‘We are really at a tipping point’ – On medical breakthroughs, drug prices, education, and keeping physicians’ offices open

_{© American Academy of Family Physicians}

Family physicians know well the broad range of factors that affect patient health and the financial health of their own practices.

Those issues often are difficult to deal with, but there are also some potential bright spots in the U.S. health care system.

This summer, the American Academy of Family Physicians (AAFP) declared a “workforce win” with new rural residencies planned by the U.S. Department of Health and Human Services and its Health Resources and Services Administration. AAFP also published the new “Practice Manual: Addressing Health Disparities for Patients With Obesity,” by contributing physician authors, to outline the best treatments and the best ways to discuss those with patients.

At the national level, the administration of President Joe Biden has targeted Medicare drug costs for reduction, while Congress and federal regulators have pressed for information about potential negative effects of health care consolidation and pharmacy benefit managers.

Steven P. Furr, MD, FAAFP, met online with Medical Economics to discuss contemporary issues pending in health care. Additional articles are here and here. This transcript has been edited for length and clarity.

Medical Economics: AAFP this year published a practice manual addressing health disparities for patients with obesity. Because obesity is a growing health concern, what should primary care physicians know as they prescribe more and more available treatments?

Steven P. Furr, MD, FAAFP
_{© American Academy of Family Physicians}

Steven P. Furr, MD, FAAFP: I think the great thing is we have more availability, more treatments to use, than we've ever had. Sometimes they're difficult for our patients to afford, but really knowing what's available and what's out there, our patients, just making them aware of the complications of obesity and how we can manage those. The great thing about some of the drugs that we're treating obesity with, we're seeing the rate of cardiovascular disease goes down, the rate of sleep apnea goes down, so not only we're treating just their obesity, we're treating the underlying medical problems that go along with that. So, it's a great time to be able to treat obesity. We still got to work with our patients to do all the things that they normally should do, to eat, right, to exercise, and do all the basics. Sometimes they get so focused on the medicines. They think the medicines can do all the work, but they've still got to do all those basics that are so important to live a healthy lifestyle.

Medical Economics: In recent days, there's been a lot of public discussion by lawmakers and federal regulators regarding pharmacy benefit managers. Can you discuss prescription drugs and family medicine?

Steven P. Furr, MD, FAAFP: We're just concerned about the price of pharmaceuticals in general, because we know it's a health equity issue, that many of our patients cannot afford drugs that cost $1,000 a month. Many of our Medicare patients quickly go in the donut hole at mid-year and then can’t afford any of their medicines. So the pricing is definitely a concern. So it is a huge issue. I mean, some people can afford the medicines, but a large number of our patients cannot. You’ve got to remember, even Medicare patients, a number of them, there's millions of them that still don't have prescription drug coverage, they don't have Part D. So that is really a huge issue.

Medical Economics: This summer, the academy announced support for new physician residencies in rural communities. What is the status of that plan, and why is that so important?

Steven P. Furr, MD, FAAFP: The importance of that is, what we found is, as you often know, wherever somebody does their residency, that's often where they tend to practice or stay in that area. So by having training in community centers and in smaller rural areas, our hope is they'll tend to practice and stay in those areas, because that's where most of our needs really are. We need family physicians everywhere, but that's where they can really make a big difference. So the importance of that training, those teaching health centers, is make sure that Congress adequately funds those. The problem, they've often, in the past, been funded on a year-to-year basis. We need to have long-term funding for that so that they can be stable.

Medical Economics: What did I not ask about the you would like other physicians to know?

Steven P. Furr, MD, FAAFP: I think the key thing – we are really at a tipping point. Congress has got to act. They can't keep pushing this can down the road. As you see, there's a consolidation in health care, physician practices, many of them are going out of practice, or just choosing to go ahead and retire, retire. And we’ve got to get the Medicare reimbursement schedule. Something has to it where there's getting an inflationary update, where it is increasing the payment that goes out. But it's not sustainable in the form that it is. And I'm worried not only for physicians, and that's for all physicians, but I'm also worried about our patients. They're not going to be able to get care if the Medicare Physician Fee Schedule is not an adequate reimbursement for our people coming out. And you've got to realize that students and residents coming out are now coming out with a mountain of debt. So unfortunately, as payment goes down, they're going they're going to tend to choose just those higher paying specialties to try and make up that difference.