Barbara L. McAneny, MD
In 2012, the federal Centers for Medicare and Medicaid Innovation (CMMI) sought to support oncologists in addressing what CMMI considered to be among the failings in cancer care— namely, fragmented care, suboptimal outcomes, high costs, and patient dissatisffaction. To remedy these weaknesses, CMMI awarded $19.8 million to Innovative Oncology Business Solutions (IOBS), Inc, in Albuquerque, NM. Barbara L. McAneny, MD, an oncologist, is the CEO and chief medical officer for IOBS, the company she launched to manage the Community Oncology Medical Home (COME HOME) program.
Board certified in internal medicine, oncology, and hematology, McAneny is a founding member of New Mexico Oncology Hematology Consultants and a former president and CEO of New Mexico Cancer Center, one of the state’s largest oncology practices.
The practice has a staff of 208, including 10 medical oncologists, 3 radiation oncologists, 1 hospitalist, 2 internists and a retired emergency department physician. We asked her to explain what outcomes the COME HOME program expects to deliver.OBM:
Congratulations on the CMMI grant, under which you and oncologists in 7 practices in 6 states are testing the COME HOME concept. CMMI has set some rather high goals for the program, saying it expects the savings after 3 years will total $33.5 million. Can you discuss the outcomes you’ve seen so far?McAneny:
Yes. To date, we have implemented the triage pathways in all 7 practices. And, we have developed and are implementing our own diagnostic and therapeutic pathways. Even though it’s early to get patient outcomes, we’re beginning to see hospitalization rates from a couple of practices drop by as much as 30 percent. So that is excellent.OBM:
Are we on track to save what CMMI projects?McAneny:
Yes. We don’t know that yet. One of the difficulties we’ve faced is getting data from the federal Centers for Medicare & Medicaid Services (CMS). That data lag well behind the years when CMS collects the data. We’re starting to get files from 2012 and early 2013. Therefore, we are unable to compare real-time data with those from other practices. Ultimately, we want to compare what Medicare spent for cancer care in the past and what we are spending now.OBM:
While hospitalizations are down, do you know if imaging in emergency department visits are down as well, both of which are costly? McAneny: Yes, both of those components are very costly and those numbers do not include the costs of imaging in the emergency department (ED). Often when a cancer patient goes to the ED, the physicians almost automatically order images. Then if the patient needs imaging of a tumor, insurers may deny it because the patient just had one in the emergency department. So, that’s not helpful.OBM:
Is that situation indicative of the need for medical homes if oncologists can coordinate care more efficiently?McAneny:
Exactly. That’s one reason we do so much patient education. We’ve discovered that in some practices, patients don’t want to bother the doctors. They would rather sit home and feel miserable than call us. So we tell them, “Please, bother us! We want to know how you’re doing.” That’s one lesson we learned early: we need better patient education.
Another reason patients don’t come in is that they want to avoid making another co-payment. These are a barrier to care because these patients are in Medicare Advantage plans and they have deductibles and coinsurance. We can’t waive those payments because we are required by law to collect that money. Yet a number of people go bankrupt from the high costs and most of them are insured. So, they don’t come to the office when they should but if it gets to be 10 pm and they still feel bad, then they may need to go to the emergency department. Unfortunately, the co-payments and deductibles are even higher there, and that’s what we’re trying to avoid. When patients are very co-payment sensitive, it means the system isn’t working.OBM:
Before applying for the CMMI grant, did you do any research to know what you could accomplish for patients and what you might save?McAneny:
We didn’t do research exactly. We just took what I had developed in my own practice. Ever since we started the practice in 2002, we’ve been trying to figure out how to deliver highly efficient care. Patients are trying to navigate the system without any assistance because typically an oncologist will tell a patient to get some imaging done or meet with a surgeon and then can call to schedule an appointment. Then the patient has to figure out how to schedule a scan and get prior authorization from the insurance company. That delays treatment for maybe 2 months, and the patient gets discouraged and the tumor gets worse.