AMA president-elect: Physicians must present ‘unified voice’ when advocating for patients, one another

Barbara L. McAneny

Barbara L. McAneny, MD, will be the first oncologist to lead the AMA when she assumes the association’s presidency next year.

AMA members chose McAneny as the association’s president-elect 5 months ago, and she will begin her 1-year term as president in June.

“I was thrilled and a bit overwhelmed with the responsibility that my peers have placed on me to take this message forward and try to make a positive change in our very confusing and very frustrating health care system,” McAneny told HemOnc Today. “I am determined to live up to everyone’s expectations.”

McAneny is cofounder and CEO of New Mexico Oncology Hematology Consultants Ltd., a multidisciplinary oncology practice. She also manages New Mexico Cancer Center, which provides outpatient medical and radiation oncology care and imaging in rural areas across the state.

McAneny — who previously served as ASCO’s delegate to AMA — has been on the association’s board of trustees since 2010 and served as its chairwoman from 2015 to 2016.

HemOnc Today spoke with McAneny about how her experience as an oncologist prepared her for this challenge, the priorities she has established for her term as AMA president, and her approach toward patient care.

Q: What will be your focus during your tenure as president-elect?

A: My focus will be the same as president-elect as it has been my entire career, which is making a health care system that works. My basic theory is that if we can make one work for poor people, the rich ones will be easy. We need to make a health care system that is affordable and provides care to every American, regardless of where they live, how much money they have or what pre-existing conditions they may have. This fits very well with the focus of the AMA.

Q : Can you elaborate on the priorities you will establish for your presidency?

A: The role of the AMA president is to be the spokesperson and also to make sure that not only physicians, but also patients and policymakers, know about the policies of the AMA. We have an incredible set of policies that have been created by the House of Delegates over the years. The House of Delegates are representatives of every state and every specialty society. Ideas are brought forth and debated, and I have always been incredibly impressed with the way the AMA can craft a sensible answer to difficult problems.

The AMA is working on the big issues. We are trying to reform medical education to meet the needs of the 21st century. The last time medical education has been reformed was more than 100 years ago. Chronic disease is now the issue we need to focus on in this country. We spend a great deal of money on managing chronic diseases, yet we do not do it well. The AMA is working on managing some of those diseases that are most prevalent in this country, such as diabetes and hypertension. We must eliminate a lot of the frustrations and impediments that exist for physicians to be able to do what they want to do, which is take care of patients. We need to come up with ways to eliminate a lot of the bureaucratic, administrative [and] frustrating experiences that are taking up physicians’ time. This will not only save money within the system, but also free up time for physicians to provide the patient care that they need to provide.

Q: What insights have you gained as an oncologist that will help you as AMA president?

A: Often times when someone describes a patient who is struggling to get the medical care they need, it is a person with cancer. When the media needs an example of someone who has a pre-existing condition and cannot get insurance, and their life has been adversely affected by our health care system with regard to delays in care and their disease progresses while they are trying to navigate their way through our convoluted system, it is a person with cancer. When we hear about the high costs of prescription drugs and how people are going bankrupt trying to buy these drugs, it often is a person with cancer. Cancer is the ‘canary in the coal mine’ for all of the ills of the health care system. If we can make the health care system work for people with cancer — particularly those with limited resources, people of all races and ethnicities, and those who have economic disadvantages — then we will have a health care system that works for everyone across all specialties, with all diseases.

Q: You and your colleagues implemented an innovative approach to reduce hospital stays for individuals with cancer who undergo chemotherapy. Can you describe it?

A: In 2012, I received a $19 million Medicare and Medicaid Innovation Center award for the Community Oncology Medical HOME. When a patient is admitted to the hospital, their quality of life often is never as good as it was before they were admitted. They become infected with MRSA or vancomycin-resistant Enterococci, or they get deep vein thrombosis, and they simply start to decondition. Also, keeping patients in the hospital is expensive and wipes out a family’s resources.

We wanted to try to keep patients out of the hospital for their physical and emotional well-being, but also for their financial well-being. We identified the triggering effect of someone being placed in the hospital — like a high fever for a patient who has undergone chemotherapy — and we figured out that, if we intervened early, we would be able to treat those patients in the office, prevent any additional hospitalizations, complications and re-admissions, and allow the patient to spend more time in their home with the people they love instead of the hospital. CMS was very interested in the fact that we saved a lot of money while improving the quality of care and the quality of patients’ lives.

For the innovative approach, we worked with six other oncology practices to implement triage pathways, an electronic decision support tool that helps nurses on the phone know the right answer to give to patients who call with various problems to get them care at the appropriate site of service. We successfully did this across the practices and estimated we saved about $4,000 per patient. This helped to shape the Oncology Care Model.

