FFFM | A Seat at the Table: Affordability Working Group on Healthcare

Earlier this fall, an AAFP member was selected to bring vital perspectives to a congressional affordability working group on health care. Hear more from Dr. Amar Duggirala on his experience participating in the event and how the group benefited from hearing directly from a family physician.

Welcome to Fighting for Family Medicine. I'm David Tully, Vice President of Government Relations and a member of the AAFP's advocacy team. In this episode, you'll hear how the AAFP advocated for family medicine during the month of October. Then I'll spend some time talking with Dr. Amar Duggirala, a family physician from Maryland, on his recent experience joining members of Congress for a roundtable on health care affordability, where he discussed affordability challenges that everyday Americans increasingly face.

You can explore more resources related to this episode in the show notes below.

Let's kick things off with some exciting news. Dr. Kisha Davis was recently installed as president during the Congress of Delegates meeting in Nashville earlier this month. As a family physician and public health advocate, Dr. Davis brings a deep commitment to advancing health equity, strengthening care delivery, and mentoring the next generation of family physicians.

Dr. Davis has her foot in both the clinical and advocacy worlds, frequently spending time on Capitol Hill elevating family medicine and working with policymakers and other health leaders to pass legislation that will improve access to care. She will lead the AAFP in representing one hundred and twenty-four thousand five hundred family physicians, residents, and medical students nationwide

AAFP President Kisha Davis recently spoke at an HHS event focused on congenital syphilis. She emphasized that congenital syphilis is preventable, but prevention requires more than screening. Patients need timely treatment, follow-up, partner services, and coordinated care. She also emphasized that family physicians often encounter patients before, during, and after pregnancy and can play a critical role in identifying infections and connecting patients to care.

HHS can help patients by supporting medication access, strengthening public health capacity and care coordination, and addressing payment and coverage barriers that delay care.

The AAFP joined other health organizations in a letter to the Federal Communications Commission, urging them to support accessible telecommunications and telehealth services in rural settings. Family physicians have long advocated for reliable connectivity, which helps rural practices to access electronic health records, prescribe medications, exchange clinical information, coordinate care, provide telehealth services, and support remote patient monitoring.

Connectivity also enables family physicians to maintain continuity with established patients that may not otherwise be available locally. You can read our full letter in the show notes below

Artificial intelligence, better known as AI, should support, not replace, the patient-physician relationship. The AAFP recently joined the American Medical Association and other physician groups rejecting claims that AI is broadly superior to physicians, or that physicians cannot be trusted to make clinical decisions without consulting it.

These claims misrepresent the evidence and risk undermining patients' trust. We will continue advocating to ensure AI never becomes another tool for denying care, increasing administrative burden, or undermining physician judgment and the patient-physician relationship.

The AAFP recently provided the Senate Finance Committee with recommendations to improve coverage, access, and affordability for patients. Our letter highlighted the need for policymakers to, one, establish a national standardized primary care benefit while reducing cost-sharing, two, increase investment in primary care, and lastly, to improve continuity in care across coverage transitions.

It also outlines recommendations to address prior authorization, claims denials, insurer transparency, corporate consolidation, vertical integration, and administrative burden, while strengthening support for independent physician practices and direct primary care models. You can read our full letter in the show notes below.

The US Department of Homeland Security has proposed an additional fee for cap-subject H-1B petitions on top of existing filing fees. If finalized, the fee would represent one of the largest increases in US employment-based immigration filing costs in US history. The new proposal would apply broadly to cap-subject H-1B petitions regardless of where the workers live.

In response, the AAFP led a sign-on letter urging the Department of Homeland Security to, one, recognize physicians, dentists, trainees as serving a permanent national medical interest. Second, permanently exempt physicians and dentists from H-1B related fees and restrictions regardless of whether the petition is cap-subject or cap-exempt.

Third, continue efforts to improve visa processing efficiency and reduce administrative barriers for physicians and other medical professionals. And lastly, work with Congress on lasting legislative solutions, including the H-1Bs for the Physicians and Healthcare Workforce Act. You can read our full letter in the show notes below.

I'm here today with Dr. Amar Duggirala, a family physician from Maryland who was invited to share his insights and observations on the impacts of rising health care costs on primary care and patients. The AAFP was pleased to join other health organizations and bring the family physician perspective to this roundtable.

