ohio-ACC Spring Summit Held on March 28th
2018 Wiggers Lecture
The Ohio-ACC held a very successful Spring Summit on March 28, 2018, at the Ritz-Carlton, Cleveland.The afternoon portion covered topics on What’s Hot in EP, Care of the Athletic Heart, Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective, and Incorporating New Devices and Medicines in Heart Failure. Dr. Rick Nishimura delivered the 2018 Wiggers Lecture and presented Diastology for the Clinician, which was an outstanding talk.


Mark your calendar for next year's Spring Summit on April 17, 2019.
Survey Seeks Input on
Future of Board Certification
The Commission on Continuing Board Certification: Vision for the Future is seeking stakeholder feedback on the current state of board certification. The Commission, which is comprised of physicians, professional medical organizations, national specialty and state medical societies, hospitals and health systems, the general public and patients, and the 24 Member Boards of the American Board of Medical Specialties (ABMS), is working to assess the current state of continuing board certification and envision a framework for the future. ACC members are encouraged to take part in the Commission’s short survey between now and May 11. This is an important opportunity to help shape the future of board certification and provide input on the current challenges, benefits and opportunities for improvement. In addition, the Commission is encouraging that the survey to be shared with colleagues, family and friends, noting “the opinion of patients and the general public is valued along with those in the health care community.” Take the survey by May 11.
 
Prior Authorization: You Can Make a Difference
Andy Miller, MD, FACC, Chair of the ACC Board of Governors
The Mission of the College is to transform cardiovascular care and improve heart health and one of our Core Values is to be patient-centered. Both of these integral parts of our professional home demand that we fight the outwardly imposed dictum of prior authorization through advocacy for our patients and profession.

Prior authorization is a payer-initiated directive that, for more than a decade, has been imposed with the goal of reducing health care expense s through the use of a "peer review" stick.

Prior authorization:

  • Imposes barriers to access for patients
  • Creates administrative burden, mostly without clinical efficacy, and
  • Is costly to us (in time and money spent by the health care team), to the patient (in unnecessary rescheduling delays or test substitution), and to the payers (through funding of this mostly unnecessary "peer review" process).

So, what are we asking for? We want:

  • "Selective application of prior authorization" to mean review and authorization for coverage of a test only when not addressed by Appropriate Use Criteria (AUC) or Clinical Practice Guidelines.
  • "Gold-carding" that would allow providers or practices that demonstrate compliance with AUC and clinical guideline recommendations to forego prior authorization.
  • "Transparency in communication" by requiring payers to publish and make available to consumer's rates of allowed and denied procedures.
  • "Continuity of patient care" by avoiding interruptions in care and permitting patients who have been granted access under one payer to transfer that coverage to another without starting the process over again with step therapy.
  • "Online standardized prior authorization tools and criteria" that offer efficiency and transparency.
  • How do we get there? This is where the rubber meets the road and we need to be the active citizens who step up and fight for what is right. We need data and we need advocacy.

The data is the PARTool. Since our official launch in November 2017, we have accumulated over 500 reports in the PARTool. These reports are catalogued by payer and benefit manager, document the burdens to our practices and colleagues, and demonstrate this process as a barrier to patient care. More data is needed though so that we can directly face the payers with actionable numbers on their comparative individual performances and demand change. Please be a best practice in your state and engage on the PARTool. Currently 33 states and Washington, DC have participated. Make sure you are one of those states. Sit down with members of your practice who are touched by prior authorization and decipher a systematic way to enter data into the PARTool. In my practice this involved two members of our business office and two of my Nurse Practitioner colleagues.

Let's put a target on prior authorization and make life better for our patients, colleagues, and health systems. Let's set a goal of getting another 500 reports into the PARTool by July. We will track this and report out by state. As a state that has plenty of room for improvement, I am taking responsibility and will be grading myself based on PARTool reports. I hope you will do the same.