From the President . . . The mission of the ACC is to advocate for quality cardiovascular care through education, research promotion, development and application of standards and guidelines, and to influence health care policy. It is important to emphasize three words: quality, application, and influence. These are the words that will focus the goals and energy of the MDACC during my term of service as your new Governor. Quality One of the goals of the ACC is to turn cardiovascular knowledge into practice. This links the application of standards and guidelines to quality. We are members of the leading medical professional society in the world. Our academic colleagues have repeatedly answered the key questions in defining quality care through large, cooperative national and international clinical trials, through ethical cooperation with industry, and through application of basic science discoveries at the bedside. The advancements in cardiovascular medicine have dominated the progress of clinical medicine for decades. More than any other professional medical organization, the College has served to convene expert panels to concisely summarize our knowledge into consensus statements and guidelines that are meant to define and achieve quality care. These publications span the spectrum of ethics, credentialing, certification, best clinical practices (including pocket guidelines), and now appropriateness criteria. Recently, the College surveyed a large sample of the membership regarding their knowledge of the 23 quality initiatives created by the College, and the application of these initiatives in their hospitals. In Maryland, less than 60% were aware of these initiatives. Knowledge is a requisite, but not sufficient, component of quality care. It must be applied. It is in the application of knowledge that we no longer function autonomously as individuals, but must work with and be supported by the health care system. I encourage members to read the Institute of Medicine’s Crossing the Quality Chasm. Quality care is defined as being safe, timely, efficient, effective, equitable, and patient centered. You have the knowledge, but can you implement it to achieve quality care? This is where your hospital bears responsibility to support you in achieving the IOM’s definition of quality, and where you bear the responsibility to insure that your office supports you equally in this challenge. The key requirement is to measure processes and outcomes to drive quality improvement. Without data you don’t know where you are; and surprisingly, it is often not where you think you are. In addition to core measures, you should help your hospital define and review other quality measures, e.g. NCDR or other registries for the cath lab/ICD implants/carotid stenting; and parameters for chest pain and/or heart failure patients. Unfortunately, we lack adequate information systems in the office to measure quality, unless you utilize an EHR. Even there, data extraction is home grown. The College is devoting resources to address these shortcomings in the office setting. Advocacy The mission to influence health care policy is vital to your future and your wallet. It is for this reason that the College changed its status to include a 501 (c) 6 corporation, to permit advocacy. Like most of you, I was not particularly interested in politics. But the time for complacency is long past, as told to you repeatedly by your county medical society, by MedChi, and by the ACC. Today, we face three major issues: medicare reimbursement, medical imaging self referral, and malpractice insurance. Medicare: For the foreseeable future, Medicare is a zero sum game. The war in Iraq, the cost of Katrina, and other priorities guarantee that the CMS budget will not increase. CMS monies will be shifted with winners and losers. While the number of beneficiary services increase, CMS continues to plan annual 4.6% reductions in Part B reimbursement. With strong advocacy from the College in coordination with the AMA and other specialty societies, Congress voted a 0% reduction for 2007. There is a “victory” here (consider failure in this effort), but we are being duped as we lose economic ground to inflation and rising overhead expenses. The typical cardiology practice receives slightly greater than 50% of its revenue from Medicare. However, the story does not end there for cardiologists. While Part B reimbursement remains static for 2007, CMS proposes major cuts in reimbursement for in-office echo and nuclear CPT codes. This is the shifting that potentially marks cardiologists to be among the financial losers. The College is vigorously fighting these proposed cuts. Medical Imaging: The next major pocketbook and advocacy issue is the prohibition against in-office referral for CT, MR, and PET imaging. The 1993 Maryland law is the most restrictive in the nation, tauted as such by the American College of Radiology (ACR) to be the benchmark for other state legislatures. The Attorney General for Maryland reaffirmed his interpretation to uphold the law as written, in his Directive of 2004. Only radiology-exclusive groups and individual solo practitioner radiologists may perform in-office CT/MR/PET. The Maryland BOP took action in 2005 against orthopedic, neurology, and neurosurgery groups to impose fines and prohibit in-office MR referral. The ACC is working with the Coalition for Patient Centered Imaging (>20 specialty organizations) on this issue and is targeting the MDACC for special assistance. Malpractice: The third major advocacy issue is malpractice insurance reform. I presume that the membership is adequately versed on this issue and the absence of new legislative action during the recent session. Involvement with the Maryland Chapter Cardiologists are people of action by virtue of our training and clinical responsibilities. The status of Fellowship is a higher calling than membership, by connoting a professional and collegial relationship of excellence. So, I encourage you not to be passive with your membership in the MDACC. Search for one area of the College’s activity that is personally meaningful; then commit your time, energy, and/or money. This might be one hour per month or $100 per year. The average contribution to a PAC is $10 per cardiologist, $70 per radiologist, and $1500 per trial lawyer. The advocacy playing field is not level by virtue of our own indifference. If you choose to become actively involved, you won’t be disappointed. In the 10 years that I have served the Council, I have met many remarkable people, who otherwise I never would have known. I have been challenged to step into the world of advocacy, knowing that “all politics is local”, and that we must respond individually and collectively. It is a goal of the MDACC to increase the value of your membership. To this end, we will be surveying your opinions about how we can serve you better. Ultimately, you will find that the value of your membership grows when you become actively involved; that it is better to give than to receive. These are challenging times that directly affect your income and professional satisfaction. President Kennedy said it best: “Ask not…” This is not a cliché; rather, it is a powerful challenge. I ask you to reflect on your response with regard to its spirit and your desired relationship with MDACC. We welcome the many, new Cardiac Care Associates (CCA) to our membership. We share your personal commitment to clinical excellence, concern for regulatory interference, and desire to be part of an exceptional organization. Together, we will shape the outcomes that will be achieved through quality, application, and influence. Finally, I want to thank Dr. Ed Kasper on behalf of the membership, for his capable leadership as Governor during the past 3 years. We will continue to rely on his intellect and energy as we move ahead. The Council is composed of a diverse and talented group of individuals. We all look forward to serving you, reflecting the high standards that you expect from your College. Roger F. Leonard, MD, FACC rfleonard@montgomerygeneral.com 301-774-8762