Congratulations!
&
Welcome to the ACC
Board of Governors!
Congratulations!
You’re an ACC
Governor!
Now what?
2008 Board of Governors Leadership Forum
George P. Rodgers, M.D., F.A.C.C., Chair
Jane E. Schauer, M.D., F.A.C.C., Chair-Elect
10,000 FT VIEW OF
ACC NATIONAL
ACC Mission Statement
“The mission of the American College of
Cardiology is to advocate for quality
cardiovascular care—through education,
research promotion, development and
application of standards and guidelines—
and to influence health care policy.”
ACC Goals
• Turn cardiovascular knowledge into
practice.
• Increase the value of membership.
• Promote innovation, people and culture
• Manage financial and legal
responsibilities.
ACC STRATEGIC PLAN
Will Hahn, Director,
Strategic Planning
ACC Strategic Plan
January 25, 2008
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
The College’s Mission & Vision
Mission
The mission of the American College of Cardiology is to
advocate for quality cardiovascular care through education,
research promotion, development and application of standards
and guidelines, and to influence health care policy.
Vision
By 2012, the ACC/ACCF will be the premier professional society
in cardiovascular medicine, dedicated to the highest quality
care that is patient-centered, evidence-based and cost effective.
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
The College’s Core Values
• Professionalism
• Knowledge
•
•
•
•
Value of the cardiovascular specialist
Integrity
Member driven
Inclusiveness
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Strategic Planning Process
Strategic planning should be an on-going process to keep the ACC relevant to its members.
Situation Analysis
Visioning
Strategy
Formulation
Action
Planning
Organizational
Review
• Mission & Vision
• Values
• Culture & Philosophy
Office of Strategic
Management (OSM)
• Strategic project
reporting
External
Assessment
• Env. Scan
• Member
Needs
Internal
Assessment
• Current State
• Balanced
Scorecard
Competitive
Position
•Core
Competencies
•SWOT
Future State /
Strategic Profile
• Alternative
futures
• Desired state
Establish Goals
& Objectives
• Strategy Map for
goals and
objectives
• Key strategies
Identify Actions
Required
• Business plan
• Project plan
• Priorities
• Resources
Update / Revise
• Which factors are subject to our influence and
control?
• How are mission and business responsibilities
balanced?
• How will our competitive position be affected
by external forces?
• What is our stance in terms of “competition vs.
cooperation”?
• How are resources allocated?
• What are the priorities for
implementation?
Source: Zuckerman, A.M. (1998). Healthcare strategic planning. Chicago: Health Administration Press.
DM# 351469
2008 Strategic Planning Timeline and Milestones
March
April
May
June
July
August
Sept.
2007
2007
2007
2007
2007
2007
2007
EC & BOT Mtgs.
(3/27 in Chicago)
EC Retreat
(5/5 in Washington, DC)
BOT Retreat
(7/31 in Vancouver, Canada)
March
1. BOT Meeting:
• Overview of strategic planning process: April
prioritization to August BOT meeting
2. Notify all committees: 2009 resource requests due by
June 15th for August BOT (enhancements, new)
August (Prioritize incremental)
April (Categorize baseline activities)
1. Staff categorizes all initiatives using groupings A, B, C, D (don’t do D).
• Infrastructure activities will be a separate category
2. BOT categorizes strategic activities (New/Ongoing/Core) via web survey
• Staff categorization provided as reference
3. Staff identifies initial efficiencies and reallocation options
1.BOT Retreat:
• Day 1: Strategic Directions
• Day 2: Prioritize initiatives and
discuss “tradeoffs”
2.Initiate budget process
• BFIC review in October
• BOT approval in December
May - July
1. EC Retreat:
• Review BOT categorization of ACC activities
• Discuss staff’s initial results of efficiency gains and reallocation options
2. Finalize incremental resource requests
• Strategic: New initiatives + Core/Ongoing enhancements (for BOT
prioritization)
• Operations: Enhancements - Core/Ongoing/Infrastructure (for staff
prioritization)
3. Finalize efficiency gains and reallocation options
• Determine total resources available for reallocation in 2009 (FTEs and
budget dollars)
• Determine mix of resources reallocated to strategic vs. operations (e.g., 80%
strategic + 20% operational)
4. Approval (Staff leadership and EC)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Strategic Planning & Budget Cycle
Jan- Feb
March
April
May-June
July-Aug
Sept
Oct
Nov
Dec
Executive Committee/ Board of Trustees
Year-end
Review
1st Qtr
Review
Planning
Retreat
2nd Qtr Review,
New Initiatives,
Planning Retreat
3rd Qtr
Review
Budget
Approval
Environmental Scanning Workgroup (ESWG)
Trends/
Analysis
ESWG
Report*
Trend
Prioritization*
Member
Survey**
Trends/
Analysis
* With BOG Input ** Frequency TBD
Budget, Finance & Investment Committee (BFIC)
Year-end
Review
DM# 351469
1st Qtr
Review
2nd Qtr
Review
3rd Qtr &
Next Year’s Budget
Reviews
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
ACC/ACCF Strategy Map
Our
Mission
Member
Service
Excellence
Members and
Stakeholders
Turn CV Knowledge Into Practice to Improve
Patient Care
To ensure
that
we attain
1. Help improve cv care and
practice
Internal Processes
8. Promote and uphold the
highest professional
standards in patient care and
physician conduct
9. Promote adequate workforce,
training and support for cv
patient care
enable
us to
execute
With
Our
People
Our
Resources
DM #350197
Increase the Value of Membership
10. Strengthen members’
ability to effectively lead,
manage and improve their
practices
12. Add value to the
FACC designation
11. Deliver cost-effective
products and services for all
member segments
13. Obtain a high level of
member involvement and
satisfaction
14. Run programs and
services in an effective
and efficient manner
17. Communicate effectively
to ensure members
recognize and appreciate
the impact of the College’s
efforts
15. Collaborate effectively with
other health related
organizations (US and NonUS) to achieve mutual goals
18. Use environmental
and market information to
drive member value
3. Communicate the latest
advances
2. Foster disease prevention
4. Create and develop
responsive, innovative, and
relevant educational
opportunities
that
drive
our
the
Strategic
Actions
DRAFT DOCUMENT for 2008
The mission of the American College of Cardiology is to advocate for quality cardiovascular care through education,
research promotion, development and application of standards and guidelines and to influence health care policy.
