How physician leaders can drive change for the future: A conversation with Barbara McAneny

The many challenges facing community oncology practices today may sometimes feel overwhelming. However, it’s important to remember that no one practice is an island. Through networking, sharing best practices, collaborating and advocating together, practices can band together as a powerful force for change.

Barbara McAneny, MD, Immediate Past President and Board of Trustees member for the American Medical Association (AMA), has served as a leader and board member for several notable industry organizations, including  Community Oncology Alliance (COA) and the Cancer Center Business Summit. VitalSource™ GPO sat down with Barbara to discuss the vital role oncologists can play in innovating and shaping the direction of healthcare for the future.

Barbara McAneny: To survive these pressures in the marketplace, we need to be able to educate our patients, the public and employers about where costs originate and the differences between sites of care. For example, if a patient receives care at a hospital, they may pay more than double the cost they would pay for care provided in the community setting. This comes as a shock to many people and there is a lack of understanding.

As community practices, we need to ensure payers understand the impact of the physician fee schedule. Sharing savings is critical to maintaining the viability of independent practices. Over the last 15 years, hospitals have seen a market basket index increase of nearly 50 percent. However, the physician fee schedule has only increased six percent.

Individual practices should band together with other like-minded clinics that are facing similar challenges. Consider forming a clinically integrated network with other independent practices in your local community to approach payers and contract together.

There’s only so much you can do in your own market. Some issues are national and can’t be solved at the local level. For example, 340B hospitals purchase the most expensive supply at a significant discount and that is a competitive advantage. An issue of that magnitude needs national advocacy. Overall, it’s not sufficient to sit in your own practice and bemoan these challenges. I encourage practices to take a more active role and get involved.

Another important area to understand is your referral base. Figure out who is referring patients to you and how you can help to solve the challenges they have. Make it easy for your referring physicians to send patients to you and give other sites of care confidence that the patient will be well taken care of. 

In order for oncologists to become physician leaders, they need to broaden their scope and look outside of oncology. They will need to recognize that many other specialties are dealing with the same challenges and that other specialties feel isolated as well.

Organizations such as COA and AMA are working with state medical societies on behalf of oncologists to review payer issues and ensure that progress is being made. However, when lobbying for a change important in oncology, our strongest advocate may be another physician in a different specialty who doesn’t have an economic interest in our issue. In return, you need to understand the issues that other specialties face and be willing to speak on their behalf.

The important thing is to build those relationships and goodwill so that your fellow physicians will be there when you need them.

When I was starting out in my state medical society, the issue that was tearing everyone apart was an infant born with cerebral palsy and the malpractice lawsuit filed against the obstetrician. Even though this was outside of my specialty, I worked on the issue to educate the public that cerebral palsy is not created during the delivery of an infant, and that a better way to improve the health of babies was to ensure better prenatal care. By establishing the prenatal task force, I demonstrated that I am someone who is willing to look out for patients, not just interested in the economics of my own practice.

Physicians are able to participate in payment technical advisory committees, which were established as a part of MACRA. These committees offer physicians an opportunity to demonstrate great ideas for delivering better care, and these ideas are then forwarded on to the Centers for Medicare and Medicaid Innovation (CMMI).

We need doctors across the country and across all specialties to figure out what will work for the people they serve. What works for one physician in their state or local community may not work for patients in another community. We need to gather all of these ideas. We need to test and pilot these ideas because there is no perfect system and no one has all the answers.

I encourage physicians to take a step back and think about how reimbursement is molding the way you provide care. Think about what you could do better for your patients if you could arrange payment for your ideas.

We now know that a patient’s longevity is not influenced by which patients have the best doctors, but by their zip code. The social determinants of health – transportation, job, access to healthy food, etc. – significantly impact their well-being. As physicians, we can’t solve these challenges, but we do need to recognize their effects. We need to think outside the medical box to address the entire scope of issues our patients face. This only happens when we see each patient as more than their 15 minute visit and the cancer you’re treating.  

One doctor alone is not going to make a difference. When doctors join arms to improve the lot of our patients, we’ll have the attention of those who have the ability to make change happen.  

Most community oncology practices that have remained independent have the core functions of managing a practice down. However, we need to be more innovative when it comes to managing the care networks across the entire patient journey. If we wait for EMR software companies to come up with new ways to share information, we may be waiting a long time. Working with a variety of other specialties and sharing information, finding ways to streamline referrals, and networking with other physicians to share best practices and drive efficiencies is important.

When it comes to navigating care, if a patient needs a navigator to understand the healthcare system, we need a better system. We need to recognize that the patient should not have the sole responsibility of navigating their own care. It’s the job of the physician to provide the best care and to develop a practice that does not require a navigator. Navigation is a function not a job description. Helping patients at every step of the way needs to be hard-wired into your practice’s infrastructure. It should be job of your entire staff, not just one person with the job title of navigator.

Both physicians and practice managers can play an important role in setting practices up for future success. Practice managers they need to have a financial education and an understanding of basic accounting. They should know how to read ledgers and balance sheets and understand the language. 

The AMA just published a book called Physician Law: Evolving Trends and Hot Topics ( Wes Cleveland JD) and this is a great resource for physician leaders. We have to understand the rules of the game we are playing. 

Managing partners should take an active role in contract negotiations. They need to be a part of the process and explain to payers why they need independent practices and how they can help them meet their goals. Think about the needs of payers and how you can help them achieve their goals. We need to be better at negotiating. Overall, a managing partner’s role should be to understand where healthcare will be in 3-5 years and figure out how to get there first. 

Remember, you don’t have to reinvent every wheel on your own. Others have dealt with similar problems and they may have developed a solution. 

Physician resources from the AMA:

• Health care advocacy 
• Patient support and advocacy
• Practice management

Sign up

Connect with us to receive monthly Industry Insights in your inbox.