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Past AMA President Nielsen to Advise Medicare and Medicaid Innovation Center

By John Reichard, CQ HealthBeat Editor

April 29, 2011 -- In a coup for the fledgling office at heart of the Obama administration's efforts to find ways to streamline health care and control spending growth, Nancy Nielsen, a physician and past president of the American Medical Association, has signed on as a senior adviser to the Center for Medicare and Medicaid Innovation.

The center has captured the imagination of policy analysts supportive of the health law (PL 111-148, PL 111-152). In the New Yorker magazine, surgeon and writer Atul Gawande devoted an article to promoting the idea of continual innovation. He noted the revolutionary gains in agricultural productivity in the 20th century brought about by constant experimentation under the auspices of the U.S. Department of Agriculture, and called for a similar system for delivering health care in the United States.

Nielsen could help make doctors a big part of the experimentation at the Center for Medicare and Medicaid Innovation, which was created by the health and has a $10 billion budget. It is housed at the Centers for Medicare and Medicaid Services (CMS). Doctors are believed by many analysts to be the key to controlling health care costs, given their power to prescribe drugs, tests and medical procedures, and make referrals.

Congressional Republicans say that while innovation is needed in health care, the activities of the center bear close scrutiny.

"I think there needs to be a lot of oversight on that center," a House GOP aide said at a Washington, D.C., conference earlier this year. "Does it hold promise? Absolutely. But any time you take $10 billion and go give it to the group holed up in a office someplace and say, 'here, good luck, and try to reduce Medicare spending with really no strings attached and no direction,' I think there's some concern there."

Nielsen "certainly knows physician leaders, not just at the AMA, but also the specialty societies," said former AMA lobbyist Julius Hobson who expressed surprise on learning about Nielsen appointment. "She would be in a position to get the physician groups to take part in the pilots" launched by the center. "It's a good move."

Nielsen will advise center director Richard Gilfillan.

Hobson also noted with interest the news that Nielsen will also report to HHS Secretary Kathleen Sebelius, who will rely on her for "special projects."

That could suggest a larger role for Nielsen at some point at HHS, Hobson said. However, her appointment is for one year.

Apart from any special projects, Nielsen is likely to find plenty to do at the innovation center, which is heavily involved in efforts to foster the growth of team-based care through the creation of accountable care organizations. One of the big questions about ACOs is how best to involve physicians in forming and running them.

Nielsen is the former head of the Office of Medical Education at the School of Medicine at the State University of New York at Buffalo. The university announced her move to Washington and said that once she finishes up her term at the agency she will return to the university to serve in her role as senior associate dean for health policy.

"The idea is to identify the best thinking and best practices, bring them to this center and then disseminate them so that we can all become a learning community throughout the country," the university's news release quoted Nielsen as saying. "It doesn't make sense to have every single community trying to figure out how to moved forward, without sharing what others have learned."

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