5. Disseminate tools and best
practices (products, services,
and programs) for ready use
by practitioners, patients and
policymakers
6. Develop clinical standards
7. Identify the latest
advances
16. Strengthen policy,
political and payer advocacy
to support and promote the
role and importance of cv
specialists
19a. Promote innovation and cv science leadership in all we do
19b. Drive Health System Reform to deliver highest quality care
People and Culture
20. Promote good governance
and maintain a member-driven
organization
23. Maximize sales
revenues from current
activities
21. Develop a high performing,
satisfied staff
22. Cultivate leadership
among engaged members
Financial
24. Manage net assets
25. Manage expenses
versus budget
26. Ensure a healthy mix
of funding sources
January 17, 2008
Roles & Responsibilities
Leadership plays a pivotal role in strategic planning, and responsibilities are
outlined for various leadership roles as follows:
•
Executive Committee – serves as strategic planning committee
–
BOG has input via 3 voting EC members
•
Board of Trustees (BOT) – set priorities, review quarterly progress in achieving
strategy, serve as initiative liaisons
•
Environmental Scanning Work Group – BOT work group that reviews internal and
external trends to support identification and development of new initiatives
–
BOG has input into final report
•
Budget Finance and Investment Committee (BFIC) – reviews quarterly progress,
recommends approval of annual budget
•
Board of Governors (BOG):
–
–
–
–
•
Participate in Environmental Scanning process
Knowledgeable about initiatives and enhance communications to membership
Propose potential initiatives to BOT via Executive Committee
Serve as early warning to BOT, when necessary
Executive Staff Liaisons:
–
–
Keep BOT and member liaisons up to date
No formal reporting
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Priorities - Primary Strategic Activities
• Healthcare System Reform
• NCDR Projects and Expansion
• Clinical Policy Capacity - Increase Speed and
Production
• Upgrading Internet & Digital Content Delivery
(Cardiosource 2.0)
• Individual Learner Portfolio Initial Phase
• New i2 Summit business model -ACCF/SCAI
collaboration
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Priorities - Other Mission Critical Activities
• Advocacy - imaging, Medicare fee schedule & pay for quality
• Cardiosource – in-source Conversations with Experts,
institutional products & patient education
• E-Business & Digital Products - multi-media/ content capture
• JACC - new journals, CME & plan Disease Prevention journal
• Workforce
• Education Strategy Task Force recommendations
• Registries - subscriber growth & business/technical capabilities
• Guidelines Applied into Practice/ Door-to-Balloon initiatives
• Federal Government & Foundation Grants in-house capabilities
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Board Priorities Supporting Quality
New Initiatives
• Medicare & National Healthcare System Reform PR Campaign for
ACC Leadership in Quality Improvement (Erickson)
• Develop an Office-Based Registry/ IC3 Program (Mitchell/ Coy)
• Congenital Heart Disease Registry Initial Seed Funding (Hewitt)
• ACS Quality Improvement Campaign/Take ACTION (Mitchell/ Coy)
• Turbo Charge Guidelines – Increase Speed/ “Roll Out” Capacity
(May)
• Appropriateness Criteria Development and Update Enhancement
(Allen)
• CV Imaging Quality Standards Development and Appropriateness
Criteria (Fitzgerald/ Hewitt)
• Baldridge-Type Award - Provide Awards for the Highest Level of
Quality in CV Care (Erickson)
• Patient-centered Approach to Quality Efforts (Erickson)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Board Priorities Supporting Quality
Expanded Initiatives
• Develop Longitudinal CathPCI and ICD Registries (Mitchell)
• Add Field-Based Support/Consultation for Quality Improvement
Activities to NCDR Client Base (Hewitt/ Coy)
• Define ACC's role in the Ambulatory Setting - IC3 Registry to Pilot
Test Guidelines Adherence and Reporting Tool (Coy/ Greenan/
Hays)
• NCDR Research/ Publication Activities (Mitchell)
• NCDR Analytics and Reporting (Mitchell)
• NCDR Business and Technical Operations Activities (Hewitt)
Continuation of Current
• Quality Alliance Activities – D2B Evaluation (Fitzgerald)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Board Priorities Supporting Education
New Initiatives
• Patience Education Materials on CV Disease Prevention - Business
Plan (Wilson/ Coy)
• ACCF CME for Chapters (Try/ Yarboro)
• CV Imaging Education Curriculum (Kovar)
• Nursing Core Curriculum (TBD)
• Individual Learner Portfolio Development (Bowman/ Green)
• Education Simulation - Development of Simulation Training
Education (Yarboro/ Byrd)
Expanded Initiatives
• Needs Assessment (Rzeszut)
• New CV Journals (JACC Imaging & JACC Intervention)
• Cardiosource 2.0 Expanded Functionality (Ettinger)
• New: CardioSmart Patient Education website
• i2 Summit Collaboration with SCAI (Kim)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Board Priorities Supporting Advocacy
New Initiatives
• Elevate Involvement with Healthcare System Reform (Green)
• Business Plan for Partnering with Patient Advocacy Groups
(Erickson)
Expanded Initiatives
• Strengthen Pay-For-Reporting/ Performance Programs (PAR3)
(Flood)
• Expand Payer Advocacy Through Development of Medical Directors’
Institute Payer Roundtables (Flood)
• Strengthen Legislative/ Regulatory Advocacy Efforts at the Federal/
State (Green)
• CV Workforce Study (TBD)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Board Priorities Supporting Membership
New Initiatives
•
•
•
•
•
Transportable CV Medical Record/ Patient Portfolio (Erickson)
Online Tools for Electronic Health Record (EHR) Adoption (Hays)
Informatics Strategy/ Business Plan (Hays)
ACC Cardiovascular Leadership Institute (Try)
Cardiovascular Administrators & Practice Resource Center (Flood/
Hindle)
• Add Imaging & Surgeons/ Councils (Miyamoto/ S. Mitchell)
Expanded Initiatives
• Informatics and Interoperability Expansion (Hays)
• ACC Management of New Chapters During Development Stage (Try)
• Implement International Membership Task Force recommendations
(Tenn)
Continuation of Current
• Bridge Products (Allen)
• Sale of Heart House Bethesda (Gates)
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Key Budget Elements
32 key Board priority initiatives overall




4 Healthcare System Reform
14 CFTF
7 funded from Operations reallocations
7 supported by grants/ contracts
65 New FTEs*
 43 support the 32 initiatives
 22 to replace consulting arrangements, create government/
foundation grant capabilities and support overall growth
Expense Redeployment of $3.0+ million
 Supports Board initiatives & normal staff/program cost increases
* 2008 Budget recognizes that some of these FTEs may continue only through duration of
grants or completion of temporal projects.
