Letter from the President – January 2019

Dear Colleagues,

What a whirlwind the last few months have been! Since our last newsletter in early summer, right after Norma Keller and I assumed our official roles as Upstate and Downstate Governors, we have had several successes to share and updates to provide. First, we have had two successful NYACC conferences. In June we held our annual Cardiovascular Team Symposium and Summer Soiree in Pittsford, NY (Upstate), which was spearheaded by our CVT Liaisons, Courtney Shores, PA (Rochester), and Kena Patel, PA (Long Island).

This meeting featured excellent speakers, headlined by Dr. Ty Gluckman from Oregon. More recently, in October, we had our NYACC Reception and New York Fellows-In-Training Jeopardy competition, along with our 90th Annual Scientific Session in Manhattan with keynote speaker Dr. Valentin Fuster, making it one of our best-ever panels of speakers.

For those who do not regularly attend, I highly recommend these conferences, as the quality of speakers is fantastic and the opportunity for CME/MOC and networking is invaluable. This year also marked our first attempt at webcasting our Scientific Session, and we intend to continue to offer this option, as we have heard from you that this may be beneficial for those members who have had difficulty getting time away to travel to conferences.

These conferences were very successful and we are already underway planning our slate of conferences for 2019. Additionally, in September our largest NY ACC delegation ever assembled in Washington, D.C. for the annual ACC Legislative Conference. Through this conference we received updates on national issues affecting the practice of Cardiology and also spent a day on Capitol Hill meeting with NY members of the House of Representatives and the Senate to advocate on behalf of our patients and the needs and interests of Cardiology providers across NY and the rest of the US.

I want to take this opportunity to encourage everyone to plan to attend ACC.19 in New Orleans on March 14-16 for the annual national ACC Scientific Session. Not only does the program look fantastic, but NYACC, in lieu of our normal New York Cocktail reception, will be hosting a NYACC parade down the streets of New Orleans in the French Quarter with our own security escort and brass marching band! This will truly be an event that is not to be missed!

Now it is admittedly difficult to follow up the announcement of a New Orleans parade with our own marching band, but there are several items I would like to highlight in this newsletter:

  1. Efforts to end prior authorization burden
  2. NY ACC Committees and participation
  3. NY ACC Awards and Recognition
  4. Maintenance of Certification for Cardiology

1)  Prior Authorization Efforts – I suspect it will come as no surprise to anyone reading this newsletter that one of the most commonly cited causes of frustration and burnout amongst our members, and others across the country, is the increasing burden of prior authorization and the impairment to delivering high- quality and timely care to our patients. I can certainly speak personally that my staff and I spend hours every week jumping through unnecessary hoops to gain approval for procedures and medications we feel are medical justified for a seemingly ever-increasing list of procedures and treatments. The national ACC has been hard at work on all of our behalf to remove these unnecessary burdens. To this end, the national ACC has released the Prior Authorization Reporting Tool (PARtool : https://www.acc.org/partool).

This web-based tool takes about 2 minutes to complete and is meant to collect data on which insurers are requiring prior authorization, which studies are being selected for prior authorization, and the outcome of prior authorization efforts (approved, rejected, alternative study recommended, etc.). The ACC has been compiling this data and conglomerating experience by state. Several states have utilized this information to launch resolutions that they have taken to their state legislatures to advocate for prohibition at a state level.

NY ACC has had some discussions with state representatives and it appears there would be an interest on their behalf to support advocacy efforts to curtail or prohibit prior authorizations, especially where there is good evidence appropriate use criteria are being reliably met. To further our NY ACC efforts on your behalf, we are asking for your support in logging all prior authorization activities within your office around cardiac procedures starting February 1, 2019.

For one month and in association with February as Heart Month, we are asking that you direct your staff to enter information regarding all prior authorizations required so that we can create a robust dossier of evidence of the time involved in and outcomes of these prior authorization requirements in an effort to begin drawing attention and seeking support to end this burden. This will only be successful with everyone’s help! Individually, our voice is small, but together our cumulative experience, even for one month, will be formidable and gain us traction in our discussions with state insurance regulators and representatives in Albany. Help us to bring an end to the prior authorization burden in 2019 and do you PARt!!!

