New AMA president vows to fight for care

BY BRUCE JAPSEN
http://www.chicagotribune.com

As a graduate student at Catholic University in Washington studying microbiology in the late 1960s, Nancy Nielsen had student health insurance, but the policy excluded family coverage.

So she paid out of pocket for pediatric care for her first three children.

“It was the only time in my entire adult life that I had to call my parents and ask them to send me money,” Nielsen said.

Her pediatrician at the time gave her diapers, formula and a box full of antibiotic samples. She said she will be forever grateful for that physician’s largesse.

Four decades later Dr. Nielsen is president of the American Medical Association.

She vowed at its annual meeting last week in Chicago to use “all of the power” of her presidency and the clout of the AMA “to let the nation know that we must cover America’s uninsured.”

Amid an intense political year when health coverage is front and center, Nielsen brings a unique perspective as only the second woman to become president of the 161-year-old AMA, the nation’s largest doctor group. She also has worked as a medical educator and health insurance executive.

“Her background allows her to speak the language of every physician in the country,” said Dr. Robert Goldberg, a fellow AMA member and friend of Nielsen’s from the New York State Medical Society.

The 65-year-old Nielsen is a part of a three-person team who’ll speak on behalf of the AMA on critical issues.

“She has a vast array of experiences,” said Dr. William Dolan, an orthopedic surgeon from Rochester, N.Y., and a member of the association’s board of trustees. “She is quite incredible. Even while having five kids, she went to medical school.”

Nielsen practiced primary-care internal medicine for more than two decades, was a medical director for a Buffalo health plan until last year and today is senior associate dean at the State University of New York at Buffalo School of Medicine and Biomedical Sciences.

She’ll be able to call on her past experiences in her new role in what promises to be a year in which doctors will be fighting with health plans, drug companies, employers and others for a seat at the table when health-care reform is debated.

In pressing for coverage for the uninsured, doctors expect that she will have a less adversarial relationship with the health insurance industry than her predecessors. The AMA has long clashed with health insurance companies on issues such as patients’ rights to sue their health plans. The organization even has a litigation center that has worked with trial lawyers to force changes in health industry business practices.

But those who know Nielsen’s past work as chief medical officer at health plan Independent Health in Buffalo say that background gives her an understanding of how health plans rate doctors on quality measures and patient safety initiatives.

Nielsen says she endorses the use of report cards by health insurance companies but wants physicians to be involved in what is rated.

“Instead of issuing that report card on what percent of my patients didn’t get a mammogram, tell me the names of those patients so I can verify the data and reach out to each one,” Nielsen said. “To be fair, some health plans have been fairly innovative and collaborative. But it’s time for all of them to be.”

And she was involved when the AMA worked with New York Atty. Gen. Andrew Cuomo last year to create a model for health plans that discloses methods insurers use to determine doctor rankings and ensure transparency.

“Most of the ratings were based on cost, and they were not transparent so physicians could challenge the data,” Nielsen says.

Nielsen will serve as AMA president until next June.

“Well, who knew—who could have ever predicted—that a girl from a small town in West Virginia would someday be president of the largest physician organization in the world,” she said in her inauguration speech last week.

“And who would have predicted that all that would happen at a time when there’s a wide open presidential election, when health-care costs are out of control, when the number of uninsured is now 47 million?”

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