Throughout the year, the College's State Advocacy team works with ACC chapters to advance legislation that enhances patient care and defeat bills that threaten cardiovascular professionals and patients. Here we highlight some of the state advocacy successes to-date and issues on the horizon for the rest of 2016. Prior Authorization Reform ACC's Ohio Chapter has actively pushed for prior authorization reform since early 2015. Laxmi S. Mehta, MD, FACC, governor of the Ohio Chapter, and 29 other members went to the Statehouse this spring to urge lawmakers to support the bill, which was signed into law on June 13. The Chapter worked closely with the Ohio State Medical Association and other organizations to pass a law that strengthens the communication between patients, providers, pharmacies and insurers, and ultimately makes the prior authorization process easier for patients to be granted coverage for the care they need. After years of discussions with the payer community, state insurance commissioner and stakeholders, ACC's Pennsylvania Chapter and medical societies were able to get a bill introduced earlier this year that would increase transparency and consistency with the process for prior authorization. Andrew R. Waxler, MD, FACC, and William A. Van Decker, MD, FACC, have been spearheading this effort, and multiple letters have been sent to Pennsylvania legislators as part of a larger grassroots advocacy plan. Delaware passed a similar bill to Ohio's earlier this month, and the ACC is working with the state medical society on the implementation. Legislation in Hawaii did not pass this session but ACC's Hawaii Chapter has been designated to work with the state insurance regulators to craft necessary reforms. In West Virginia, the Step Therapy Regulation Act passed both the House of Delegates and the Senate with unanimous support. ACC's West Virginia Chapter supported the bill, which would permit physicians to reject insurance mandated step therapy protocols and substitute medically proven therapies for patients when medical evidence demonstrated that the insurance imposed formularies did not achieve the best results for patients. STEMI Systems of Care ACC's Illinois Chapter – working with the state hospital association and physician groups – defeated a proposal to update the state's ST-elevated myocardial infarction (STEMI) program by creating new agencies whose oversight would be duplicative of hospitals. The Chapter is working with the American Heart Association (AHA) and other stakeholders to improve STEMI response time and access without new and costly regulations. ACC's Colorado Chapter is undertaking a similar leadership initiative after legislation reflecting task force recommendations was tabled. Virtually all of the Chapter's recommendations were accepted as a result of their participation on the three-year taskforce. CPR Training in High School "Cardiopulmonary Resuscitation (CPR) in Schools" legislation continues to be a priority for ACC chapters. In collaboration with the AHA and through a successful grassroots approach that included meeting with legislators, providing testimony and reaching out to media, seven states (New Mexico, Kentucky, South Carolina, Wisconsin, Ohio, Arizona and Missouri) have enacted laws requiring high school students to receive training in CPR as a condition for graduation. These actions bring the total to 34 states. Final action mandating the requirement in Michigan and the District of Columbia is anticipated before the end of the year. Pulse Ox Screening Three more states (Kansas, Vermont and Wyoming) are on the way to requiring that newborns be screened for critical congenital heart disease (CHD) using pulse oximetry screening. In Kansas and Wyoming, the states' respective Departments of Health initiated rulemaking proceedings. In Vermont a legislative solution was achieved. These actions bring the total to 49 states and the District of Columbia with critical CHD screening requirements. Idaho is the only state that has not enacted legislation or addressed the issue through regulations. Tobacco Control California enacted five tobacco control laws this year including the nation's second tobacco-21 law raising the purchase age for all tobacco products to 21. A comprehensive e-cigarette law added the devices to the state's smoke free law. The District of Columbia Council appears positioned to follow in California's footsteps before the end of the year. The Council is reviewing a tobacco-21 bill and a smoke-free sports venue measure that would make all organized sports events in the District of Columbia completely tobacco free. Sarah B. Clauss, MD, FACC, testified on behalf of the ACC during a joint hearing before the council's Committees on the Judiciary and Health and Human Services. Allen J. Taylor, MD, FACC, also testified on behalf of the ACC in strong support of an e-cigarette parity bill that would add e-cigarettes to the existing smoke-free law. Six states enacted tobacco tax increases in 2016: Connecticut (25 cents), Louisiana (22 cents), Minnesota (10 cents), Oregon (one cent). Pennsylvania ($1) and West Virginia (65 cents). The Indiana House passed a $1 cigarette tax hike, but the Senate rejected it. In November, California voters will decide on a $2 per pack increase strongly supported by the California Medical Association. A Missouri ballot proposal for a 23 cent cigarette tax hike faces long odds. Medical Malpractice States continue to reject