Jack Lewin

Changes in the final rule for accountable care organizations will improve the chances of getting physicians to participate; but it is not clear physicians are going to flock to ACOs right away.

We are pleased that the government listened to the concerns that were raised about the initial ACO plan. One improvement in the rule was the decision to allow specialists in some cases to act as the primary provider. For example, under the new plan, a patient with advanced heart failure, arrhythmias, congenital heart disease or another unstable cardiac condition that requires management by a cardiologist would not have to get a referral from a primary care physician to see the cardiologist. The specialist could act as the primary care provider while continuing to manage the serious heart condition. This is a sensible approach for the minority of heart patients who need this.

The main ACO acceptability problem is there’s so much uncertainty in the system—especially with the looming threat of 29 percent cuts to physician payments through the flawed formula used to

It is critical that our processes for evaluating new and emerging technologies are as innovative as the technologies themselves. This is no small task, but it is necessary to ensure that the Americans have access to medical care based on the most current science. We must determine the appropriate balance between risk and speed-to-market.

Clinical trials remain the gold standard for science-based evidence development. To qualify for clinical trials, patients must meet certain ideal criteria, facilities and physicians are hand-selected for participation, and the evidence is closely reviewed. Clinical trials simply cannot fully predict all potential outcomes in the real world. This is where a fully developed post-market surveillance system can help.

It is essential that we continue to gather data on a product to observe usage and effects in the real world. By doing so, we learn more about how to best treat our patients and this is where registries make a significant impact. The American College of Cardiology’s National Cardiovascular Data Registry tracks physici

Changes in the final rule for accountable care organizations will improve the chances of getting physicians to participate; but it is not clear physicians are going to flock to ACOs right away.

We are pleased that the government listened to the concerns that were raised about the initial ACO plan. One improvement in the rule was the decision to allow specialists in some cases to act as the primary provider. For example, under the new plan, a patient with advanced heart failure, arrhythmias, congenital heart disease or another unstable cardiac condition that requires management by a cardiologist would not have to get a referral from a primary care physician to see the cardiologist. The specialist could act as the primary care provider while continuing to manage the serious heart condition. This is a sensible approach for the minority of heart patients who need this.

The main ACO acceptability problem is there’s so much uncertainty in the system—especially with the looming threat of 29 percent cuts to physician payments through the flawed formula used to c

Conventional wisdom tells us with the current political climate, it appears the President’s understandable insistence on bringing in new revenues as well as seeking savings in Medicare is DOA on the Hill. But another hang-up is what’s NOT in his plan.

The President has been supportive of eliminating the scheduled 30 percent cut to the Medicare physician payment formula, known as the sustainable growth rate formula (SGR). That’s nearly a one-third cut in reimbursements to physicians and will greatly affect access to care for millions of seniors battling heart disease, our nation’s number one killer, but he’ll need to push for this clearly much harder for this to happen.

Without an adequate “doc-fix,” Medicare will never be able to provide quality care to millions of those suffering from heart disease and will continue to be a drag on our nation’s finances. Furthermore, physicians will have to continue worrying about the solvency of their individual practices.

With cost driving the discussion, Congress should b

There was an interesting back and forth recently when former HHS Secretary Michael Leavitt and the current CMS Administrator Don Berwick engaged in a tit-for-tat on The Washington Post opinion page over the health of Medicare.

Leavitt, the former Bush Administration official makes good points. Despite the report from Medicare's trustees last month that the hospital insurance trust fund will not be depleted until 2029, he points out that Medicare is no better off than it was a year ago in that the proposed savings can only go to reducing costs, OR increasing the entitlement, but not both.

But Administrator Berwick is also right in acknowledging if the new health reform law is fulfilled; it should produce the estimated savings.

This is indicative of where both parties currently stand. I know this is crazy talk in an election year, but heading into the mid-term elections, dare I say that both Republicans and Democrats could be right?

Guaranteeing the Medicare trust fund savings is tougher than it appears on paper. Leavitt (and Republicans) is

This is a complicated issue. Clinicians, patients and payers should have input about the design and function of a new structure. For example, the ACC believes an ACO should reward providers for reducing unnecessary and discretionary services but not denying necessary care. ACO members also should not be at risk for costs they can’t control.