However, the value of what we did extends beyond cancer. It shows that, if physicians are given resources, they know what they need to do to keep their patients healthier and out of the hospital and save money. If we can give endocrinologists, pediatricians and gastroenterologists the resources they need, they will be able to come up with a system like this to keep people healthier and improve care. One of the major areas the AMA is focused on is alternative payment models that will allow every physician in every setting and every part of the country to be able to improve how they are paid in relation to what they do.

Q: Drug pricing in the United States has been the subject of extensive debate. What must happen for change to occur?

A: The AMA has set up a website, www.truthinrx.org, to look at drug pricing. We also have a team looking at these prices. Drug pricing, to paraphrase our president, is complicated. There are a lot of people between the manufacturer and the end user. We need to follow the money trail, understand what functions — such as research and development — are essential and valuable, and what functions — such as direct-to-consumer advertising and pharmacy benefit managers — are not adding value. Then we can develop a rational way of pricing drugs.

Q: President Trump declared the opioid crisis a national public health emergency. How can the AMA help address this epidemic?

A: The AMA has been very active in this. The association created a program along with other physicians to provide education to make opioid prescriptions much more safe and rational. Since 2015, the AMA has been working with 25 physician organizations, 17 specialty societies and seven state medical societies as part of the AMA Task Force to Reduce Opioid Abuse. The task force focuses on identifying best practices to combat this public health epidemic and working quickly to implement these practices across the country. Because of the work that the AMA has done, physicians are using the prescription drug monitoring program and limiting the number of opioids that are prescribed for sprained ankles, headaches and other symptoms. The AMA also is concerned that patients who have pain are not stigmatized and have pain that is out of control because people are afraid to prescribe drugs that work. We are working hard to find a balance. In addition, we need to have more physicians that are trained in addiction medicine. Many of our patients on opioids who are ready to come off of pain medication do so with no issues. However, some patients have difficulty, and many have difficulty finding a physician who is trained to help them get off opioids. We need to focus on this shortage of addiction therapy in this country, as well.

Q: How can the AMA help address the looming physician shortage , as well as prevent or reduce physician burnout to ensure the emotional well-being of those already in the workforce?

A : Physician burnout is a major problem. We do not have enough physicians right now and, with the looming shortage across medical disciplines, we will need to keep all physicians as productive as possible. We have a very specific shortage of physicians, particularly in rural and inner-city areas. If physicians are burning out and leaving their career to do something else, this is a tragedy. The AMA conducted a study with RAND Corporation as part of the association’s professional satisfaction and practice sustainability initiative. One of the things we learned is that the electronic health record is a [potential contributor to] burnout because it speaks to the documentation requirements, administrative burden, and all things that drive physicians crazy and take them away from their patients. We need to do away with a lot of these impediments.

Additionally, the prior authorization process adds to burnout every time you have to play ‘Mother May I?’ with the insurance companies before treating a patient. They do not normally turn us down but we have to jump through hoops, and this is incredibly frustrating. Physicians also feel a loss of control. They want to be able to treat their patients while working well with other team members, and these goals are not always the same goals of the hospital administrator who is employing them or the large corporation for which they are working.

There is a lot of frustration built into working for someone who does not have the patient’s best interest at heart. There is a lot we can do at the AMA and other societies to address these factors. Some of this will require a lot of restructuring in terms of how our health care delivery system works. What I do not want to do is blame the doctors and try to teach them to be satisfied in a flawed system. I want to change the system

Q: Where does the field of medicine stand in such an uncertain legislative time ?

A: Physicians need to be in better charge of health care. I do not see it being delivered very well in the current system. We are working in a system that is very lucrative for large health plans, hospitals and big pharmaceutical companies. It is very difficult for individual patients and the doctors who care for them. This is the time for the AMA to lead the way with every specialty society and every doctor — member or nonmember — to put aside our small disagreements about what our specialty needs vs. what other specialties need and focus on the big picture. How are we going to create a health care delivery system that is affordable and equitable, and gives the right care to the right patient in the right setting? This is crucial.

Q: Is there anything else that you would like to mention?

A : One of the things I have learned during my career in organized medicine is that, when doctors advocate for one another and for patients rather than out of economic self-interest, we are unstoppable. One of the huge values of the AMA is that it brings together all specialties. Oncologists should certainly understand that none of us can do what we do without other doctors doing what they do. We need to work together, advocate for one another, and make sure that we present a unified voice for the other forces that are trying to shape the health care system. – by Jennifer Southall

Reference:

Friedberg MW, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. RAND Corporation. 2013. Available at https://www.rand.org/pubs/research_reports/RR439.html.

For more information:

Barbara L. McAneny, MD, can be reached at New Mexico Oncology Hematology Consultants Ltd., 4901 Lang Ave NE Ste 202, Albuquerque, NM 87109.

Disclosure: McAneny reports no relevant financial disclosures.

