Susan E. Wiegers, MD, FASE

The healthcare world is changing at a rapid pace. With the adoption of the Affordable Care Act, healthcare is moving away from the fee-for-service model to value-based models based on patient outcomes. These include Accountable Care Organizations, Patient-Centered Medical Homes, and other care models, which are focused on innovative payment and service delivery models intended to reduce expenditures, while aiming to preserve or improve the quality of care. These models are complicated and not yet fully developed, much less adopted. The current environment requires all of us and the ASE to work efficiently within the current model but have input into the new models of care.

In terms of the current environment, ASE has dedicated significant resources to ensure that echocardiography remains accessible to our patients. Since being retained by the Society, ASE’s lobbyist Peggy Tighe has worked tirelessly to position herself as the point person on echo on the Hill to make our members’ voices heard. With her contacts and guidance, ASE has been able to take our message to the members of Congress that influence policy. When Congress was negotiating the permanent repeal of the Sustainable Growth Rate (SGR), which has been criticized since its passage 10 years ago, she was in contact with key staff members to ensure that cuts to echo would not be used to fund this historic piece of legislation. When Congress was crafting the Appropriate Use mandate that established burdensome administrative requirements to imagers, she was able to prevent echocardiography from being included under the definition of “advanced cardiac imaging.” Therefore, for now, the burdensome regulations do not include echocardiography.

We also were able to attain full delegate status within the American Medical Associations’ (AMA) House of Delegates in 2013. This is critical because this is the only way for echocardiography to be represented before the AMA/Specialty Society Relative Value Scale Update Committee (RUC) and the Current Procedural Terminology Panel (CPT). The committees make recommendations for Relative Value Unit (RVU) and CPT code changes. Despite the pressure to decrease RVU for many procedures, ASE has successfully led efforts to increase the RVU for TTE by documenting the need for the “ultrasound room” and established a new interventional TEE code as well the recent establishment of a new myocardial strain imaging code.

For the future, it is really key that echocardiography has a voice in the development of new care models. Since many echocardiograms are done every year in this country, even a comparatively inexpensive tests winds up on the radar screen of regulators because of the price tag. This is where the issue of value is essential. Through ASE’s membership in the Alliance of Specialty Medicine and our lobbyist’s visibility on the Hill, and thanks to the personal efforts of key ASE member’s during lobbying “fly-ins” (which Tighe arranged), ASE has also increased its visibility and is now regularly contacted by legislators and regulators asking for comment on key legislation and policy initiatives. The Alliance’s round table events and communication resources provide additional means to drive policy in Washington. Having ASE’s CEO, Robin Wiegerink, invited to the White House ceremony in April for the signing celebration of the permanent repeal of the SGR is a true honor. It also reflects the Society’s status as a recognized political entity in Washington, the only one solely dedicated to cardiovascular ultrasound imaging.

This past September the ASE Foundation hosted the first of its kind Value-Based Healthcare Summit. The forum featured speakers and panelists from across the healthcare spectrum offering their perspective on the transition to value-based healthcare, with a focus on the role of cardiovascular ultrasound in the changing environment. Proceedings from this event have been published in the July issue of JASE ( http://www.onlinejase.com/article/S0894-7317(15)00379-X/fulltext ) and are serving as a resource to the community to help our members and others advocate for the value of echo in patient care. It is the goal of our organization, through the efforts of its officers, Advocacy committee, lobbyist, and most importantly our members, to make sure that echocardiography remains accessible to the patients who need it and that its use is not inappropriately restricted.

Susan E. Wiegers, MD, FASE is Senior Associate Dean of Faculty Affairs and a Professor of Medicine at Temple University School of Medicine.