An Rx for the health care system
ABQ’s Barbara McAneny has bold agenda as president-elect of nation’s biggest physician group
Almost every American cares about access to quality health care and its ever increasing cost. Albuquerque oncologist Barbara McAneny, president-elect of the American Medical Association, shares her vision for making the system work for patients — not profits — in this interview with Journal senior editor Kent Walz.
Dr. Barbara McAneny turns from cheerful to intense as she talks about the two things she spends her life fighting: the cancer that attacks her patients and a health care system she says costs too much, delivers too little and puts too much money in the wrong pockets. Actually, fierce is more accurate. “We are the most expensive health care system on the planet, yet we rank 19th among industrialized nations on the quality of our lives for those things health care can affect — like how long you live and infant mortality,” the Albuquerque oncologist and president-elect of the American Medical Association said in a recent interview.
Why the disconnect?
“Because the system is perfectly designed to concentrate wealth and power in the hands of large institutions. There’s a lot of money in our system but it’s going to the wrong places — hospitals, health plans and insurance companies. Meanwhile, doctor practices are going out of business.”
McAneny said attempts to solve the problem have “made it worse because we have layers and layers of bureaucracy chasing every dime. And each of these layers is full of well-paid people.”
Outspoken and passionate with a
touch of “Irish” temper — the opposite of what one might expect from a one-time math major turned physician — McAneny will have a big megaphone for those views when she assumes the presidency next June of the nation’s oldest and largest physician group.
The president, CEO and driving force behind the New Mexico Cancer Center, McAneny became president-elect of the AMA, founded in 1847 with 240,000 members and publisher of the highly regarded Journal of the American Medical Association, or JAMA, by defeating a primary care physician from Pennsylvania.
“I’m the first oncologist, fourth woman and first New Mexican,” she says.
Despite her new duties — she was scheduled for appearances in Chicago, Washington, D.C., and Montana within days of this interview — McAneny still sees cancer patients in Albuquerque and Gallup, working to help them with the physical, emotional and financial challenges of cancer.
“Cancer isn’t just one disease; it’s hundreds,” she says, pointing out that cancer patients often are sick for an extended period of time as they undergo treatment and say they go bankrupt twice as often as those with other diseases.
That’s one reason McAneny and her partners have done groundbreaking work in developing systems so patients can stay at home during their treatment, and to help them with the financial hurdles.
“We have three people working here who we pay to find free drugs for patients because people with high deductible health plans can’t afford their chemotherapy. Some of the new wonder drugs that are oral are in the insurance company pharmacy benefit, which means patients are supposed to pay 20 percent. That can be $1,000 a month. So we pay people to find the money through co-pay foundations.”
NM love story
McAneny describes herself as a Midwestern “transplant,” born in Kansas City and graduating cum laude from the University of Minnesota with a math degree before enrolling in medical school at the University of Iowa where she studied internal medicine and did her residency.
She was in college studying math and computer technology when she realized she didn’t want to spend her life in front of a computer terminal.
“I was too much of a people person,” she recalled in a “Local Legends” biography published as part of a celebration of America’s women physicians.
One of three children, McAneny grew up in a college town where her father taught physics and was dean of Science and Technology at Southern Illinois University. Her mother taught math there.
McAneny came to New Mexico to check out a fellowship at the University of New Mexico in 1980 — partly because “I really wanted to get away from those Midwestern winters.”
“I spent a week traveling around northern New Mexico and fell in love with the people, the diversity of the people, what the state looked like, the weather, the food, of course, and decided this is where I wanted to live.”
“I figured out early on in my medical career that what I wanted to do was take care of patients,” she said.
“I really wanted to go to a place where there was significant need, which there is in New Mexico.”
“I think New Mexico is the canary in the mine for what’s going on across the country. It’s long been my theory that if you want a health care system that works, if you can make it work for poor people the rich ones will be easy.”
The need level and the difficulty in navigating health care is one of the reasons for McAneny’s widely recognized innovation — COME HOME — a system designed to let cancer patients stay at home and out of the hospital as much as possible. It has since become the basis for Medicare’s Oncology Care Model.
“If we can keep people out of the hospital, they do better. What prompted me to set up COME HOME is that every time a cancer patient went into a hospital they came out a little worse. They never regained all their strength. There are complicating infections, blood clots, bedsores or they just lose muscle mass.”
It’s better if “people get to spend the night at home in their own bed, be with the people they love and still get the care they need.”
“So we (New Mexico Cancer Center) know their meds and their needs and we try to figure out ways to intervene before a triggering event that might require them to go to the hospital.”
Patients can call here, she said, and “talk to a human being, hopefully by the fourth ring.”
An added benefit: “We are saving the system a huge amount of money.”
“What stimulated me was patients telling me they were going broke. That’s why we also have a foundation. We pay people’s rent when they can’t work because they are sick. Patients told me they were sick and didn’t have the energy to make a phone call and navigate the system. So we built this practice along the premise that all the patient should have to do is show up. And we’ll even help them do that.”
The cancer center staff makes appointments for imaging tests and blood work and insurance authorizations.
Thousands of New Mexicans have had firsthand experience with McAneny, her partners and staff — about 200 employees in all. The practice has seen about 87,000 patients since it opened in 2002 and sees between 3,000 and 4,000 new patients a year.
Hospital questions
McAneny, of course, agrees that hospitals are necessary.