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
New/Reallocated Funding
New Revenues/ Reallocated Resources total $14.1 million
• Campaign For The Future contributions - $4.5 million
• Dues Increase - $1.6 million
• Healthcare System Reform Assessment - $1.0 million
• Secured Contracts and Grants – $4.0 million
• Organizational Assessment Cost Savings - $3.0 million
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Appendix
DM# 351469
CONFIDENTIAL – For ACC/ACCF use only. Do not copy or distribute.
Environmental Scanning WG
In preparation for the August 2008 BOT meeting, the
ESWG will use the following process to identify trends in
the healthcare market:
Sg2
Environmental
Scan Report
(2007)
Staff conducts
initial
research
Updated
Report
(May 2008)
AS NEEDED
Conference
Calls
(June 2008)
Prioritized
Environmental
Trends
with BOG
Present
Findings
to BOT
(August 2008)
1
Staff researched trends for draft 2008 report
1
Survey developed and distributed to ESWG
members and Board of Governors
2
Face-to-face meeting of ESWG at ACC.08 event
2
ESWG members and Governors asked to
complete electronic survey
3
ESWG and BOG members review draft report and
revise based on expertise of the CV environment
3
DM# 351469
Environmental trends are prioritized based on
two attributes:
1. “Likelihood College Can Contribute”
2. “Impact on the College/ CV Medicine”
Environmental Scanning WG
Top Twelve Environmental Trends
•
Trend 1.1 – The Evolution of CME and the Focus on Outcomes: Continuing
medical education (CME) enables practicing physicians with the resources and
tools to maintain their professional standing and keep abreast of medical
advancements and knowledge.
•
Trend 1.2 – Care of Chronic Diseases via Cardiac Care Team: Due to the
increasing demands for greater efficiency with a declining workforce and a higher
burden of disease, the future will incorporate ever increasing collaboration
between all members of the CV team. (Systems turn good care into great care.)
•
Trend 1.3 – Controversies and Advances in Cardiac Imaging: In the era of
emerging advanced imaging technologies for CV system, it is essential that
cardiologists perform and interpret the testing of appropriate patients to provide
appropriate continuity of care. (It’s not the picture, it’s the patient.)
•
Trend 1.4 – Advances in Interventional Therapeutic Technologies (Coronary
and PVD): Expanding approaches to endovascular treatment, in complex
coronary lesions and percutaneous valve repair and replacement, are continuing
an upward trend of shifting cases that were once treated in the hospital into the
outpatient setting.
DM# 351469
Environmental Scanning WG
Top Twelve Environmental Trends
•
Trend 1.6 – Advances in Aggressive Cholesterol Management: Recent
research has provided evidence that select patients may benefit from lowering
LDL-C levels below the current target of 100 mg/dL (to as low as 62 mg/dL).
•
Trend 1.8 – Quality and Outcomes Measurements, Reimbursement Linked to
Quality: The quality incentive model is being expanded to hospitals and
specialists as providers are concerned with lowering costs while addressing
patients’ needs in receiving high-quality care.
•
Trend 2.1 – Participation by Young/Next Generation in Organizations: ACC,
on a chapter and national level, should engage young and international members
and mentor their involvement on a national basis so as to engender future
support.
•
Trend 2.3 – Changes in Re/Certification Requirements: ACC needs to
educate and help members with the new requirements for maintenance of
competency and the Evaluation of Performance in Practice module. (Partners in
lifelong learning.)
DM# 351469
Environmental Scanning WG
Top Twelve Environmental Trends
•
Trend 2.4 – Participation by ACC Members in Other CV Societies: CV
Specialty/CCO’s are developing to provide targeted customized benefits and
opportunities for members seeking experiences very specific to their individual
needs. As such, special interest CV medical organizations continue to emerge and
special interest groups have developed around emerging technologies.
•
Trend 2.5 – Key Findings from Member Surveys: Conducted on a yearly basis,
the member survey provides the college an opportunity for internal reflection and
evaluation based on the members’ perception of how their needs and the needs of
cardiovascular medicine as a whole are being met.