proposals to scrap the current state litigation system and replace it with a workers compensation model that would create regulatory, quasi-judicial "expert panels" with authority to identify valid claims of injury and patient compensation. Proponents promise that physicians will no longer need legal representation or malpractice insurance but fail to explain how the administrative function and patient awards would be funded. Working with state medical societies and The Doctors Company this year, ACC chapters helped defeat proposals in Maine, Tennessee and Ohio. ACC's Indiana Chapter worked with the state medical society and others to pass legislation to raise the cap on non-economic damages. While the medical community does not usually support such increases, Indiana's cap had not been raised in several years rendering it vulnerable to elimination. Further adjustments may be needed to ensure the cap remains. Edward T. A. Fry, MD, FACC, and the chapter pushed this as part of lobby day in conjunction with Indiana Medical Association efforts. Medicaid Reform ACC's North Carolina Chapter has taken a leadership role in Medicaid reform and prevention issues. The Chapter has provided information to a state task force on how cardiovascular specialists interact with Medicaid patients and launched Improving Cardiovascular Care in NC Free and charitable Clinics, a monitored grant from the North Carolina Chapter to the state's free clinics to provide medication and follow-up compliance and outcomes. ACC Grassroots in Action ACC's Kansas Chapter took steps toward addressing obesity and improving the priorauthorization process for the cardiovascular team. In response to a tough legislative environment, several members of the Kansas Chapter Council held a Stakeholder Engagement Day, hosting meetings with the Kansas Medical Society, Kansas AHA Chapter, Kansas Insurance Commissioner and several legislators. Participants included Dhanunjaya R. Lakkireddy, MBBS, FACC; Steven D. Owens, MD, FACC; Prashanth S. Katrapati, MD, FACC; Prasad C. Gunasekaran, MD; Jeffery L. Curtis, MD, FACC; and Donita Atkins, RN. Through a series of meetings, letter campaigns and legislative receptions co-hosted with the Vermont AHA, ACC's New England Chapter in Vermont was instrumental in getting several key pieces of legislation passed that included an e-cigarette ban, pulse oximetry testing for newborns and nutritional standards. Most notably Prospero B. Gogo Jr., MD, FACC, governor of ACC's Vermont Chapter; Sean Robert McMahon, MD; Shahab Moossavi, MD; Patrick Hohl, DO; Friederike K. Keating, MD, FACC, and many others, participated in sending letters to their legislators. Get Involved in State Advocacy ACC's State Advocacy team can provide resources and opportunities for members to communicate directly with state and local legislators and government officials, as well as help ACC chapters and members coordinate their advocacy efforts with stakeholders. Those interested in this type of opportunity should contact the ACC State Advocacy team: Kelly Memphis, email@example.com, or Michael Lawrence, firstname.lastname@example.org. Grassroots Advocacy in Action Unfortunately, millions of people across the U.S. are impacted by cardiovascular disease each year – either directly or indirectly. As the leading cause of death in the U.S. and the world, it’s crucial that congressional and state leaders understand the consequences of cardiovascular disease; advances in research, treatment and prevention; and how the cardiovascular community is working to improve the quality of and access to care. As the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is implemented, it’s also important for cardiovascular professionals to meet with lawmakers to educate them about the realities of navigating an increasingly complex health care system. The ACC offers a number of ways for its members to get involved in advocating for health policies that ensure continued patient access to quality, cost-effective care. Grassroots advocacy opportunities include sending an email to members of Congress; hosting lawmakers for a practice or hospital visit; or coming to Washington, DC, as part of the College’s annual Legislative Conference. Taking part in grassroots efforts at the national, state and local level ensures the voice of cardiology is heard. This spring, ACC Immediate Past President Kim Allan Williams Sr., MD, MACC, and colleagues hosted Rep. Danny K. Davis (D-IL) at Rush University Medical Center for a “Legislator Day in Cardiology” event. This was an opportunity for cardiology leaders to share how Rush University Medical Center is advancing cardiovascular care through its Rush Heart Center for Women, community screenings and other programs. During mini-presentations on topics ranging from lifestyle and prevention to cardiooncology and stem cell research, cardiology faculty helped Davis grasp the current cardiovascular landscape and challenges health care professionals are faced with. “To succeed, we must address our care processes and carefully consider what we measure and incent,” Williams stressed. Earlier this year, Michelle Hadley, DO, met with Rep. Jim McGovern (D-MA) at his office in Worcester, MA. After outlining the ACC’s major advocacy objectives, Hadley and McGovern discussed funding for the National Institutes of Health and U.S. Food and Drug Administration, electronic health record usability and cardiac rehabilitation. They also agreed on the importance