2) NY ACC Committees and Participation – Did you know that NY ACC has 11 different committees who help to address the professional needs of our members and deliver value to our membership in NY ACC? At conferences and over email, I routinely hear from members inquiring how to get involved in NY ACC or national ACC. These state committees are excellent opportunities to get involved and advance issues meaningful to us all. I encourage you to check out our Committee and Group list and to reach out to committee chairs to get involved and communicate your input and recommendations to the appropriate committee chair. Likewise, Dr. Keller and I as you NY ACC Governors are always available and interested to hear from you and help you become more involved in NY ACC!

3) NY ACC Awards and Recognition – This has been a banner year for recognition for NY ACC and its members! First, for the Chapter, in September, the national ACC recognized our Chapter for its commitment to CVT membership and developing educational programs and recognition for our CVT members. Additionally, we were recognized for our Diversity and Inclusion efforts to expand representation among gender and ethnic minorities but also to include the representation from private practices, rural practices, etc.

The latter kudos belong to our terrific Diversity and Inclusion Task Force leader, Dr. Robert Roswell and the Chair of our Women in Cardiology group, Dr. Smadar Kort. Thank you to these two leaders within our Chapter! Next, at our NY ACC Scientific Session, we announced the creation of the Tracey Shannon Lecture for our annual CVT Conference to honor one of our great CVT leaders who actually was instrumental in creating the successful NY ACC CVT conference.

Tracey was on hand to accept the award of the named lecture in her honor and we look forward to the inaugural lecture next summer! Finally at our recent Scientific Sessions, our FIT members took home a host of awards. With our annual FIT Jeopardy competition we crowned our winning team who will be going on to the ACC.19 in March to represent our state proudly. The winning team includes: Drs. Puvanalingam Ayyadurai, MD; M. Miguel Amor, MD & Doris Chan, MD. Congrats to the self-proclaimed Disciples of Braunwald! Additionally, our abstract award recipients were Beom Soo Kim, MD; Matt Mills, BS, OMSII; and Hamza Sadhra.

4) One of the largest topics within the house of Medicine over the last couple of years has been the ABIM’s requirements for Maintenance of Certification (MOC). We have seen challenges from the National Board of Physicians and Surgeons (NBPAS) and even lawsuits against the ABIM regarding the high cost and time burden to maintain certification, especially as most of us must have proof of certification for hospital privileging, to maintain status on insurer panels, and even for department appointments.

Our National ACC has been hard at work to address and reduce this burden and find an alternative to meet the needs of our membership. At our NY Annual Scientific Session in October, Dr. William Oetgen, ACC Executive Vice President and the leader of the MOC efforts on behalf of the College, presented the most recent agreement ACC has reached with ABIM on behalf of our members. This includes the following alternatives to the 10- year MOC exam through the ABIM:

  1. ABIM has approved a 2-year Knowledge Check-In exam, hosted by the ABIM, which can be taken online and does not require taking the exam at a testing center. This can be used in lieu of the once every 10-year exam and even if taken and not passed, Diplomats will have the opportunity to take it again while still being listed as active and participating in MOC.|
  2. We anticipate final approval in 2019 of the collaborative Adult Clinical Cardiology Self- Assessment Program where ACC members can utilize ACCSAP and complete one module a year followed by an online, secure test to demonstrate continuing education and medical knowledge. ABIM has indicated they will accept this ongoing effort as a replacement for the 10-year exam to maintain certification. We have not yet learned what the cost of this option would be and anticipate this may be and anticipate this may be available as early as third quarter of 2019.
  3. For those not wishing to maintain ABIM status, but who wish to demonstrate ongoing knowledge update and performance, ACC will be offering the same Self-Assessment program without the online testing component, but with generation of a certificate upon completion of the modules that can be presented to credentialing bodies as evidence of continuing education. While there is no guarantee that this will be universally accepted in lieu of ABIM status, it will be accepted by NBPAS and others.
  4. ABIM will continue to offer the 10-year MOC exam for those who wish to continue with this pathway. For any members due for Cardiology ABIM recertification this year, ACC is currently recommending to plan to take the 2-year Knowledge Check-In this year and then, pass or fail, those who wish can plan to enroll in the ACCSAP program moving forward. We will keep you informed as more information comes available on this important topic!

Finally, mark your calendars for important upcoming events:

March 14-16, 2019: ACC.19 in New Orleans
June 7, 2019: NY ACC Cardiovascular Team Conference in Manhattan
August 2-3, 2019: New York ACC Annual Scientific Session, Long Island Aquarium, Riverhead, NY

That’s all for now! We look forward to seeing you in New Orleans at ACC.19!

J. Chad Teeters, MD, MS, FACC
Upstate Governor | President
New York ACC