An Update from the American College

of Cardiology

Andy Miller, MD, FACCChair of the Board of Governors

andSecretary, American College of

Cardiology

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

ACC Governance Transformation:Centralized Authority and Decentralized Decision Making

Diversityin Cardiology and the ACC

ABIM Has Listened to Internal Medicine

Stakeholders Like ACC and Made the

Following Changes to the MOC Process:

• Reversal of the double jeopardy provision

• Decoupling of the initial board exam from MOC participation

• Streamlining the ability for practitioners to get both CME

and MOC Part II credit

• Suspending MOC Part IV requirement

• Launch of a 2-Year Knowledge Check-In as alternative to 10-

year Exam starting in 2018

ACC’s Health System

Strategy

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

Diversityin Cardiology and the ACC

In comparison to the U.S. population,

cardiology is far less diverse…

• 5.4% of cardiology trainees were African American and 6.8% were Hispanic, compared to 5.8% and 7.8% respectively in internal medicine in the 2015-2016 (ACGME)

• <10% of medical students and less than 3% of medical school faculty are African American

• ACC 2016 Professional Life Survey suggests that African Americans and Hispanic each represent 3% to 6% of ACC membership

• Approx. 300 African American men and 100 African American women FACCs

• 9.8% of FACCs who are U.S. board certified in adult cardiovascular disease are women

• An improvement in CV medicine from 9.7% in 2007 to 13.2% women in 2015, but this is still far below the 37% of women in general internal medicine (AAMC)

…to promote health equity

…to better serve diverse patients

…to provide diverse mentors at all levels

The case for diversity in medicine…

…to bring different points of view to debates and problem solving

…to better engage our communities

…to include investigatorswith a broad range of perspectives in their scholarly activities

Diversity and inclusion are essential to the ACC’s mission, values, patients, and strategic business goals as a profession and as a professional society.

Moving toward solutionsTo address these issues, the ACC Task Force on Diversity was formed in early 2017 and charged with providing recommendations to the BOT to enable the achievement of the following goals:

To ensure both cardiovascular medicine in general, as well as the ACC itself, attracts and provides rewarding careers for the full range of talented individuals in medicine.

To ensure both cardiovascular medicine in general, as well as ACC itself, benefits from diversity of backgrounds, experiences and perspectives in leadership, cardiovascular healthcare delivery, education and science.

To ensure the diverse needs of cardiovascular patients are met by cardiovascular clinicians sensitive to and respectful of their gender, cultural, racial and ethnic diversity.

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Objective #1: To enhance the culture within the cardiology profession and the perceptions of the field to be inclusive, professional, equitable and welcoming.

Objective #2: To realize and sustain the value of diversity over the long-term by implementing structures and continuous improvement programs within the ACC to ensure accountable execution.

Objective #3: To engage and leverage all available talent by attracting and providing value to under-represented groups in cardiology (URCs) across the ‘career life-span’, from ensuring a deep pipeline, to recruitment, retention and leadership development.

2018 Road Map

1. Build a knowledge-based culture of inclusion in cardiology

2. Develop data-driven, meaningful and feasible diversity goals across the ACC and the profession

3. Build a robust pipeline of medical students and internal medicine residents interested in cardiology

4. Ensure diversity and inclusion in our training programs (Program directors)

5. Education and leadership development

6. Assess and influence the perception, importance and reality of professional issues important to URCs. Embrace the Quadruple Aim

7. Enhance ACC organizational capabilities and commitment

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Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

Transforming Governance for the Future of the ACC

The Need for ChangeThe ACC has experienced significant growth and change over the last decade:

Changes in the health care environment

Changes to member demographics

The new governance structure and process is intended to address these changes and to strengthen the ability of ACC leaders to focus on the College’s mission in a manner that is nimble, strategic, accountable and inclusive of the diverse needs of the global CV community.

ACC Governance Transformation:Centralized Authority and Decentralized Decision Making

2013:

5-Year Strategic Plan Launched

2014:

Governance Transformation

Discussions Began

2015:

Governance Transformation

Plan and Principles Approved

2016-2018:

Governance Transformation

Plan Implementation

Begins

2018 – 2023:

Launch New Strategic Plan and

Reassess Governance

Along the Way

Implementing the ACC’s Governance Transformation

Council and Committee Charters

• Committees completing charters to detail the roles and responsibilities within

• Will also define the key competencies that are required for committee functions to be completed.

• Draft charters were shared at the August 2017 BOT meeting.

