Family Physicians Assess Impact of Economic Downturn
By James Arvantes
12/9/2008
Although the economic meltdown in the United States has forced many patients to regularly delay or even forgo health care, family physicians may not be as severely affected by the economy as subspecialists and other health care professionals. Family physicians' ongoing relationship with their patients provides a bulwark against the economic downturn in many cases, said FPs recently interviewed by AAFP News Now.
AAFP Board Chair Jim King, M.D., is prescribing more generic medications for his patients these days because they cannot afford the corresponding brand-name medications.
"Physicians who provide more episodic types of care, like plastic surgeons, are seeing a significant drop-off," said George Shannon, M.D., of Columbus, Ga. Shannon is a physician partner with Horizon Diagnostics, which comprises 15 family physicians, one gastroenterologist, two general surgeons and a support staff of about 100 employees. "Family docs who care for multiple types of problems in a single visit bring more value to a visit," said Shannon. "While treating chronic conditions, like diabetes, patients have the opportunity to have other acute or subacute problems also treated."
Shannon, like many family physicians, takes care of a sizeable number of Medicare patients, giving him and his practice a measure of insulation against current economic woes.
"We have a stable Medicare population with an insurance company called the United States," said Shannon. "These are people with chronic diseases who are working to control their chronic diseases, so we are still seeing a maintenance of that amount of business."
Shannon, who is a member of the AAFP Board of Directors, emphasized, however, that family medicine practices are not recession-proof. His practice, like other practices, is experiencing a reduction in acute business -- patients who come in with colds, sore throats, lacerations, strains and sprains. Increasingly, Shannon and other family physicians are treating patients who have lost their jobs and their health insurance or patients who are in imminent danger of losing them.
"These are people I have taken care of for 20 years, and I am not going to let them out there without care," said Shannon. "So during this time, you sometimes see them for free, recognizing that they will get back on their feet again someday, and you will still have a good patient."
Shannon, like many family physicians, takes care of a sizeable number of Medicare patients, giving him and his practice a measure of insulation against current economic woes.
"We have a stable Medicare population with an insurance company called the United States," said Shannon. "These are people with chronic diseases who are working to control their chronic diseases, so we are still seeing a maintenance of that amount of business."
Shannon, who is a member of the AAFP Board of Directors, emphasized, however, that family medicine practices are not recession-proof. His practice, like other practices, is experiencing a reduction in acute business -- patients who come in with colds, sore throats, lacerations, strains and sprains. Increasingly, Shannon and other family physicians are treating patients who have lost their jobs and their health insurance or patients who are in imminent danger of losing them.
"These are people I have taken care of for 20 years, and I am not going to let them out there without care," said Shannon. "So during this time, you sometimes see them for free, recognizing that they will get back on their feet again someday, and you will still have a good patient."
Cost Considerations
Shannon's assessments and observations are reinforced by recent data. A study by the Commonwealth Fund that was published in the Nov. 13 Health Affairs identified cost considerations as a major deterrent for chronically ill Americans trying to access care. The study, which was based on surveys of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States, found that 54 percent of Americans surveyed said higher costs prevented them at some point from accessing recommended medical care, filling prescriptions or seeing a physician when ill. By comparison, 7 percent of the Dutch patients surveyed identified cost as a barrier to care.
At the same time, 41 percent of U.S. patients said they spent more than $1,000 during the past year on out-of-pocket medications, compared with 4 percent of British and 5 percent of French patients.
Another analysis, conducted by IMS Health, found that the number of physician office visits in the United States between July 2007 and July 2008 fell 1.2 percent. In addition, the number of prescriptions filled in the United States fell 0.5 percent in the first quarter of 2008 and even further in the second quarter, according to the IMS Health analysis. The analysis also found that the total number of prescriptions dispensed in the United States through August 2008 was lower than that seen in the first eight months of last year.
In many instances, family physicians are urging their patients to fill their prescriptions at Target or Wal-Mart, where they can pick up some 30-day prescriptions for $4, compared with $30 for the same prescription at a drug store.
At the same time, 41 percent of U.S. patients said they spent more than $1,000 during the past year on out-of-pocket medications, compared with 4 percent of British and 5 percent of French patients.