Dr. Duggirala, thanks for being on the podcast, and I would love for you to describe what it was like to participate in this roundtable with other stakeholders across the health care sector.

Thanks, Dave. This was a really exciting opportunity for me. I'd not been inside the Capitol Building Visitor Center since its renovation a few years ago, and I'd never been to a stakeholder roundtable like this before, so it was a really great experience.

So, want to thank you and your team at AAFP for giving me that opportunity to go to that roundtable. I'd been to Capitol Hill several times for the AAFP Family Medicine Advocacy Summit to meet with my senators and representatives, but being part of a roundtable like this was definitely a new experience for me.

It was really interesting seeing the perspectives from the different stakeholders, particularly the patient advocacy organizations and the health-related nonprofits, because they give really interesting perspectives from a patient standpoint. Perhaps the thing I was struck by most was that I was the only physician speaking at the roundtable out of, like, I think there were 30 people there at the roundtable, and I think this just speaks to the importance of physicians having a seat at the table when these discussions are occurring.

So, I think this also really emphasizes the importance of AAFP having these relationships with members of Congress to give physicians like myself the opportunity to be at these discussions

absolutely. And I think, I think the Hill staff appreciated having the physician voice there, and that's sometimes a challenge is to get to, the right people at the table.

And I think having a family physician to be there to describe some of the challenges, I think was beneficial for them as they were pulling their takeaways together.

To kind of bring the subject of affordability back home, you live not too far from here, you work not too far from here. What are some of the ways that health care affordability issues are showing up in your community, and specifically in the practice that you function in?

I unfortunately see it every day. I have a large Medicare population in my practice, and these patients are, of course, on a fixed income, and the decisions made on Capitol Hill regarding Medicare funding and benefits affect them directly. I also have a mix of patients from a big spectrum. I have farmers, federal employees, teachers, and small business owners.

So, the mix of different types of insurance, including federal or employee plans, health exchange plans, and employer plans, all vary greatly. However, the common themes are the same, which is that premiums are increasing, out-of-pocket costs are increasing, and the benefits seem to be decreasing. So that affects almost all of my patients.

We also see some uninsured patients in my office. Our practice has been working with a local nonprofit to help local community members who don't qualify for insurance. So, our nonprofit we work with has some funding through a grant, and so this has been a real lifeline for our patients.

But this type of partnership doesn't take the place of full health care benefits that we really need in our community. So unfortunately, those issues dealing with insurance really come down to my patients every day, whether they can afford their medications, whether they can see their specialists, even their co-pays to see me or to go get testing done.

It's been a... It continues to be a major issue.

So, you talked about this a little bit at the beginning about how important it is for physicians to have a seat at the table, and I wonder if we can just take a second and kind of open that up a little bit further. You have been one of our strongest advocates.

You've come to our summit. I know you've also been very active at the state level. You've gone to Annapolis for the Maryland Academy days. Why is it so important, especially right now, as we're talking about affordability, as we're talking about access, as we're talking about the physician-patient relationship, why is it so important for lawmakers to hear from family physicians on these issues?

And what is it that family physicians see that policymakers don't see on a daily basis?

You bring up a really good point. When I've met with lawmakers, both on the federal and state level, I think they see it more from a theoretical perspective, and they may see it somewhat from a patient perspective.

But when they're making these bills, I think they're— they look great on paper, but they may not work as they intended them to work, and they may not understand all the unintended consequences that some of these bills have in real life that we see. And I have seen a big difference between when I'm in a meeting with state legislators versus federal legislators.

Like state legislators, oftentimes they're not in the health care field. They don't have enough staff or staffing experts who really understand how the health care system works, so we're oftentimes giving them an education of this is what's actually happening in health care. On the federal level, they usually have— they're much more well-versed.

Their staff are really knowledgeable. So there, we're just trying to give them our perspective. But I think the type of advocacy that we do on a state level versus a federal level; I think is a bit different. But as family physicians, we see every day how federal and state laws affect our patients, whether that's federal plans like Medicare or Medicaid, but even private insurance, which— a lot of which are regulated by states.

For instance, one of the issues we have is high-deductible health plans. That was seen as a way to get lower cost insurance for people and get lower premiums. But in primary care, we see patients who put off coming in for sick visits or even taking care of their chronic conditions because they don't— they have to pay several thousand dollars out of pocket before the insurance kicks in.

