May 2012 Edition Vol.0, Issue 0

On-Conversation with Michael N. Neuss, MD, Chief Medical Officer of the Vanderbilt-Ingram Cancer Center

On-Conversation with Michael N. Neuss, MD, Chief Medical Officer of the Vanderbilt-Ingram Cancer Center

Michael N. Neuss, MD, was appointed Chief Medical Officer at the Vanderbilt-Ingram Cancer Center (VICC) in Nashville, TN, July 2011. The VICC is an NCI-designated cancer center that has more than 100,000 outpatient cancer visits and serves approximately 6,000 newly diagnosed patients with cancer annually. Formerly, Dr. Neuss was in private practice, and he led the medical oncology group at Oncology Hematology-Care, Inc., Cincinnati, OH.  Admittedly, he has not been part of an academic medical center for 25 years and finds his new position both tremendously exciting and appealingly frightening—like riding a really good roller coaster.  He has served on many prestigious committees including Chair of the American Society of Clinical Oncology Clinical Practice and is currently Chair of ASCO’s Quality Oncology Practice Initiative (QOPI), an oncologist-led, practice-based quality improvement program.

OBR: You’ve been in private practice for many years, how does the academic environment compare and how would you describe your current role at Vanderbilt?

MN: The predominant reason I was hired at Vanderbilt was to help improve an already good patient experience here. The charge that was given to me was, “if you can make it better, make it better,” and so we have put in place a variety of metrics that examine the safety of our care as well as the care processes. And while we’re doing well on the metrics, we’re not perfect; there’s always room for improvement. What I think I’ve had to learn is that there’s much more consensus building in an academic environment than in a private practice. Any initial resistance I’ve had has been modulated by my awareness of just how important communication is and because of that, initial resistance has dramatically decreased. The faculty is very supportive of the things we’re trying to do.

OBR: Is it a relief not to have the headaches of running a community practice?

MN: Taking care of patients with cancer, which I still do, is harder, yet more rewarding than any administrative activity I’ve undertaken either in Cincinnati or Nashville. I love the administrative opportunities I’ve had in both places, and both experiences have led to sleepless nights. But it isn’t anything like the responsibility of being someone’s doctor, particularly someone with a very serious illness like cancer. However, it’s fantastically challenging to be in this completely different world of an academic medical center after not being part of one for 25 years and never being anything other than a trainee within an academic environment. Doug Blayney is the highest profiled private practitioner I know who went to an academic medical center in a similar position, but there’s actually a group of us now who are chief medical officers at cancer centers. We’ve formed a variety of information sharing groups and it has only added to the reward and fun of this experience. 

OBR: How are things trending for the community practice? Is all the doom and gloom prophecy being fulfilled?

MN: Actually, nobody knows, and ASCO is starting a study called “AESOP” which stands for “Assessment of the Evolution and Status of Oncology Practices.” This is an initiative to understand the changing nature of oncology practices as it seems that more and more practitioners are leaving independent private practices as they engage in various types of hospital affiliations. ASCO is interested in getting a census of United States practices. It surely seems as if the 1 to 20 person “private” practices have been under enormous financial pressures. Many have sought cover in employed relationships with hospitals and academic institutions.

OBR: If you had to name 2 things, but feel free to elaborate, that you think pose the biggest threat to quality of cancer care, what would you say those are?

MN: It’s drugs and drugs. First, I think the cost of cancer care needs to be addressed. This is a very difficult subject, but it is obvious that there is a tipping point on drug pricing. An exaggerated example might help explain. Let’s say there was a drug that if taken daily kept an otherwise fatal cancer in remission. Consider if the drug cost the patient $1,000 and the payer $10,000 daily. There would be almost no possibility of anyone taking this medication. That is, though the thresholds vary, clearly a tipping point.

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