Transcript Health Care Reform and Cardiovascular Care

Disclosures
No relationships or conflicts to report
Industry Relationships:
Necessary for Systematic Quality Improvement
QCOR
May 2010
Jack Lewin, M.D., CEO
The American College of Cardiology
History and Evolution of
Industry Support
The good (bad) old days
The Changing Environment
• OIG – DOJ
• House and Senate Oversight Committees
• Voluntary Industry Changes
• Physician Sunshine Act
Need for Industry Support
Medical Societies and Industry
Funding
•
•
•
•
•
•
Scientific Publications
Expositions at Meetings
Research Grants/Funding
CME Funding
Quality of Care Projects
Other (philanthropy)
The Real Question
What should national policy be for
future support of medical
education, scientific publication
and research?
The Real Question
• Public support for CME, scientific research and
publication is scarce
• Industry funds most research and advances in care
• RWI and intellectual conflicts should be addressed
• Restricting expert participation can be good or bad
with respect to societal needs for quality
improvement
How are we doing in
systematic quality improvement?
Beth McGlynn
RAND study
in NEJM
The Quality of Health Care Delivered to Adults in the United States; N Engl J
Med 2003 348: 2635-2645
Variation in Care
PCI Rates per 1,000 Medicare Enrollees (2002 – 2003)
13.5 to 38.1
11 .5 to < 13.5
10.0 to < 11 .5
8.5 to < 10.0
3.5 to < 8.5
Not Populated
(63)
(53)
(75)
(53)
(62)
Source: http://www.dartmouthatlas.org/
National Academy of Sciences (NAS)
explosion and acceleration of
knowledge
Changing pressures
of practice
Government to the rescue?
Is there a role for industry?
Does industry have business
motives?
so…
If you accept
industry funding,
can you be…
unbiased
ethical
Industry relationships
can be managed effectively
They provide value
when ethically structured
OK for research
but not for CME?
How do we
manage vs. restrict?
Relationships With Industry
• Disclosure
• Managing relationships
vs.
Restricting participation
• ACC Industry Forum
• ACC OIG – DOJ discussions
• ACC Web site
What the ACC has done
Full disclosure on acc.org
Complete transparency
2008 Industry Forum
Sen. Chuck Grassley (R-IA) speaks at
ACC’s 2008 Industry Forum
Principles for Relationships
with Industry
The ACC must self-regulate in nine areas of operation:
1
Advertising
2
Charitable donations
3
Clinical document development
4
5
6
Governance
7
Government grants/foundation
support
8
Registries
9
Sponsorship
Continuing medical education
Exposition
Disclosure of Relationship
• Level/value
• Relevance
• Timing and Frequency
• Type
New Challenges In Addressing
Patient Education and
Adherence
• National health initiative designed to improve
heart health
• Key Principles
– Engage people in the active management of
their own heart health.
– Empower individuals to make better, hearthealthier lifestyle choices.
• How it works:
– Strengthens the doctor/patient relationship by
delivering patient-centered tools to doctors’ offices.
– Provides a comprehensive, web-based platform with
information and smart, practical tools for patients
– Uses community-based events to provide everyday
strategies to improve heart health
– Works with national consumer products companies to
help deliver CardioSmart strategies to people at risk
for heart disease.
• Industry partners must:
– Show a substantial and credible commitment to
CardioSmart goals and objectives and offer products
and/or services that relate to encouraging heart healthy
behaviors.
– Be approved through the ACC’s review process, which
includes initial approval by the College’s PatientCentered Care Committee followed by approval by the
Executive Committee of the Board of Trustees.
– Not require or expect any endorsement by the ACC,
either actual or implied, of any product or service.
• Industry partners must:
– Commit to the complete editorial independence of the
ACC.
– Abide by the ACC’s overarching “Principles of
Relationships with Industry”
– Ensure that food products and over-the-counter
medications that make scientific claims related to
health (including heart health) are substantiated by
the appropriate Federal governing body (such as the
FDA or USDA).
Fries with that?
McDonald’s in Cleveland Clinic
Photo credit: Brynne Shaw For The Washington Post
Bumps in the Road
Prystowsky,
Ellenbogen,
Cannon,
HRS,
ACC,
etc.
We’re all in
this together!
www.AFibProfessional.org
Lessons
• Not just CME!
• Competing clinical views need to be aired
and balanced
• Disclosure and transparency is broader
than individuals
Managing RWI is the key!
At the ACC.10 and i2 Summit 2010, who
paid for meeting registration, travel?
Who paid?
Meeting Registration
Travel
U.S.
Non-U.S.
U.S.
Non-U.S.
Me
31.53%
37.96%
39.15%
35.06%
My practice
26.11%
8.36%
24.21%
8.17%
Industry
7.18%
32.69%
7.83%
38.68%
University
16.60%
9.39%
20.93%
11.39%
Other
18.58%
11.59%
7.88%
6.70%
Source:
ACC Market Intelligence Research
n=1,110 physician attendees at ACC.10
March 26 - April 28, 2010
CMSS Code for Interaction with Companies
Source: www.cmss.org; released April 2010
Our ongoing commitment to
an evolving process
Our Commitment to Science
ACC and its members are committed to an
unbiased and balanced review of the
science
… regardless of funding sources.
Our Commitment to Patients
The ACC must and will continue to manage
our relationships with industry
responsibly, ethically and in the best
interests of patient care.
“The best interest of the
patient is the only interest to
be considered.”
– William Mayo, M.D.