Barbara L. McAneny

Barbara L. McAneny, MD, will be the first oncologist to lead the AMA when she assumes the association’s presidency next year.

AMA members chose McAneny as the association’s president-elect 5 months ago, and she will begin her 1-year term as president in June.

“I was thrilled and a bit overwhelmed with the responsibility that my peers have placed on me to take this message forward and try to make a positive change in our very confusing and very frustrating health care system,” McAneny told HemOnc Today. “I am determined to live up to everyone’s expectations.”

McAneny is cofounder and CEO of New Mexico Oncology Hematology Consultants Ltd., a multidisciplinary oncology practice. She also manages New Mexico Cancer Center, which provides outpatient medical and radiation oncology care and imaging in rural areas across the state.

McAneny — who previously served as ASCO’s delegate to AMA — has been on the association’s board of trustees since 2010 and served as its chairwoman from 2015 to 2016.

HemOnc Today spoke with McAneny about how her experience as an oncologist prepared her for this challenge, the priorities she has established for her term as AMA president, and her approach toward patient care.

Q: What will be your focus during your tenure as president-elect?

A: My focus will be the same as president-elect as it has been my entire career, which is making a health care system that works. My basic theory is that if we can make one work for poor people, the rich ones will be easy. We need to make a health care system that is affordable and provides care to every American, regardless of where they live, how much money they have or what pre-existing conditions they may have. This fits very well with the focus of the AMA.

Q : Can you elaborate on the priorities you will establish for your presidency?

A: The role of the AMA president is to be the spokesperson and also to make sure that not only physicians, but also patients and policymakers, know about the policies of the AMA. We have an incredible set of policies that have been created by the House of Delegates over the years. The House of Delegates are representatives of every state and every specialty society. Ideas are brought forth and debated, and I have always been incredibly impressed with the way the AMA can craft a sensible answer to difficult problems.

PAGE BREAK

The AMA is working on the big issues. We are trying to reform medical education to meet the needs of the 21st century. The last time medical education has been reformed was more than 100 years ago. Chronic disease is now the issue we need to focus on in this country. We spend a great deal of money on managing chronic diseases, yet we do not do it well. The AMA is working on managing some of those diseases that are most prevalent in this country, such as diabetes and hypertension. We must eliminate a lot of the frustrations and impediments that exist for physicians to be able to do what they want to do, which is take care of patients. We need to come up with ways to eliminate a lot of the bureaucratic, administrative [and] frustrating experiences that are taking up physicians’ time. This will not only save money within the system, but also free up time for physicians to provide the patient care that they need to provide.

Q: What insights have you gained as an oncologist that will help you as AMA president?

A: Often times when someone describes a patient who is struggling to get the medical care they need, it is a person with cancer. When the media needs an example of someone who has a pre-existing condition and cannot get insurance, and their life has been adversely affected by our health care system with regard to delays in care and their disease progresses while they are trying to navigate their way through our convoluted system, it is a person with cancer. When we hear about the high costs of prescription drugs and how people are going bankrupt trying to buy these drugs, it often is a person with cancer. Cancer is the ‘canary in the coal mine’ for all of the ills of the health care system. If we can make the health care system work for people with cancer — particularly those with limited resources, people of all races and ethnicities, and those who have economic disadvantages — then we will have a health care system that works for everyone across all specialties, with all diseases.

PAGE BREAK

Q: You and your colleagues implemented an innovative approach to reduce hospital stays for individuals with cancer who undergo chemotherapy. Can you describe it?

A: In 2012, I received a $19 million Medicare and Medicaid Innovation Center award for the Community Oncology Medical HOME. When a patient is admitted to the hospital, their quality of life often is never as good as it was before they were admitted. They become infected with MRSA or vancomycin-resistant Enterococci, or they get deep vein thrombosis, and they simply start to decondition. Also, keeping patients in the hospital is expensive and wipes out a family’s resources.

We wanted to try to keep patients out of the hospital for their physical and emotional well-being, but also for their financial well-being. We identified the triggering effect of someone being placed in the hospital — like a high fever for a patient who has undergone chemotherapy — and we figured out that, if we intervened early, we would be able to treat those patients in the office, prevent any additional hospitalizations, complications and re-admissions, and allow the patient to spend more time in their home with the people they love instead of the hospital. CMS was very interested in the fact that we saved a lot of money while improving the quality of care and the quality of patients’ lives.

For the innovative approach, we worked with six other oncology practices to implement triage pathways, an electronic decision support tool that helps nurses on the phone know the right answer to give to patients who call with various problems to get them care at the appropriate site of service. We successfully did this across the practices and estimated we saved about $4,000 per patient. This helped to shape the Oncology Care Model.