•
Trend 4.1 – Declining Reimbursement: (a) Members will find it necessary to cut
back on services given the climate of declining reimbursement (Professional
perspective). (b) Dissatisfaction with this issue will lead to declining willingness to
participate in ACC. (Association perspective.)
•
Trend 5.9 – Consumer Perceptions: According to a Harris Poll doctors and
nurses are perceived to have “very great” prestige by at least one-half of adults,
however, physicians’ level of prestige has slipped over the years falling 7 points
from 61% to 54% over the last quarter century.
DM# 351469
BOG/Chapters History
1949 – College Founded
1951 – College chartered BOG & 22 Chapters
1954 – BOG and Chapters abolished
1957 – BOG reactivated with 35 US and 3
Canadian Governors
Mid 60’s – BOG grew to current 66 members
1986 – Chapters reintroduced
2006 – CCA Liaison appointed to BOG
2007 – CCA’s, FIT’s, MA’s and AA’s approved to
vote in the BOG elections
2008 – Chapters grow to 42 strong
ACC Leadership
Board of Trustees
Exec Comm
BOG
Leaders
Steering
Comm
Board of Governors
WHO THEY ARE
BOG
- Elected leaders of College
- Representatives of membership
- Diverse with unique perspectives
- Majority are in private practice
BOT
- Responsible for decision making, policy setting
- Guardians of College resources
- 16 of 30 members are former BOG
WHAT THEY DO
BOT
BOG
• Sets ACC direction
• Sets ACC policy
• Manages financial
responsibilities
•Relays “grassroots” needs
and concerns to BOT
•Lobby for better cv care
environment on local level
•Implement quality projects
on local level
•Educates membership on
ACC initiatives and value
BOG Steering Committee
• Set BOG agenda w/ Governors input
• Review requests from Governors/Chapters
• Bring requests to BOT for discussion and
decision
• Review requests from National ACC
• Conflict resolution
BOG Steering Committee
April 2007 – April 2008
C. Michael Valentine, Immediate Past Chair
George P. Rodgers, Chair
Jane E. Schauer, Chair-elect, New Mexico
John G. Harold, Incoming Chair-elect, California
Stuart A. Winston, Michigan
Mark H. Schoenfeld, Connecticut
Blair D. Erb, Jr., Montana
Ganpat G. Thakker, West Virginia
Brenda Garrett, Georgia, CCA, Georgia
BOG WORKING TOWARD
EFFECTIVE….
•
•
•
•
Member Involvement
Education
Advocacy
Quality
To improve cardiovascular patient care
BOG GOALS
BOG GOALS
1.Local Quality Improvement projects
2.Chapter Relevance and Member Value
3.Leadership Development &
Opportunity
BOG GOALS
1. Quality Improvement
– P4P
– D2B
– MDI
– State Quality Champions
– Web-based quality training program
BOG GOALS
2. Chapter Relevance / Member Value
– Communicate BOG activities to members
– CCA Involvement
– Chapter involvement in imaging battles
– Chapter Recognition and Incentive
program
– CME/CEU for Chapters
– Workforce Initiatives
BOG GOALS
3. Leadership Development &
Opportunity
– Enhanced Leadership Forum
– Expanded member involvement opportunities
outside the Committee system
– Improved communication with BOT
D2B Update
Jason R. Byrd, JD
American College of Cardiology
January 25, 2008
D2B Background
• January 2006 - Initiated by ACC
leadership
• March 2006 – D2B Workgroup first
meeting
• June 2006 – Evidence established
• November 2006 – D2B Launched
• October 2007 – 90 Days to 90 Minutes
Effort Launched
• January 2008 – Evaluation Initiated
Key strategies associated
with reduced D2B times
Strategy
% of Minute
hospita
s
ls
saved
23
8.2
14
13.8
9
15.4
13
19.3
EM physician activates the cath lab
Single call to the operator
Pre-hospital EKG
Cath lab team expected within 20-30
minutes
Real time data feedback to ED and
42
8.6
Bradley et al, NEJM, 2006
cath lab
DTB Time & No. of Key Strategies
Used
Strategies
Hospitals
(%)
Median
DTB
0
137 (38.8)
110
1
130 (35.9)
100
2
56 (15.5)
88
3
31 (8.6)
88
4
8 (2.2)
79
Overall P value for trend: < .001
Bradley et al, NEJM, 2006
“What” » “How”
•
Evidenced-based strategies:
1. ED physician activates the catheterization lab
2. One call activates the catheterization lab
3. Catheterization team ready in 20 – 30 minutes
4. Prompt data feedback
5. Senior hospital management commitment
6. Team-based approach
– Optional: Activate based on pre-hospital
ECG
• Goal:
– D2B of ≤90 minutes >75% of
patients at participating hospitals.
• Recruitment
– 38 strategic partners
– 39 ACC chapters
– 10 countries
– 1,005 participating hospitals
Thanks for Your
Response!