of Congress working with medical specialty societies and federal agencies as MACRA is implemented. “Meeting with McGovern has allowed me to take my first independent steps in defining my career as an active member of the ACC,” said Hadley on the ACC in Touch Blog. “Attending ACC’s Legislative Conference helped me to carry on my conversation with a sense of ease and confidence, which will allow me to continue growing my relationship with the congressman.” ACC’s 2016 Legislative Conference Sept. 11 – 13, Fairmont Hotel, Washington, DC With implementation and congressional oversight of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) well underway, it is a critical time for ACC members to come to Washington, DC, to personally deliver cardiology’s message. Now in its 25th year, ACC’s 2016 Legislative Conference will provide the inside scoop on regulatory changes, legislative action and the state of cardiology to empower members to become effective advocates for patients and cardiovascular professionals. Don’t miss this unique opportunity to hear directly from the experts who shape health policy. Attendees will also have an opportunity to meet directly with congressional leaders to share ways the cardiovascular community is providing quality, cost-effective, evidence-based care to millions of patients nationwide. The conference will kick-off on Sunday, Sept. 11 with a special ACC Political Action Committee (ACCPAC)- sponsored reception and dinner featuring leading presidential historian and best-selling author Michael Beschloss. On Monday, educational sessions on the hot button issues that impact cardiovascular professionals and patients will arm the entire cardiovascular care team with the information and tools necessary to effect change on both the state and national level. On Tuesday, attendees will head to Capitol Hill for pre-arranged meetings with their congressional offices. Register to attend at ACC.org/LegislativeConference. FDA Releases Final Regulation Extending Authority Over E-Cigarettes, Other Tobacco Products More than two years after the U.S. Food and Drug Administration (FDA) proposed a rule to extend its authority to cover unregulated tobacco products, including e-cigarettes, the Agency has released a final regulation. Under the Final Tobacco "Deeming" Rule, an extension of the Family Prevention and Tobacco Control Act of 2009 (Tobacco Control Act), the FDA now has control over all tobacco products, including e-cigarettes, cigars, hookah tobacco and pipe tobacco, and will ban sales of these products to anyone under 18 years of age. The FDA will also "evaluate important factors such as ingredients, product design and health risks, as well as their appeal to youth and non-users" for all products in these categories commercially marketed after Feb. 15, 2007. "Marketing tobacco products, especially e-cigarettes, to children would slow the progress we’ve made in reducing heart disease brought about by the decline of smoking in the U.S.," said ACC President-Elect Mary Norine Walsh, MD, FACC. "The FDA's decision to restrict the sale of all tobacco products is a significant step forward." According to the Agency, smoking, which is responsible for 480,000 deaths each year, is the number one cause of preventable disease and death in the U.S. Under the Tobacco Control Act, only cigarettes, cigarette tobacco, smokeless tobacco and roll-your-own tobacco were automatically "deemed" subject to FDA authority. Until now, there was no federal oversight of the manufacture, distribution or marketing of e-cigarettes, cigars and other tobacco products, and no restrictions in place to protect public health against the risks of these products. "The actions being taken today will help the FDA prevent misleading claims by tobacco product manufacturers, evaluate the ingredients of tobacco products and how they are made, as well as communicate their potential risks," the FDA said in a statement. "As a physician, I’ve seen first-hand the devastating health effects of tobacco use," said FDA Commissioner Robert M. Califf, MD, MACC. "At the FDA, we must do our job under the Tobacco Control Act to reduce the harms caused by tobacco. That includes ensuring consumers have the information they need to make informed decisions about tobacco use and making sure that new tobacco products for purchase come under comprehensive FDA review." In April 2015, the ACC joined numerous health care organizations to urge President Barack Obama to take action and finalize the regulation. The College submitted comments to the FDA on its proposed rule in August 2014. ACC Advocacy is reviewing the final regulation and will work with the College’s coalition partners to address any deficiencies. CDC Tips From Former Smokers Campaign Offers Free Resources The Centers for Disease Control and Prevention (CDC) is continuing its national tobacco education campaign, Tips From Former Smokers, with TV commercials that feature real people who have been harmed by smoking. The ads began airing across the U.S. in January. Tobacco use remains the single largest preventable cause of death and disease in the U.S. Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke. The CDC has a number of free resources for health care providers, including 1-800-QUIT-NOW notepads for patients, handouts with reasons to quit smoking, conversation starters and more that you can access at CDC. gov/Tobacco.
Published by American College of Cardiology. View All Articles.