Combining Community Practice and Health Policy Advocacy 

A Conversation With Barbara L. McAneny, MD

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Barbara L. McAneny, MD, is a board-certified medical oncologist/hematologist with a robust community practice in Albuquerque, New Mexico. Dr. McAneny, who has held many leadership roles in oncology associations, became a delegate to the American Medical Association (AMA) from ASCO in 2002, was elected to the Board of Trustees in 2010 and most recently was elected Chair-Elect to the Board of Trustees for the AMA. The ASCO Post recently spoke with Dr. McAneny about her ongoing work in the clinic and the policy arena, and her new position at the AMA.

Origins and Early Career

Are you a native of New Mexico?

No, I’m from the Midwest. I was born in Missouri, and I grew up in southern Illinois. I went to the University of Minnesota in 1973 and graduated from the University of Iowa College of Medicine in 1977. I finally figured out that not everyone in the country endures 7 months of winter, so I decided to move to the Southwest. I fell in love with New Mexico.

Why did you choose oncology as a profession?

When I was going through my internal medicine residency at the University of Iowa College of Medicine, I learned that I loved taking care of patients with cancer, which is the simple reason I decided to become an oncologist. I also learned that my skills were in relating to patients and delivering hands-on cancer care, not in writing papers, so that is the reason I decided on community practice over an academic career.

Please tell the readers about your early days in practice.

After my fellowship at the University of New Mexico in oncology and hematology, I cofounded a private practice with Dr. Clark Haskins, which evolved into the New Mexico Hematology/Oncology Consultants. In 2002, we built the New Mexico Cancer Center, a freestanding physician-owned multidisciplinary clinic handling medical oncology, radiation oncology, imaging, and clinical trials. We have an on-site pharmacy as well, so it is a full-service oncology clinic.

Making Strides in Prevention

You have championed numerous health-related issues such as reduction/avoidance of tobacco use. In what other ways can cancer prevention be improved?

Prevention is the perfect example of where oncology needs to partner with other specialties. Oncologists pride themselves on being multidisciplinary, but we only see people after the cancer is diagnosed, when prevention is meaningless. If we are going to make strides in prevention, we’ll need to work hand-in-hand with our overworked primary care colleagues to help facilitate the inclusion of cancer screening, smoking cessation, and obesity into their practices so they can have those vital conversations with their patients.

We also need to make ourselves available to talk with the public. When I present at a legislative hearing, I want to make sure the message is taken seriously. For instance, when I was working on New Mexico’s Clean Indoor Air Act, I opened my comments before the committee with this statement: I am here to ask you to decrease my business by one-third by making it harder for people to become addicted to tobacco. That got policymakers’ attention because nobody goes in front of a legislature and pleads for help in decreasing their business.

So oncologists can truly have a potent voice when we choose to use it for the public good. But we need to be aware that political change is a long, incremental process during which you need to build consensus and educate the population. Thanks to the Clean Indoor Air Act, smoking in buildings is no longer allowed in New Mexico, so the work certainly paid off.

Innovation Grant

You were awarded a grant from the Centers for Medicare & Medicaid to test how oncology practices in the community could provide better, more cost-effective care. Please share that experience with our readers.

Over the years at New Mexico Oncology, we figured out that using an aggressive approach to managing cancer side effects prevents a huge amount of unnecessary emergency room visits and hospitalizations. We also extended our office hours to accommodate after-hours patients and put in place a system that encourages patients to call us before making any other decision, such as racing to the ER.

It certainly makes more sense to see a community oncologist than to sit in an ER next to someone with pneumonia for 5 hours while waiting to see a doctor who is not trained in oncologic side-effect care. In another efficiency-minded step, we shredded our paper charts in 2002 and went completely electronic. I now realize how much money we’re saving the system by the processes we put into place. So prior to the grant, I had a template of cost-effective care delivery.

In 2012, I was awarded a $19.8 million Center for Medicare and Medicaid Innovation (CMMI) grant to test how oncology private practices could provide better care for patients with cancer at a lower cost. To accomplish that, I created a small company called Innovative Oncology Business Solutions in which we will try to replicate the care and cost-saving practices that we initiated at the New Mexico Cancer Center in six other practices across the United States. We are documenting that our measures and interventions are providing better-quality, cost-effective care in terms of real outcomes.

The data gathered at the seven sites involved in our pilot program are important for the oncology community, not only because we’re seeing better outcomes, but also in light of the cost savings component. In today’s setting, we need to figure out how to care for the growing patient population on a very tight budget. There’s simply no more money out there, and we need to keep our patients healthier and avoid preventable clinical scenarios that erode our precious resources.

Balancing Public Health and Clinical Roles

Please describe your recent appointment as Chair-Elect, Board of Trustees, of AMA, particularly as it pertains to oncology.

The AMA is hugely relevant to the oncology community’s success moving forward. We need to be part of the AMA’s “big tent.” It is the house of medicine where all specialties and subspecialties gather and work together on all the issues that affect our patients and us. It is a great honor to be the Chair-Elect of the AMA. In June 2014, I will become Chair of the Board. We direct the vision and direction of the AMA, which is to promote the art and science of medicine and the betterment of public health.

How do you balance the clinic with the myriad public health issues you undertake?

I have a busy clinical schedule, so I save my evenings and weekends for everything else, which includes answering hundreds of e-mails, hours of conference calls to map out strategies, and writing grant proposals.

I started my career wanting to take care of every cancer patient in the world. When I realized that wasn’t possible, I began working on public health issues because I see that as being able to positively affect the lives of multitudes of patients with cancer.

Your work covers such a broad medical canvas; please share a bit about your patient care activities.

Our group serves a very diverse patient population across the state, including some of New Mexico’s most underserved.

A clinic that means a lot to me is our Gallup Clinic in the heart of the Navajo Nation. Many of these people live on less than $20,000 per year and have no running water or electricity. We are the only cancer providers for 120 square miles. For many of these patients, a tank of gas is cost-prohibitive, so they would not be able to travel long distances for their care.

I leave for this clinic on Thursday morning and return on Friday evening, staying over at a small motel in Gallup. I take care of patients that otherwise probably would not have their cancers treated. It means a huge amount to me.

Anyone who works in public health programs of any stripe needs to ground him or herself in a clinic that provides care to the underserved. It reminds us of why we became doctors in the first place. There are vulnerable patients out there whose lives you can affect in a very positive way.

State Medical Societies

Do you have any closing thoughts?

Oncologists tend to forget how important their state medical societies are, particularly if one wants to further issues critical to the community. The state medical societies are a tremendous vehicle for gathering voices and sending a collective message to local policymakers, and the AMA can affect national policy. So I urge my colleagues across the country to make use of this resource and become involved in issues that further the goals of delivering high-quality, cost-effective care to our patients. ■

Disclosure: Dr. McAneny reported no potential conflicts of interest. 

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