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
AL – 25
AR – 10
AZ – 14
CA – 77
CO – 24
CT – 14
DC – 2
DE – 2
FL – 63
GA – 18
HI – 3
IA – 14
ID – 5
IL – 45
IN – 34
KS - 9
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
KY – 19
LA – 18
MA – 9
MD – 15
ME – 3
MI – 43
MN – 15
MO – 20
MS – 9
MT – 8
NC – 22
ND – 2
NE – 9
NH – 7
NJ – 29
NM - 6
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
NV – 5
NY – 28
OH – 44
OK – 16
OR – 15
PA – 52
RI – 3
SC – 17
SD – 4
TN – 26
TX – 92
UT – 6
VA – 29
VT – 1
WA – 15
WI – 31
WV - 8
The Campaign
Components
• Evidence-based strategies
• Enrollment & follow up hospital
surveys
• Website, tool kit, change package
• Webinars
• Foster community (list serve, mentor
network, success stories)
• Sessions at national and regional
meetings
• International Outreach
• ABIM and CME credit
Single Most Challenging Problem
Reported by Responding Hospitals
(N=522)
Percentage of hospitals
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
ED physician
activation
of cath lab
Single call
activation
of cath lab
Cath lab team
available 2030
minutes after
page
Prompt data
feedback
Senior
management
commitment
Team-based
approach
Other
challenging
problem
Percentage of Hospitals Willing
to Mentor Other Hospitals on
Key Strategies
Percentage agreeing to serve as mentor
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
ED physician
activation
of cath lab
Single call
activation
of cath lab
Cath lab team
available 20-30
minutes after
page
Prompt data
feedback
Pre-hospital
ECG & activate
while
patient enroute
to hospital
* Some hospitals reported they would mentor on multiple strategies, so % adds to more than 100%
Senior
management
commitment
Team-based
approach
90 Days to 90 Minutes
• October 2, 2007-December 31,
2007
• Webinars, emails, success
stories, mentor network
• Emphasis on implementation of
all D2B strategies by end of
2007
• Governors and Chapters
90 Days to 90 Minutes:
Pulse of the Participants
Of the six D2B evidence-based strategies, how many has your
hospital implemented since October 2, 2007, that were not
previously implemented?
Number of Respondents
50
37.1%
45
40
35
24.2%
30
25
20
9.7%
11.3%
15
5.6%
10
4.8%
4.8%
5
2.4%
0
0
1
2
3
4
5
Number of Strategies
6
Unknown
n = 124
Preliminary NCDR Data
(Needs analysis)
Percentage of Primary PCI with D2B <= 90 minutes
NCDR CathPCI v3
80%
70%
50%
40%
30%
20%
10%
D2B
New GL
and
CMS Reporting
0%
20
04
Q
3
20
04
Q
4
20
05
Q
1
20
05
Q
2
20
05
Q
3
20
05
Q
4
20
06
Q
1
20
06
Q
2
20
06
Q
3
20
06
Q
4
20
07
Q
1
20
07
Q
2
Percentage
60%
Tim efram e
Where do we go from here?
• Intervention ending by June 2008
• Survey distribution begins Jan 2008
• Evaluation begins Jan 2008
– Three analyses using NCDR,
GWTG, HQA and D2B survey data
• No follow up campaign to D2B
currently planned
• Use D2B foundations to continue
quality improvement in your states
Carrier Advisory
Committee –
Who It Is and Why It’s
Important to You
Henry McCants, 202-375-6642
January 25, 2008
Heart House, Washington D.C.
Carrier Advisory Committee
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History and Purpose of the CAC
Responsibilities of ACC CAC members
Activities of the National CAC
Working with your CAC member
Future of Medicare Contracting
History and Purpose of the CAC
• Medicare is the largest healthcare payer in
the US
• Over 80% of Medicare’s payment
decisions are made at the local carrier
level
• Currently, each Medicare carrier is
required to establish a CAC
History and Purpose of the CAC
• Carrier Advisory Committee
– Consists of representatives of all providers
(medical specialties) in the state
– Representatives are chosen by the provider’s
recognized professional society
– CAC provide only a “review and advise” role
for the draft Local Coverage Determinations
(LCD)
ACC CAC Member Responsibilities
• Attend CAC Meetings
• Seek comment on proposed new or
revised policies from informed / expert
members of the College’s local chapter
• Provide these comments to the Carrier
Medical Director for consideration
• Create an open communication between
the ACC Chapter and the Medicare Carrier
Activities of the National CAC
• Creation of the Model Local Determination
Document
– Transthoracic Echocardiography
– SPECT Myocardial Perfusion Imaging
– Cardiac Computed Tomography (CT) and CT
Coronary Angiography
– Cardiac Magnetic Resonance (ongoing)
• Expanded Opportunity for Intersociety
Cooperation
Working with your CAC representative
• Introduce yourself
• Create a support system for you and the CAC
representative
– Request feedback on proposed medical policies from
your chapter membership via website
– Form a chapter level “payer advisory committee”
made up of the CV subspecialties
• Send comments to the Carrier Medical Director
on your ACC chapter letterhead
Future of Medicare Contracting
• Starting December 1, 2006, Medicare
began combining its Part A Fiscal
Intermediaries and Part B Carriers into
Medicare Administrators Contractors
(MACs)
• Under the MAC system, CMS is no longer
required to have a CAC
• Local ACC Chapters must advocate for
continued use of the CAC system
YOUR PLACE IN THE BIG
PICTURE
Governors
• 66 Current Governors
– 50 U.S. States, D.C., Puerto Rico, 2 for PA, NY, CA, 5
Canada, 1 Mexico, 3 Military, 2 other Gov entities
(Public Health, Veterans Affairs)
• 20 Governors-Elect
– Elected Dec 2006
– Assume governorship March 2008
• 20 Future Governors-Elect
– Elected Dec 2007
– Assume governorship March 2009
Chapter Membership
44 Chapters
represent 46
states & Puerto
Rico
4 Non-Chapter
States
85.3% of ACC-National members belong to Chapters
Governors/Chapter Presidents….
• Provide Rapid Environmental Scanning
• Are the Primary contact for State Issues
• Relay ACC’s goals & initiatives to
members
• Represent membership and BOG on
committees and task forces
• Make collective recommendations to BOT
• Mentor future leaders
Chapters….
– Facilitate an effective response to state
and local issues.
– Provide opportunity for members to
participate in College activities.
– Provide networking and support
opportunities that create a
“cardiovascular community” of
membership.