However, the value of what we did extends beyond cancer. It shows that, if physicians are given resources, they know what they need to do to keep their patients healthier and out of the hospital and save money. If we can give endocrinologists, pediatricians and gastroenterologists the resources they need, they will be able to come up with a system like this to keep people healthier and improve care. One of the major areas the AMA is focused on is alternative payment models that will allow every physician in every setting and every part of the country to be able to improve how they are paid in relation to what they do.

PAGE BREAK

Q: Drug pricing in the United States has been the subject of extensive debate. What must happen for change to occur?

A: The AMA has set up a website, www.truthinrx.org, to look at drug pricing. We also have a team looking at these prices. Drug pricing, to paraphrase our president, is complicated. There are a lot of people between the manufacturer and the end user. We need to follow the money trail, understand what functions — such as research and development — are essential and valuable, and what functions — such as direct-to-consumer advertising and pharmacy benefit managers — are not adding value. Then we can develop a rational way of pricing drugs.

Q: President Trump declared the opioid crisis a national public health emergency. How can the AMA help address this epidemic?

A: The AMA has been very active in this. The association created a program along with other physicians to provide education to make opioid prescriptions much more safe and rational. Since 2015, the AMA has been working with 25 physician organizations, 17 specialty societies and seven state medical societies as part of the AMA Task Force to Reduce Opioid Abuse. The task force focuses on identifying best practices to combat this public health epidemic and working quickly to implement these practices across the country. Because of the work that the AMA has done, physicians are using the prescription drug monitoring program and limiting the number of opioids that are prescribed for sprained ankles, headaches and other symptoms. The AMA also is concerned that patients who have pain are not stigmatized and have pain that is out of control because people are afraid to prescribe drugs that work. We are working hard to find a balance. In addition, we need to have more physicians that are trained in addiction medicine. Many of our patients on opioids who are ready to come off of pain medication do so with no issues. However, some patients have difficulty, and many have difficulty finding a physician who is trained to help them get off opioids. We need to focus on this shortage of addiction therapy in this country, as well.

Q: How can the AMA help address the looming physician shortage , as well as prevent or reduce physician burnout to ensure the emotional well-being of those already in the workforce?

A : Physician burnout is a major problem. We do not have enough physicians right now and, with the looming shortage across medical disciplines, we will need to keep all physicians as productive as possible. We have a very specific shortage of physicians, particularly in rural and inner-city areas. If physicians are burning out and leaving their career to do something else, this is a tragedy. The AMA conducted a study with RAND Corporation as part of the association’s professional satisfaction and practice sustainability initiative. One of the things we learned is that the electronic health record is a [potential contributor to] burnout because it speaks to the documentation requirements, administrative burden, and all things that drive physicians crazy and take them away from their patients. We need to do away with a lot of these impediments.

PAGE BREAK

Additionally, the prior authorization process adds to burnout every time you have to play ‘Mother May I?’ with the insurance companies before treating a patient. They do not normally turn us down but we have to jump through hoops, and this is incredibly frustrating. Physicians also feel a loss of control. They want to be able to treat their patients while working well with other team members, and these goals are not always the same goals of the hospital administrator who is employing them or the large corporation for which they are working.

There is a lot of frustration built into working for someone who does not have the patient’s best interest at heart. There is a lot we can do at the AMA and other societies to address these factors. Some of this will require a lot of restructuring in terms of how our health care delivery system works. What I do not want to do is blame the doctors and try to teach them to be satisfied in a flawed system. I want to change the system

Q: Where does the field of medicine stand in such an uncertain legislative time ?

A: Physicians need to be in better charge of health care. I do not see it being delivered very well in the current system. We are working in a system that is very lucrative for large health plans, hospitals and big pharmaceutical companies. It is very difficult for individual patients and the doctors who care for them. This is the time for the AMA to lead the way with every specialty society and every doctor — member or nonmember — to put aside our small disagreements about what our specialty needs vs. what other specialties need and focus on the big picture. How are we going to create a health care delivery system that is affordable and equitable, and gives the right care to the right patient in the right setting? This is crucial.

Q: Is there anything else that you would like to mention?

A : One of the things I have learned during my career in organized medicine is that, when doctors advocate for one another and for patients rather than out of economic self-interest, we are unstoppable. One of the huge values of the AMA is that it brings together all specialties. Oncologists should certainly understand that none of us can do what we do without other doctors doing what they do. We need to work together, advocate for one another, and make sure that we present a unified voice for the other forces that are trying to shape the health care system. – by Jennifer Southall

Reference:

Friedberg MW, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. RAND Corporation. 2013. Available at https://www.rand.org/pubs/research_reports/RR439.html.

For more information:

Barbara L. McAneny, MD, can be reached at New Mexico Oncology Hematology Consultants Ltd., 4901 Lang Ave NE Ste 202, Albuquerque, NM 87109.

Disclosure: McAneny reports no relevant financial disclosures.