Another analysis, conducted by IMS Health, found that the number of physician office visits in the United States between July 2007 and July 2008 fell 1.2 percent. In addition, the number of prescriptions filled in the United States fell 0.5 percent in the first quarter of 2008 and even further in the second quarter, according to the IMS Health analysis. The analysis also found that the total number of prescriptions dispensed in the United States through August 2008 was lower than that seen in the first eight months of last year.
In many instances, family physicians are urging their patients to fill their prescriptions at Target or Wal-Mart, where they can pick up some 30-day prescriptions for $4, compared with $30 for the same prescription at a drug store.
Offering Choices
AAFP Board Chair Jim King, of Selmer, Tenn., has always tried to prescribe less expensive generic medications whenever possible, but now he is forced to prescribe them for some patients even when the brand-name medication is a better choice because the patients can only afford a generic.
King's practice is located in rural western Tennessee, an area more economically depressed than many parts of the United States. In the past few years, three manufacturing plants have closed in the area, leaving hundreds without jobs and health insurance, and making the provision of health care services that much more difficult, King said. In rural areas, it is difficult to refer some patients to a subspecialist who is 40 or 50 miles away because patients cannot afford the gas.
"We may have to delay care until a later date or work around trying to do something different than what we would have preferred to do," said King.
According to King, the goal is to "get (patients) the best care that we can. We try to discount and allow them to charge services," he said.
King and others also are seeing an increase in high-deductible health plans that require patients to spend $1,000 or more of their own money before their deductible is met and their insurance actually kicks in. As a result, many patients are unable to afford health care, even though, technically, they are insured.
"Companies are looking for ways to save money, and they are going for these high-deductible plans that shift costs to the patients," said Jennifer Hollywood, M.D., of Easton, Md. Hollywood owns Bayside Family Practice, which is a solo practice in Easton.
She has noticed distinct changes among her patients during the past few months. For example, more patients are canceling their annual physicals. Others are trying to access "phone medicine" by asking Hollywood to prescribe refills via the phone even though she may not have seen the patient in more than a year. "A lot of patients are just not coming in at all," she said.
Some patients are not refilling medications for serious conditions, such as heart disease or diabetes, leaving them open to complications that could result in hospitalizations or even death, she said.
Hollywood's patients also have become savvy about their health care in recent months. Some are coming into her office with a list of preferred medications from their insurance formularies and are asking Hollywood to prescribe medications off those lists because they are cheaper. In addition, more patients are "pushing the edge" by asking Hollywood to conduct physical examinations when they are being seen for sore throats or colds so they will only have to meet a single copay.
"I've had patients come in with a list of 10 complicated things they want managed in one day because they don't want to come back," she said.
King's practice is located in rural western Tennessee, an area more economically depressed than many parts of the United States. In the past few years, three manufacturing plants have closed in the area, leaving hundreds without jobs and health insurance, and making the provision of health care services that much more difficult, King said. In rural areas, it is difficult to refer some patients to a subspecialist who is 40 or 50 miles away because patients cannot afford the gas.
"We may have to delay care until a later date or work around trying to do something different than what we would have preferred to do," said King.
According to King, the goal is to "get (patients) the best care that we can. We try to discount and allow them to charge services," he said.
King and others also are seeing an increase in high-deductible health plans that require patients to spend $1,000 or more of their own money before their deductible is met and their insurance actually kicks in. As a result, many patients are unable to afford health care, even though, technically, they are insured.
"Companies are looking for ways to save money, and they are going for these high-deductible plans that shift costs to the patients," said Jennifer Hollywood, M.D., of Easton, Md. Hollywood owns Bayside Family Practice, which is a solo practice in Easton.
She has noticed distinct changes among her patients during the past few months. For example, more patients are canceling their annual physicals. Others are trying to access "phone medicine" by asking Hollywood to prescribe refills via the phone even though she may not have seen the patient in more than a year. "A lot of patients are just not coming in at all," she said.
Some patients are not refilling medications for serious conditions, such as heart disease or diabetes, leaving them open to complications that could result in hospitalizations or even death, she said.
Hollywood's patients also have become savvy about their health care in recent months. Some are coming into her office with a list of preferred medications from their insurance formularies and are asking Hollywood to prescribe medications off those lists because they are cheaper. In addition, more patients are "pushing the edge" by asking Hollywood to conduct physical examinations when they are being seen for sore throats or colds so they will only have to meet a single copay.
"I've had patients come in with a list of 10 complicated things they want managed in one day because they don't want to come back," she said.
