"To reform means to shatter one form and to create another."

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Spanish philosopher George Santayana gets to the root of why people fear reform in any milieu; to reform a system will require a change in the method of operations. However, at this juncture of American politics, healthcare delivery system reform seems imminent, and executives at the American College of Cardiology (ACC) this week intensified their participation in the ongoing debate.

ACC President Dr. Alfred Bove responded to a recent policy options paper on healthcare reform, issued by top Senate leaders, in a letter highlighting the ACC's stance on topics including linking payment to quality outcomes, hospital readmissions and bundling, health IT, comparative effectiveness research, transparency and medical liability reform.

Specifically, the college questioned the Senate Committee's proposal to rely upon radiology benefit managers or prior authorization programs as a means to obtain better imaging quality measures. Bove also urged the Committee to test approaches that could reduce the cost of defensive medicine and protect physicians participating in Medicare quality incentive programs.

Also, with its sights on reducing the costly problem of heart-related hospital readmission, the college announced that it is launching the "Hospital to Home" program with a goal of reducing preventable readmissions for heart failure and acute MI by 20 percent by the end of 2012.

However, system-wide reform often can be positively or adversely affected by individuals. A recent New England Journal of Medicine perspective suggested that physicians should play a leading role in achieving U.S. healthcare reform. The authors believe that this entails changing the way healthcare is paid for and delivered, helping achieve a guaranteed 1.5 percent annual cost savings.

The authors suggested that physicians could champion to eliminate waste and avoidable complications through "innovative payment models" including shared savings, bundled payments, or global fees for primary, acute or comprehensive care, as well as performance measures that promote care coordination.

While these changes may cause jitters among practitioners, unlike Santayana's concept of reform, the proposals for healthcare reform do not require a "shattering" of current procedures, but instead new approaches to current processes.

On these topics, or any others, feel free to contact me.

Justine Cadet