Barbara McAneny, MD
The practice of medicine has undergone innumerable changes since Barbara McAneny, MD, graduated from medical school 40 years ago. Diagnostics have improved, treatments have improved, and patients are living longer. But not all the changes have been positive. Regulations have proliferated, treatment costs have skyrocketed, and the control of medical decision making has largely shifted from doctors to hospital administrators and insurance companies.
Many doctors complain about such trends, but McAneny hopes she can help fix American healthcare’s shortcomings while also promoting its strengths, which is why she’s running for president of the American Medical Association (AMA).
McAneny has donated countless hours to various medical associations over the decades, honing her understanding of how they can get things done while working to limit public health hazards such as second-hand smoke. She has also succeeded in making her practice, New Mexico Cancer Center, demonstrate the feasibility of what many people believe to be the future of American healthcare: outcome-based compensation that improves patient health, reduces total healthcare costs, and provides fair compensation for physicians and nurses.
McAneny developed the Community Oncology Medical Home (COME HOME) practice model, implemented it at New Mexico Cancer Center, and helped to implement it at 6 other practices across the country. The program has generated several years’ worth of data indicating that the model improves outcomes and reduces total expenditures.
“Many physicians are skeptical about any transition to outcome-based payments. They worry that payers will pocket any savings from reduced hospitalizations while putting them on the hook for unexpected and unavoidably high costs. I understand that fear, but the pilot projects have shown such cost reductions and such health improvements that payers have a huge incentive to strike fair deals,” said McAneny, who is running against Stephen R. Permut, MD, JD, a family physician from Delaware.
The vote will be cast by the AMA’s House of Delegates during an annual meeting in Chicago, which will take place June 10 to 14. Permut is endorsed by groups such as the American Academy of Family Physicians and the American College of Physicians.
McAneny has strong support from ASCO and the American Society of Hematology.
“If compensation is fair, then outcome-based payment is great for physicians and patients alike,” McAneny said. “The current system forces medical practices to waste a huge amount of time and effort documenting services and requesting payment. It also pays nothing for many services that clearly help patients, things like telephone consultations or Barbara responding to patient e-mails. With outcome-based payments, practices don’t have to justify everything they do. The system automatically rewards physicians for providing any service that helps patient health and discourages them from providing any service that doesn’t. And that’s really what basically everyone should want.”
Analyses of trial programs funded after the ACA’s passage have concluded that most experiments using these basic ingredients simultaneously improve outcomes while reducing costs. One analysis of 7 oncology practices that adopted McAneny’s COME HOME blueprint reported a reduction of 10 ED visits and 3 hospitalizations per 1000 patients per quarter and a savings of $673 per patient per quarter.
Hospitals will likely fight the adoption of such programs for fear of reduced utilization of both ED and in-patient facilities, said McAneny, but she believes the AMA should still push to speed up the transition because it will be good for patients and physicians.
“Any substantial reform to an industry that represents a sixth of the nation’s entire economy will always be very difficult. Savings for 1 group of people represents lost livelihoods to another group of people,” McAneny said. “Outcome-based payment will almost become the norm at some point, though, because the nation simply doesn’t have the money to keep paying more for the same quality of care.”
McAneny also believes the AMA should do more to make use of another factor that could shift payment away from hospitals and toward physicians in private practice: site-of-service compensation differentials.
Hospitals in many markets have negotiated significantly higher payment rates for many types of diagnoses and treatments. This extra money, McAneny said, has allowed those hospitals to increase their lobbying power, upgrade their facilities in ways that independent physicians cannot afford, and pay physicians more than they can make in private practices that receive lower payments for the same work.