• Committee nominations open through Sept. 22

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Visit www.acc.org/about-acc/leadership

to view the full document

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

ACC’s Health System

Strategy

An ACC Strategic Priority

Critical need:

To provide hospitals, health systems and other facilities with an integrated, holistic approach to quality improvement across the cardiovascular care spectrum.

The ACC’s health system strategy

consists of three areas:

NCDR

ACC Accreditation Services

Quality Improvement & Education

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Leveraging Data to Improve Quality

of Care and Patient Outcomes

• Data collection

• Research

• Analytic and reporting solutions

Where Does the Data Come From?More than 2,500 hospitals

and 3,500 outpatient providers nationwide

participate in the NCDR by providing real-time patient data

on specific cardiac conditions.

ACC Accreditation Services, provides hospitals/health systems with a comprehensive suite of QI resources

Accreditation Services

Registry Services

Quality Initiatives

Education

ACC’s Health System

Strategy

CV Summit

• February 14-16, 2019

– Thursday - Saturday

• Orlando, Florida

• Cathie Biga will be the program co-chair

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Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

What is MACRA?• Medicare Access and CHIP Reauthorization Act

– Ended the Sustainable Growth Rate (SGR) for Medicare Part B payments

– Extended CHIP funding

– Set goals for EHR interoperability

• Passed by Congress with overwhelming bipartisan support

Who is in the QPP?IN

• Clinicians billing Medicare Part B• Physicians

• Physician Assistants

• Nurse Practitioners

• Clinical Nurse Specialists

• Certified Registered Nurse Anesthetists

EXEMPT

• Clinicians billing <$30,000 or providing care to <100 Medicare beneficiaries

• First-year Medicare participants

Report a minimum amount of data in at least 1 MIPS category: 1 quality measure, 1 improvement activity, or all 5 base Advancing Care Information measures.

Avoid a 4% payment penalty in 2019

Submit MIPS data across all categories for at least 90 days, beginning anytime between Jan. 1 and Oct. 2, 2017

Potential for a bonus in 2019

Submit data across all MIPS categories covering the full year starting Jan. 1, 2017.

Potential for a bonus in 2019 with more opportunities based on MIPS score

Participate in a recognized A-APM and meet the patient or payment threshold in 2017

5% incentive payment in 2019

Pick Your Pace

Advocacy Efforts Continue• 2017 and 2018 will be transition years with ongoing

refinements to the QPP

• ACC working with Congress, HHS and CMS to ensure that the QPP supports evidence-based, cost-effective, high quality care

• Analyzing current regulations

• Developing strategic, effective education

• Assessing the APM landscape for cardiology

Alternative Payment Model Framework

• www.acc.org/apm

• Self-guided readiness tool to prepare ACC

membership for participation

• Organizational readiness, Clinical practice

transformation, Reporting & analytics, and

Financial risk

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• MACRA Information Hub

– www.ACC.org/MACRA

– ACC Advocate Newsletter

– Twitter (@Cardiology), Facebook

• CMS Quality Payment Program

– https://qpp.cms.gov

– Subscribe to Quality Payment Program Updates

• E-mail: macra@acc.org

MACRA/QPP Resources

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

Understanding

Future MOC Assessments

Current MOC Process

MOC remains a continuous process with specific

requirements at the two, five, and 10 year milestones:o Every Two Years: Participation in at least one MOC activity

o Every Five Years: 100 points must be earned, including a

minimum of 20 Self-Evaluation of Medical Knowledge Points

(Part II).

o Every 10 Years: Pass a secure MOC exam*

The ACC Listened …and developed a three-pronged approach to MOC changes

focused on –• Serving as a source of information about

the changes for members

• Providing tools and resources to help

members more easily meet the new

requirements

• Advocating on behalf of members

for changes to the MOC process

ABIM Has Listened to Internal Medicine

Stakeholders Like ACC and Made the

Following Changes to the MOC Process:

• Reversal of the double jeopardy provision

• Decoupling of the initial board exam from MOC participation

• Streamlining the ability for practitioners to get both CME

and MOC Part II credit

• Suspending MOC Part IV requirement

• Launch of a 2-Year Knowledge Check-In as alternative to 10-

year Exam starting in 2018

A New 2-Year Alternative Assessment was

Announced for MOC:

The Knowledge Check-In

The shorter 2-year

Knowledge Check-In

opens to physicians

certified in Internal

Medicine and

Nephrology in 2018

Highlights of an Evolving Assessment

The Knowledge Chick-

In to be rolled out to

all specialties by

2020.*

The 10-year and

2-year options will

have an open-book

feature for IM and

Nephrology in 2018;

all 10-year exams will

be open book in fall

2018

*Adult Congenital Heart Disease will be available the first year the MOC is

offered in 2023. (Source: ABIM Slide Deck)

