ACC Council on Academic Cardiology Section Meeting Joseph A. Hill, MD, PhD Marvin Konstam, MD March 10, 2013

1. ACC Council on Academic Cardiology Section Meeting Joseph A. Hill, MD, PhD Marvin Konstam, MD March 10, 2013 No disclosures

2. Current State of Affairs

3. US Job Losses in Recent Recessions

4. Focus on Deficit Reduction

5. Health care is the primary driver of future federal spending

6. Healthcare Expenditures • $2.7 trillion • $8,600 per person • 17-8% GDP • 45% is by federal, state, and local governments • Medicare $500B per year, 12% of federal budget

7. Workforce Needs • • Aging population • In just 14 months, 32 million additional Americans will enter the health care system with health insurance, just as the United States faces a shortage of physicians. • • For the next 19 years, 10,000 people a day will turn 65.

8. Workforce Needs • Physician shortage will reach 91,000 by 2020; • What is the right mix of primary care physicians versus specialists? • Role of mid-level providers? • Role of other professionals (e.g. nurses, pharmacists, counselors); • 43% of cardiologists are over 55 (worse in other specialties, such as family practice and internal medicine).

10. Cuts to Research

11. Debt Ceiling Delayed but Sequestration Started

12. Sequester Cuts • NIH 5.1% • GME 2% • Medicare 2%

13. Sequester • Cram $85B in across-the-board spending cuts into the seven months that remain of the fiscal year. • $30.7 billion National Institutes of Health will lose $1.6 billion; • National Science Foundation, more than $370 million; • Department of Energy’s Office of Science, $260 million; • NASA’s science budget, almost $270 million.

14. Sequester • Loss of 2,000 disease trackers supported by the Centers for Disease Control and Prevention might not become apparent until the next time Salmonella poisons peanut butter

15. Cuts to GME

17. Graduate Medical Education Total GME ≈$20B Medicare GME $9.5B • Direct $3B Resident salaries and supervisor costs • Indirect $6.5B Costs associated with running a training program; resident to bed ratio • MedPAC $3.5B too much • Simpson-Bowles minus $60B by 2020

19. Cuts to Medicare

21. What can we do?

26. Next steps…