My concern (and that of the ACC) is that 85 percent of Americans’ health care delivery system is not organized in an ACO-friendly manner. As I’ve stated publicly, if the ACO idea flies with inherent bonuses and payment incentives, the integrated systems will rightfully take off with these new advantages, but others will be left in the dust. That’s why we’ve pioneered a third path to becoming an ACO over time, rather than just sticking with the fee-for-service status quo.

Our approach is to create a virtual group practice model around a registry-based voluntary group of primary and specialty physicians with new Medicare incentives for increased reimbursement

The National Institutes of Health has numerous institutes, mainly devoted to the study of basic mechanisms of disease leading to better treatment and prevention. Our belief is that if we used the prevention and wellness money to create an additional institute, the National Institute for Keeping People Healthy, dedicated to keeping people healthy even with the presence of a chronic disease, we could reduce the amount of health care dollars spent on end of life care by reducing chronic disease.

Two weeks ago, the Journal of the American College of Cardiology (JACC) released a report titled “Our Physicians and Our Profession Must Lead in Improving Our Health Care System.” I had the pleasure of co-authoring the report with Dr. Tim Garson of the Office of the Executive Vice President and provost at the University of Virginia, and Carolyn Engelhard, MPA with the Department of Public Health Sciences also at the University of Virginia.

In it, the ACC calls for a National Institute for Keeping People Healthy (NIKPH), this would be designed to lower the cost of

I am most inspired by the vision of President Obama with respect to health system reform, and his principles for effecting needed changes to America’s health care system.

I believe the principles he has provided to this conversation are in full alignment with the principles developed by the College during the past year. I firmly believe the President has taken a pragmatic approach that will bring persons on both sides of the aisle together to get reform passed this year. His concern and desire to address the flawed SGR payment formula and to work with Secretary Sebelius to reduce defensive medicine through achievable tort reforms is also most welcome to all physicians. It is essential that the nation move forward in 2009 with a meaningful and historic health reform proposal.

We look forward to working with the President, Secretary Sebelius, and the Administration to help move legislation through Congress this year and then to work on the process of implementation over the coming years.

There is no doubt that malpractice reform can impact health care reform. In a session at the ACC’s Legislative Conference held on Monday with staffers from Rep. Michael Burgess and Rep. Bart Gordon, medical liability reform c a me up several times as an area that needs to be addressed in health care reform.

Though the cost of medical malpractice is estimated by CBO to be at least 1 percent of overall annual U.S. health care spending, the big number is the cost of defensive medicine. While the amount is controversial, it has been estimated by a number of legitimate sources to approximate $200 billion. Therefore, a little bit of malpractice relief could save a lot of money in reducing defensive medicine. If, for example, tort reform was able to save $50 billion per year in defensive medicine, it would add up to $500 billion over 10 years -- over half the projected costs of health care reform spending.

The ACC has long-held that caps on non-economic damages and other reforms, such as those contained in California’s MICRA, have

President Obama is a remarkable orator, no doubt about that. He made his case for health system reform fairly effectively despite receiving a cold shoulder from Republicans. It is apparent that the public option is not off the table from his smile and Speaker Pelosi’s obvious excitement, but there were some subtle messages in the address that show openness to compromise.

First, his apparent enthusiasm for the public option was tempered significantly by his acknowledgment that it is not an essential part of the strategy. That allows Senator Baucus to propose reforms that do not include a true public option (or any public option at all). And the President’s comment that health system reform will not contribute one dime to the deficit is another way of possibly suggesting that the solution for getting a bill passed will be reconciliation. To use reconciliation, which the Republicans will hate (although it was used to pass the Bush tax cuts), the net has to be budget-positive or budget-neutral. However, reconciliation does pose problems as key issues in reform p

Sen. Edward M. Kennedy (D-Mass.) served in the U.S. Senate for nearly 47 years before succumbing to glioblastoma at the age of 77. Even through this challenge he waged a gallant effort. The “lion” of the Senate, Sen. Kennedy championed many progressive issues through his storied career, but none more consistently than his passion for health care. His clear vision was that all Americans should have access to affordable, high-quality care.

Known as the most organized and capable member of the Chamber of Colleagues, he was more able than any member in recent history to reach across the aisle to form bipartisan agreement on the toughest issues and with his toughest adversaries. He exhibited extraordinary and youthful leadership in helping President Lyndon B. Johnson with the passage of Medicare and Medicaid in 1965, just five years after assuming his brother's Senate seat at age 30, and just two years after President John F. Kennedy’s assassination. It was then that he earned, and has maintained, a reputation as a man who was consistentl