Lessons Learned and What’s Next From Million Hearts Janet S. Wright, MD, FACC, executive director of Million Hearts, a national initiative co-led by the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS), with the goal of preventing 1 million myocardial infarctions and strokes by 2017, gave the 48th Annual Louis F. Bishop Lecture at ACC.17. She spoke with Cardiology editors about her time at Million Hearts and whatfs next for the initiative. What have been some of the biggest Million Hearts accomplishments to date? The accomplishments really belong to our 120+ partners, like the ACC, the American Heart Association, the American Pharmacists Association, the Preventive Cardiovascular Nurses Association, and the American Association of Nurse Practitioners, as well as more than 20 federal agencies and offices. As a result of their collective efforts, millions of patients are now cared for by health systems and practices that have been recognized and rewarded for performance on key cardiovascular disease measures. Additionally, more than 7 million smokers have quit and standardized treatment protocols for hypertension are being implemented across entire systems of care. The first ever pay-for-prevention model is also underway in 48 states to recognize and manage those at high risk for cardiovascular disease. What have been some of the biggest lessons learned? Implementing what works and doing it at such a large scale is a challenge. Success definitely takes a team with focus and commitment from the top. Even with these assets, however, the wheels of progress turn very slowly. Engaging networks . Formal and informal, communitybased, health system-based, and best of all, hybrids of these . To focus on a few key strategies can make all the difference in the rate at which our nationfs cardiovascular health and care improve. How important is the entire care team in achieving Million Heartsf goals? Team care is essential not only to achieving the aim of a million fewer cardiovascular events in five years but also to good health. We have been particularly committed to disseminating the evidence for pharmacists, community health workers and cardiac rehabilitation teams, among others. While practices and health systems excel in prevention and treatment, teams that bridge the traditional silos of public health and health care are also important for building strong communities that support healthy behaviors. What are your hopes/goals for Million Hearts moving forward? In order to tip the current flattening of cardiovascular disease mortality rates downward again, we need all-hands-on-deck. Based on modeling, expert interviews, partner feedback, and recent scientific literature, we have designed a new framework for the next five years, Million Hearts 2022. By adding a new focus on physical activity, cardiac rehabilitation and patient engagement, along with very powerful public health and health care actions related to reducing sodium and tobacco and continued improvement in the gABCSh (Aspirin for those at risk for heart attack and stroke; Blood pressure control; Cholesterol management; and Smoking cessation), we are providing a roadmap to partners for more progress, faster. ACC Asks Congress for Continued Funding for CV Research The ACC in March submitted written testimony for the record to the House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee urging continued funding to ensure future medical research advancements in FY ‘18 and beyond. The testimony recommends Congress appropriate the following funds towards agencies doing vital work in cardiovascular disease treatment and prevention: $34 billion for the National Institutes of Health (NIH), with $3.3 billion going towards the National Heart, Lung, and Blood Institute and $1.8 billion towards the National Institute of Neurological Disorders and Stroke to increase the NIH’s purchasing power and preserve U.S. leadership in research; $7.8 billion for the Centers for Disease Control and Prevention (CDC), with $175 million towards the CDC’s Division for Heart Disease and Stroke Prevention to strengthen heart disease prevention efforts at state and local levels, $5 million towards CDC’s Million Hearts initiative, $37 million towards CDC’s WISEWOMAN to help uninsured or under-insured women prevent or control heart disease, $7 million towards CDC congenital heart research to study its effects over the lifespan, and $210 million towards CDC’s Office on Smoking and Health to maintain the program’s cost-effective tobacco control efforts. ADVOCACY BRIEFS Coverage Proposal for PAD Supervised Exercise Therapy The ACC recently joined with other stakeholders to urge the Centers for Medicare and Medicaid Services (CMS) to move forward with a positive national coverage decision for supervised exercise therapy to treat symptomatic peripheral artery disease. In a joint letter, the ACC and others expressed support for the fundamental proposal, and suggested revisions that would add flexibility and clarity for patients and clinicians. CMS will publish its final decision by May 31, though it could come several weeks before that deadline. Coding Corner CMS has announced that practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island are required to report on claims data on post-operative visits furnished during the global period of specified procedures using Current Procedural Terminology code 99024, beginning July 1. The specified procedures are those that are furnished by more than 100 practitioners and are either nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. Although reporting is required for global procedures furnished on or after July 1, the ACC encourages all practitioners to begin reporting as soon as possible. FDA Issues Safety Alert for Absorb GT1 BVS The U.S. Food and Drug Administration (FDA) has issued a safety alert for the Absorb GT1 Bioresorbable Vascular Scaffold (BVS) by Abbott Vascular due to an increased rate of major adverse cardiac events observed in patients receiving the device. The FDA recommends health care providers follow the instructions included in the FDA-approved BVS physician labeling regarding selecting appropriately-sized heart arteries for BVS implantation and methods to properly implant the device against the vessel wall. The agency also recommends that BVS patients be advised to follow dual antiplatelet therapy recommendations prescribed by their health care providers. Additionally, patients experiencing any new cardiac symptoms such as irregular heartbeats, chest pain or shortness of breath should be advised to seek clinical care. Any adverse events related to the BVS should be reported through MedWatch. HHS Delays Start of Episode Payment Models The U.S. Department of Health and Human Services (HHS) has delayed the effective date for the final rule for Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Rehabilitation (CR) Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model until May 20. This postpones the start date of the EPMs and the CR Incentive Payment Model for three months . From July 1 to Oct. 1. In its statement, HHS noted it is seeking comments on the appropriateness of this delay, as well as a further start date delay until Jan. 1, 2018. According to HHS, the additional three-month delay gis necessary to allow time for additional reviewh and to ensure that the agency ghas adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps due to the rule taking effect for a short duration before any potential modifications are effectuated. "Creating value-based payment models for patients with cardiovascular disease is extremely challenging and the ACC has urged the Centers for Medicare and Medicaid Services (CMS) to proceed with great caution in implementing and testing these models in order to ensure that they allow for accurate beneficiary attribution, valid quality and cost measurement, meaningful comparisons and ultimately development of best practices to achieve better health outcomes for patients,h says ACC president Mary Norine Walsh, MD, FACC. This newest delay provides an opportunity to continue working with CMS to find ways to further refine and improve the effectiveness of the modelsf clinical and operational designs. The ACCfs NCDR registries may be helpful in this effort. In the meantime, the College encourages members who are part of the model to continue to prepare for implementation. Health Reform Bill Stalled in U. S. House of Representatives The American Health Care Act (AHCA) was pulled from consideration in the U.S. House of Representatives last month. After much debate, lawmakers could not muster the votes to pass the legislation, which would have repealed and replaced provisions under the Affordable Care Act – a key priority for the new presidential administration and Congress. The ACC had previously expressed concerns about elements of the AHCA, particularly its impact on patient coverage. “As reflected in CBO’s analysis of the legislation, the estimated impact of the AHCA does not align with ACC’s Principles for Health Policy Reform,” said ACC immediate past president Richard A. Chazal, MD, MACC, in an earlier statement. “We are concerned over the sharp projected increase in the number of uninsured Americans, especially among our most vulnerable populations.” The College’s principles prioritize improved coverage for – and access to – efficient, high quality care; protection for individuals with pre-existing conditions; and continued national investment in preventive care, medical research and innovations. “Adhering to our Principles for Health Policy Reform, the ACC will continue to work with lawmakers on both sides of the aisle in our efforts to improve coverage for – and access to – efficient, high quality care, particularly for patients with pre-existing conditions like heart disease,” said ACC president Mary Norine Walsh, MD, FACC.
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