Member Segment Update
Stephanie Mitchell, ACC
Staff, Member Segments
ACC Member Sections
Your Community.
Great Opportunity. Great Impact.
Member Strategy
Who we are.
• Within the department of Membership Strategy,
Sales, & Service
• Member Strategy partners with Section leaders
to identify & develop strategic initiatives within the
College.
• Member Strategy partners with ACC Staff
leaders to implement member driven initiatives
within the College.
Member Sections
What they are and why they are important.
Section Definition
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A group of members who align themselves around an area of clinical or
professional interest
– Sections are governed by their respective governing Council/Committee
Benefits to Members
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Increased member involvement and leadership opportunities
Better meets members’ needs for education, advocacy, clinical tools
Enhances collaboration and partnership opportunities with existing
societies
Creates opportunities to become more involved with local Chapters
Benefits to the College
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Increased dues and grant support revenue
Increased loyalty
Membership growth
Overview - Member Section Governance
External
Organizations
Council/Committee
SCAI
STS
American College of Cardiology
Board of Trustees
ABP
etc…
The Council is the
initial POC for
collaborations and/or
strategic partnerships
with the College on
related initiatives.
• The Council is responsible for
developing an overarching strategy for
ACC’s council specific initiatives
• The Council coordinates activities and
supports development of initiatives
ACC/ACCF
Related Committees
• Education
• Quality
• Advocacy
• Membership
• Publications
• Etc…
• The Council prepares an integrated
report to the BOT on initiatives of the
College
• The Council will work with other
committees as appropriate for initiatives
by providing support on proposals
submitted to the BOT
The focus of a Council is on identifying the vision and strategies for section related
initiatives of the College. The Board maintains its oversight role, and relationships, with
internal committees and external organizations.
Section Objectives
• Articulate the need of the profession/special
interest to ACC leadership
• Coordinate related activities with relevant
Boards, Sections, Committees, Working
Groups and members
• Communicate with Section membership
• Provide opportunities to involve ACC
members
Section Leadership
• Adult Congenital and Pediatric Cardiology
– Chair, Gerard Martin
– Staff member, Stephanie Mitchell, smitchel@acc.org
• Interventional Scientific Council
– Co-chairs, George Dangas, Jeffrey Popma
– Staff member, Stephanie Bailes, sbailes@acc.org
• Women in Cardiology
– Chair, Athena Poppas
– Staff member, Stephanie Bailes, sbailes@acc.org
Section Initiatives
• Adult Congenital and Pediatric Cardiology
– Quality, Adult Congenital Heart Disease,
Education, Advocacy,
• Interventional Scientific Council
– Advocacy, Education, Quality, Guidelines and
Training
• Women in Cardiology
– Virtual mentoring program, leadership
development, resource to female medical students
How Can You Support?
• Consider leveraging Section leadership for
support of relevant Committee initiatives
• Remind Chapter membership of Section
opportunities and activities at Annual Meeting
and throughout the year
• Provide information to members about the
Section
• Encourage involvement!
ACC Sexual Harassment Policy
Cathy Gates, Division Vice
President, Human Resources &
Operations
ACC Leadership Orientation 2008
Thomas E. Arend, Jr., Esq.
General Counsel
American College of Cardiology
January 2008
Corporate Structure and Tax Exemption
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ACC/ACCF Structure
– Nonprofit
– District of Columbia
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Section 501(c)(6) professional society and business/trade
associations
• Member Organization
• Unlimited lobbying
• Political Action Committee
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Section 501(c)(3) charitable and educational organizations
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Public benefit
Private inurement prohibited
“Excess benefits” law
Ban on political activity
Restrictions on lobbying
ACC/ACCF Leadership
• Trustees, Governors, Officers, Staff,
Committee Members (will refer to as
“Directors”) have Fiduciary Duties of Care,
Loyalty, and Obedience
• Compliance with fiduciary duties protects
directors from personal liability and maintains
corporate integrity
• Important to understand and comply with
fiduciary duties
• Legal and financial scrutiny directed at tax
exempt and nonprofit corporations and boards
• Sarbanes-Oxley establishes new best
practices standards
Fiduciary Duties of
College Leadership
• Care
• Loyalty
• Obedience
Duty of Care
• Most Important
• Must Act
– Honestly
– In Good Faith
– Consistent with the Best Interests of the
College
“with the care an ordinarily prudent person in like
position would exercise under similar
circumstances.” - Revised Model Nonprofit Corporations Act
Business Judgment Rule
• Protects Member Leaders from
personal liability when acting in
accordance with duties
• Act on informed basis
• Good faith
• Best interests of organization
Duty of Loyalty
• Must act – Only in best interests of organization
– To avoid conflicts of interest
• Should not – Usurp corporate opportunity
– Directly compete with organization
Conflicts of Interest
• When a member leader participates in the
organization’s work and at the same time
has other professional, business, or
volunteer responsibilities that could bias
the individual one way or another.
• Potential conflict should be disclosed and
appropriately addressed by disinterested
members
Rules Regarding Conflicts of Interest
• Actual or potential conflicts must be disclosed
• Recusal from deliberation and/or vote may be
advisable or necessary
• Resignation may be advisable or necessary
• Board can enforce these rules
• Resolution of such conflicts is the obligation of
the disinterested parties not the party(ies) with
the conflict or exclusively the responsibility of the
chair
Duty of Obedience
• Obligation to faithfully pursue the
corporation’s purpose or mission
• Purpose/mission are as stated in
governing documents
– Certificate of Incorporation
– Bylaws
– Policies
Confidentiality
• An important obligation that fits under all
duties
• Member Leaders must not disclose
information about the corporation that is
confidential or not authorized for
disclosure
• Financial, governance, personnel, etc.