“We’ll always need a place for emergency care and trauma and complicated surgeries. If you need open heart surgery you need a hospital to manage you until you’re well enough to get on your feet. But what hospitals get used for is for failures of the chronic disease management system to keep people healthy.”
Asked her thoughts on the push for a new University of New Mexico hospital, she responded, “I do not believe we need more hospitals. …We really should be investing our resources in primary care and having enough doctors out where the people are. …”
“So I think building more and more hospital beds is not a good sign. Now I understand that the UNM hospital is very old and run down, but they just built a new one in Sandoval County and there is a big new Presbyterian hospital practically across the street from it.
“Look under a crane in most cities and you’ll find either a health plan or a hospital, and that’s not where we should be spending our resources.”
‘Trained denial personnel’
As for health insurance companies, McAneny thinks they should be nonprofit and says the AMA favors individually owned health insurance — “Why as an employer should I be in the middle of your health insurance" — that is subsidized by tax credits. The cost would be geared to a percentage of income and the tax credits would be refundable in advance for lowincome people.
McAneny’s New Mexico Cancer Center accepts all insurance, but in reality some companies try to steer their members into their own system or systems they have deals with. The cancer center has been locked in a five-year antitrust lawsuit against Presbyterian.
She also wrangles with health insurance companies as an employer and says she goes through the same ritual every year — companies want more for premiums at the same time they want higher deductibles and co-pays for her employees.
Her rocky relationship with the health insurance industry comes to fore when McAneny is asked about the best and worst things in a distinguished career that includes a host of awards and recognitions. The best? “Helping patients through the scariest thing that ever affected them. Oncology is amazing in that way. As a cancer doctor when people are facing something that scary you get to know them really well. That is such a privilege.” The worst? “Fighting with insurance companies to get patients what they want. Being on the phone, I have been less than polite on many occasions when the Irish temper kicks in because I am faced with a bureaucracy of what I call ‘the trained denial personnel’ whose job is to say no, no, no. Trying to get over that barrier is the hardest thing.”
Pre-existing conditions
McAneny says that along with Medicaid expansion covering more people, prohibiting companies from denying coverage over pre-existing conditions was one of the ills Obamacare did fix.
“I saw this as a cancer doctor many times. People would come in thinking they had insurance and then the insurance company would say, ‘Oh, you didn’t put on your application that you saw a dermatologist three years ago for a zit, so now you don’t have coverage.’ We would see patients who had been cured of their cancers who could never get insurance again. So you get cured of breast cancer in your 40s but by the time you needed somebody to take care of your heart attack in your 60s you were out of luck because you once had cancer.”
“We have a bunch of people here at this practice whose job is to fight with insurance companies for what we are owed, and to resubmit claims.”
But she acknowledges the problems with Obamacare, including high deductibles that in reality mean people “who don’t have two nickels to rub together” find out they really don’t have insurance when they need it.
“Two-thirds of the bankruptcies in this country are related to medical issues,” she said, “and two-thirds of those people have insurance.”
Gallup clinic
The New Mexico Cancer Center’s Gallup clinic, where about 40 percent of the patients are Native Americans, is near and dear to McAneny’s heart.
She and her partners — whom she frequently praises — opened the center several years ago “when we realized that when we were treating a patient who was Navajo or Hopi or Zuni they would come to town and stay for about half a course of treatment and then go home.
“You don’t cure anybody with half a course of treatment, so we weren’t doing a very good job for them.”
Attempts to keep them with hotel vouchers and gas cards didn’t work, so “we figured if you can’t bring people to health care, you take health care out to where the people are.”
“So we put a cancer center there. It struggled for many years and is now breaking even. We made it beautiful and put a traditionally built hogan in the front as a signal to people that we would show them the respect they deserve.”
“We’re now there five days a week and busy all five days. We have 25 to 30 patients a day for chemo and 10 to 15 for radiation. When I go out there to see patients, it’s a full day.”
And, yes, the president-elect of America’s largest doctor group hopes to continue being in the Gallup clinic rotation as time allows. She has told all of her patients that if they feel her new duties are interfering with their care they can move to another doctor in the group.
McAneny is married to retired nephrologist Steven P. Kanig, who travels with her and does IT work for the practice. He’s also the AMA delegate from New Mexico.
Sour note
When she’s not at work, McAneny describes herself as an avid reader — “policy stuff, historical fiction, spy novels, all kinds of stuff.” Bernard Cromwell’s historical fiction is a favorite and “on the elliptical every morning I treat myself to a novel.” As for other hobbies? She never played sports in school, doesn’t play golf now and has “absolutely zero musical talent. If I sing, people leave the room. I was the only kid I’ve ever heard of whose piano teacher asked if she could quit.”
She gave up the piano, but she isn’t giving up her quest to reshape the health care system.
Her campaign message for the AMA presidency was: “We need to transform the system from one focused on concentrating profits and power in the hands of institutions to one that is directed by physicians and gets back to focusing on patients.”
Is health care, she asks, “Something that should be providing double digit profits for venture capitalists?”
As she ascends to the presidency of American’s premier physician group, she also has a message to her colleagues in New Mexico: “We are reconstructing health care in this country. If you want to have a say and be a part of how we shape the rest of your careers, you need to come and join me as an AMA member and spend a little bit of time thinking about what the future ought to be like and help us shape it — instead of letting the people with money and power shape it.”
Face to Face is a feature by senior editor Kent Walz, who periodically sits down for a chat with a newsmaker. You can contact Walz at kwalz@abqjournal.com.