Knowledge Check In Roll-Out: 2018-2020

● The 2-year Knowledge Check-In is a shorter, lower-stakes assessment

o Can be taken at home, in an office or at a testing facility

o Initially, assessment will cover the breadth of discipline

o Testing time is currently estimated to be between two and three hours

● The “Knowledge Check-In” offers more continuous learning, feedback and

opportunities for improvement

● Physicians don’t need passing scores on each 2-year assessment

● Assessments are only offered on alternating years in each discipline

2-Year Assessment Option:

Overview

● 2018 is a pilot year for the Knowledge Check-In.

o Unsuccessful performance on the 2-year assessment will not mean having to pass

the MOC exam the following year in order to remain certified

o Allows the physician community to gain important insights into taking this new form

of assessment.

o If unsuccessful, diplomates will have opportunity to attempt the Knowledge Check-In

again before being required to take the traditional MOC exam

● “No consequence” doesn’t mean physicians can skip the assessment.

o Failure to take an assessment if it is due in 2018 will result in loss of certification.

● The Knowledge Check In will only be “no consequence” in 2018.

No-Consequence Assessment in 2018

● Diplomates who want to take the Knowledge Check-In but have a due date in a

year when the Knowledge Check-In is not available in their discipline must

either:

o Pass the traditional MOC exam by the due year, or

o If it is available, begin taking the Knowledge Check-In in the year prior to

the year their assessment is due

What If the Knowledge Check-In Isn’t

Available in a Diplomate’s Due Year?

● If diplomates wait until their assessment due year and are not

successful on the Knowledge Check-In, they will have to take the

traditional MOC exam in the next year to stay certified.

● To be guaranteed two attempts of the Knowledge Check-In,

diplomates should begin taking it 2-3 years prior to their

assessment due date.

Pass an Assessment Within 10 Years

of Last Traditional MOC Exam Pass

Source: ABIM Slide Deck, Fall 2017

Source: ABIM Slide Deck, Fall 2017

On the Horizon: Collaborative

Maintenance Pathways

• ABIM is working with ACC, ACP and ASCO to explore

developing Collaborative Maintenance Pathways

o These pathways would be alternatives to what ABIM

currently offers for recertification

o For cardiology, the ACC would provide clinicians with

learning material and assessments modeled after its

lifelong learning self-assessment program (ACCSAP)

Basics of Proposal

● Major goals

o Society/Board collaboration

o Ideally integrate formative and summative

components → identify gaps, improve knowledge

o Allow customization for scope of practice

(modules)

ACC, HRS, HFSA, SCAI Collaboration

● Will partner to develop new modules to help potentially meet collaborative maintenance pathway requirements. (Awaiting final outcomes on pathways from ABIM.)

● The partnership would enhance existing ACC Self-Assessment Program (ACCSAP) product line with CathSAP, EPSAP and Heart Failure SAP productsto help fulfill the MOC needs. (An analogous product for ABIM diplomates in Adult Congenital Heart Disease will be developed by 2021.)

● Development is in the early stages, but new products may launch as early as 2019. During development the current ACCSAP 9 remains in place to help clinicians maintain professional competence.

"It is a shared goal of

ACC, HFSA, HRS and

SCAI to help our

collective members

ensure their patients

are receiving the

highest quality,

evidence-based care."

– ACC President Mary

Norine Walsh, MD,

FACC.

The ACC’s online MOC hub at

www.ACC.org/MOC contains the

latest MOC resources and updates,

including free MOC activities.

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy

More than 85 percent of U.S.

cardiologists are ACC members

48 Domestic Chapters52,000+ members across the entire cardiovascular care team

10 NCDR Registries

40 International Chapters

Snapshot of ACC Today:

Domestic

Chapter Growth

1986:

First Chapters Formed

1990:

16 Chapters

2000:

39 Chapters

2017:

48 Chapters (Representing all 50 states plus Puerto

Rico and DC)

ACC in 2000 (26,000 Members) ACC in 2017 (54,000 Members)

Source (Right): Data compiled from 2017 Year End Official Member Count

FACC/MACC

52%

Associate

Fellows9%

Intl

Associates14%

FITs

12%

Resident/

CV Team Student

2%

CV

Team/AACC9%

CV Admin

1%

Affiliate

1%

ACC’s Current Strategic Plan2014-2018

Innovation and the ACC

Hot Topics

• Strategic Plan

• Governance

• Diversity

• MACRA

• MOC

• Health System

Strategy