Potential Liabilities
Common to Nonprofit Associations
• Due Process
• Defamation
Due Process
• Ensure substantive and procedural
due process
• Common law “fairness”
• All procedures should be fair and
reasonable, not arbitrary or capricious
• For example - member discipline and
ethics matters
Defamation
• Untrue statements that another is dishonest,
unprofessional, fraudulent, immoral, etc.
• Slander = spoken
• Libel = written
• Truth and personal opinion stated as such are
defenses
• Publication or Re-publication of defamation
creates liability as well
• “Qualified Privilege” for confidential board and
committee deliberations
Legal Risk Management and
Liability Protections
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Observe Fiduciary Duties
Corporate Status
Insurance
Indemnification
Contractual Protection (waivers and
releases)
• Volunteer Protection Statutes
Corporate Status
• Corporate form protects against
personal liability
• But plaintiffs can attempt to “pierce
the corporate veil”
• Maintain corporate formalities and
respect fiduciary duties
Insurance Coverage
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Comprehensive General Liability (“CGL”)
Directors and Officers (“D&O”)
Errors and Omissions (“E&O”)
Provides coverage for antitrust,
certification or accreditation,
employment practices, infringement, etc.
Indemnification
• ACC provides protection to Trustees
• To full extent of law
• Limited by ACC’s resources
Volunteer Protection Statutes
• States have volunteer protection laws
• Federal
– protects volunteers
– acting within proper scope of duties
– properly licensed, if necessary
Volunteer Protection Statutes
• Federal
– Not caused by willful or criminal
misconduct, gross negligence, reckless
conduct, or conscience/flagrant
disregard for rights or safety of others
– Not motor vehicle
– Other exclusions (sexual offense, civil
rights, criminal, alcohol)
Ethics & Leadership in a
Sarbanes-Oxley World
New Governors OrientationAgenda Item # 11
January 2008
DM# 350391
Background: History of Sarbanes-Oxley
Financial reporting scandals (Enron, Tyco, WorldCom) and the
resulting stock market decline in 2001 generated a
government response which drastically changed corporate
accountability.
• Sarbanes- Oxley legislation (primarily for publicly traded
companies)
• Higher level of scrutiny of public accounting- Public
Company Accounting Oversight Board (PCAOB vs. AICPA)
• Other agencies taking higher level of oversight- GAO, IRS.
• Nonprofits also on the “radar screen.”
Sarbanes-Oxley: Requirements for
Nonprofits
• Sarbanes- Oxley had many requirements for publicly-traded
companies and FEW for nonprofits.
• Whistle-Blower policy was the only thing required for
nonprofits.
• But……
– “Best in class” nonprofits adopted many of the
requirements of Sarbanes-Oxley
– Oversight/ financial accountability changed for ALL in a
corporate governance role.
– Audit community/ Governance community changed.
What Have Nonprofits Done?
Grant Thornton Annual National Board Governance Survey of
Nonprofits:
• 2003: 80% of nonprofits had NOT made changes to
governance policies
• 2007: 87% of nonprofits HAVE created new policies.
• ACC/ACCF implemented a “best in class” Sarbanes-Oxley
Implementation Plan in late 2003.
What Have Nonprofits Done?
G.T. National Board Governance Survey of Nonprofits- 2007
What Nonprofits have done?:
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Conflict of Interest policy- 89%
Separate/ Independent Audit Committee- 54%+
Document Retention policy- 78%
Code of Ethics- 75%
Whistle Blower policy- 68%
New Board/ Governance policies- 87%
Accounting Policies and Procedures Manual- 92%
Internal Audit Function- 49%
Contemporary Written Investment Policy- 87%
What Has ACC/ACCF Done?
In addition to the practices that most nonprofits have
implemented, ACC/ACCF has done the following:
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CEO and CFO certify/ sign IRS 990s
990s reviewed by Audit Committee
Financial competency of Board and Finance Committee
Rotation of audit “lead”
Required communication of auditor directly to Audit
Committee
• Limit Audit firm’s providing “non-audit” services other than
tax preparation
• Employee dispute resolution policies clarified
Board Member Liability- What Have
You Gotten Yourself Into?
Summary of board member liability:
• Liability to third parties- vendors/ contractors; members,
donors/ funding source
• Liability to organization itself and constituents
Board Member Liability- What Have
You Gotten Yourself Into?
Summary of board member liability (continued):
• Fiduciary obligation: must act in “good faith” and “loyalty” to
the organization.
• Legal duty to “conserve and protect assets”
• D&O Insurance can protect board members from legal liability
• Volunteer protection statutes (in some states)
• Financial Penalties for board members for improper
dealings w/ nonprofits or knowingly approving excessive
transactions- Congressional legislation
• Conflict of interest liability- board member receives improper
or undisclosed personal or financial benefit
What Other Emerging Governance
Trends Should You Consider?
Emerging “best practice” Governance Trends:
• Board/ Audit Committee review of IRS 990s (before filing)
• Executive Director/ Treasurer/ Chapter Governor certify/
sign IRS 990s
• CPA on Audit Committee or Board (financial competency of
Board/ Audit Committee)
• Conflict of Interest- required disclosure statements
• Investment Policy- Conflict of Interest Statement
• Required Directors & Officers insurance
• Board Self-Assessment annually
STRENGTHENING
YOUR CHAPTER
Chapter Structure
– Share ACC’s mission, goals and logo.
– Come in all shapes & sizes
– Are incorporated separately from ACC
National. They are their own entity.
– Are non-profit organizations with legal
and financial responsibilities
Chapter Structure
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Governor/Chapter President
Chapter Executive
Executive Committee
Council
– CCA Ex-officio Councilor
– FIT Ex-officio Councilor
• Committees
– Education; Advocacy; Quality
Strong Chapters Need…
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Dedicated, energetic Chapter Executive
Dedicated, energetic Chapter President
Nucleus of Champions
Membership Input
Strategic Goals with Timeline
Involved Council with defined
responsibilities
Pitfalls to Avoid
• Ineffective, unresponsive Chapter management
• No strategic goals or clear direction
• Lack of understanding of members’ wants and
needs
• Lack of communication with membership
• Unused resources – other interested volunteers
• Ineffective time management – the “I’m too
busy” pitfall
Responsibilities
of a Chapter President
• Chapter meets federal and state requirements
• Financial past and future responsible, clear,
recorded and unbiased
• Clear and constant communication with the
Chapter Executive
• Goals strategic, within available resources,
clearly delegated, set with timeline and a review
process
• Conducts performance reviews of Chapter
Executive
Responsibilities of a Chapter
Executive
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Operations
Financial Services
Data and Document record keeping
Governance assistance
Meeting and Event planning
Facilitate communication to/from members
Attend ACC Natl meetings for Chapter
Executives
*Full list in Chapter Operations Checklist Sample Contract
Responsibilities of a Governor-Elect
• Pay attention!
• Have regular phone calls/meetings with
current Governor & Chapter Executive
• Shadow Governors to mtgs when possible
• Develop transition plan with Governor,
Chapter Executive
• Read Natl/Chapter Emails and Updates
• Ask questions!
THE REWARDS OF A
JOB WELL DONE
THE REWARDS
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Professional educational growth
Professional visibility
Social contribution
Mentoring opportunity
Personal satisfaction
ALL DONE – NOW WHAT?
ACC Advocacy
Justin Beland, Senior Specialist, Grassroots Outreach and Development
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Regulatory
Payer Relations
Legislative (Federal/State)
Political Action Committee
(PAC)/Grassroots
Perceptions of Advocacy
• Not my job
• Someone else will take care of it
• I don’t have the time
• Nothing I do will make a
difference
The Reality Is…
• Advocacy is a partnership
• Policymakers need to hear from
you.
• Staff and lobbyists can’t speak
from experience; they aren’t
directly affected
• Physician leadership is critical
The “Coat of Credibility”
Most Trusted Occupations in the U.S.
The Harris Poll® #61, August 8, 2006
"Would you generally trust each of the following types
of people to tell the truth?"
Doctors – 85%
Police Officers – 76%
Clergymen – 75%
Judges – 70%
Members of Congress – 35%
Lawyers – 27%
Governors as Leaders
• Foster information flow to and from the
membership and national organization;
• Foster participation for College members at
the state level in College-related activities;
• Encourage representation by the College in
state medical association policymaking bodies,
councils or medical specialty societies; and
• Create value for members
Advocacy Staff
• Provide policy expertise, analysis of issues,
particularly as they coincide or differ from ACC policy,
and guidance
• Collaborate in developing the message and strategy
with appropriate allies (AMA, Alliance of Specialty
Medicine, etc.)
• Steer the state chapters to appropriate local
collaborators and allies
• Provide the “toolkits” to ease participation
• Measure level of participation
State/National Partnership
ACC Advocacy staff partners with chapters to coordinate state
government relations efforts. ACC Advocacy assists our chapters
in a number of ways, including:
• Grassroots mobilization
• Legislative tracking and analysis
• Lobbying and legislative strategy
• Planning and executing lobby days
• Preparing and presenting legislative testimony
• Building relationships with policymakers: “Cardiologist for a
Day”; policy panels; promoting ACC quality
programs; political involvement;
• Strategic coalition development: medical society; physician
specialty groups; American Heart Association; industry
What Can You Do Right Now?
• Review/Comment on OSCAR
(www.acc.org/OSCAR)
• Join the ACC’s CardioAction
Network (CAN) (www.acc.org/can)
• Contribute to ACC’s PAC
• Write or (preferably) Meet Your
Legislator
What Can You Do Right Now?
The ACC Legislative ConferenceSept. 14-16, Washington, D.C.
• Analysis of complex health policy issues
• Meetings with legislators and regulatory
experts
• Political experts, seasoned policy veterans
• Networking opportunities with colleagues
Justin Beland
Senior Specialist, Grassroots Outreach
and Development
202.375.6222
jbeland@acc.org
TOOLS TO HELP YOU
Resources for All Governors
• BOG Meetings
– (Jan Leadership Forum, Mar ACC Sci Session, Sept
Legislative Conference)
• ACC National Staff
• BOG Update Weekly E-Newsletters
• Dedicated website – member.acc.org/oscar
– OSCAR - Online System for Chapter to Access
Resources
• BOG Steering Committee
• Fellow Governors
• Target emails
Additional Resources for Chapters
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Chapter Executive
Chapter Council
Chapter Operations Check List
Financial Management Templates
ACC Chapter Staff
ACC Advocacy Staff
Tips
• Set STRATEGIC achievable GOALS with
timeline and review process
• Have scheduled times for touchbase with
Chapter Executive and Council
• Give 20 mins/day to Chapter business
• Check e-mail daily
• Create energized team around you
• Delegate
• Run organized meetings and calls with
expected action items
Lifelines
• Chapter Executive
• ACC Chapter Staff
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Kristin Try, Sr. Director (Ext. 6996)
Jayne Purcell Jordan (Ext. 6609)
Helen Smith (Ext. 6269)
Taryn Gold (Ext. 6248)
• BOG Chair
– George P. Rodgers (3/07 – 3/08) grodgers@biophysical.com
– Jane E. Schauer (3/08 – 3/09) jschauer@phs.org
– John G. Harold (3/09 – 3/10) John.harold@cshs.org
• Other Governors
• BOG Steering Committee
BOG GOALS