And this often makes them sicker because they're not coming in for their basic visits, and then it's actually costing the health care system even more in the long run

So, you mentioned a little bit earlier in our conversation that you were one of 30-plus people that were sitting around the table with these lawmakers.

I had the privilege of kind of sitting back and watching you and others kind of talk through some of the big issues. What were some of the big themes that came up throughout the course of the roundtable discussion?

I think there were such diverse groups in that discussion that I think the perspectives were quite varied, and there were a lot of different topics.

I think the common theme between all of them was that health care costs are too high and becoming more unaffordable for most Americans. I will say the other main theme was maintaining expanding care for the most vulnerable populations, and that included disabled Americans. So, I was really glad to see the patient advocacy groups there really talking about how these issues are affecting not only disabled people, but also people with chronic conditions There was some talk about Medicaid funding as well.

I think particularly with the new Medicaid work reporting requirements; I think this has really become much more of a front and center issue. And I know that's affected us in Maryland, where we already have really good Medicaid funding, but I'm— but I know it's affecting people in other states as well.

Absolutely. So, there's a lot of swirl in national conversations right now about health care affordability. We're hearing it talked about at the presidential level. We're hearing it talked about on the congressional campaign side. I was curious from your perspective, what do you think is missing from the national conversation when we think about health care affordability?

And if you had a wish list pulled together, what are some of the things that you would like policymakers to act on your wish list as a way of reducing health care costs and making health care more accessible and affordable?

So, I think AAFP has done a great job promoting how increased funding to primary care can improve health care affordability.

But I think in general that there needs to be more discussion about this. I still think it's really missing in the core of the health care affordability talks that are going on nationally. We know that primary care is the only part of the health care system where increased funding results in overall savings to the system, but it's just not talked about enough.

Regarding my wish list, it would be pretty long, but I'm going to keep it to my top three. I would say the number one thing I've really been involved in is increasing primary care investment. I'm on a Maryland work group for increasing primary care investment. In many states, they're working on this, including in Maryland.

However, I think we need a national goal to increase primary care investment. Currently, only four and a half cents of every dollar of health care spending is spent on primary care. In Maryland, the goal is to try to increase it to ten percent. But really to be on par with other nations with the highest health care outcomes, it probably should be about fourteen percent.

That's a pretty big goal, but I think we have to start somewhere. So, I'm glad that states are taking this on, but we really need something on a national level. Secondly, it's an administrative burden. It seems kind of counterintuitive for people in the insurance industry. They see administrative work like prior authorizations as reducing costs, but I think that's really looking at it very one-sided.

Prior auths and administrative work are just taking up so much time away from physicians to actually do what they're supposed to do, which is see patients. And I think this really leads to increased cost to health care teams and reduces access to patients because physicians are spending their time doing paperwork rather than actually spending that time with their patients.

The third thing I would say is Medicare and Medicaid funding. If we give our older and low-income community members high-quality primary care, we're going to reduce costs in the long run, particularly reducing costs for chronic care conditions, which I know has been a big focus for Medicare, but we just need the funding to be able to do that.

I would say in Maryland, one of the issues we've had is we have the longest ER wait times in the country, and increasing funding for primary care along with Medicare and Medicaid, I think will go a long way in keeping patients out of the ER and reducing those really high costs of health care, which is really ER and hospitalizations.

So those would be my top three.

Those are, those are good top three items, I would say, very consistent with a lot of the work that we're doing at the national level. So, I'm glad to see that our lists are lined up.

As we wrap up our time together, we talked a little bit about your advocacy journey.

You've attended our summits. You're very involved at the state level. You've been an active ambassador for the Academy. There are probably some family physicians that are listening to this that are thinking about starting their journey in advocacy. And I guess my final question for you is, what advice would you give to family physicians who are interested in getting more involved in policy and advocacy?

Why is it so important for them to get involved, and what advice would you give them as they're thinking about starting their journey with us?

I think as family physicians, we see every day how our inefficient and high-cost health care system affects our patients, and I see being involved in advocacy as an extension of just being a family physician.

if my patients can't afford their medications or can't get access to their doctors, that's my issue, too, because overall, I'm interested in how to make them healthier. I think part of that is also producing more primary care physicians. That's another thing that I've really been involved with.

My practice is the only medical practice in our community, and we're trying to recruit another family physician to take care of the need that we have in our community. And making family medicine and primary care more desirable to medical students to pursue will produce more family physicians and I think will improve our overall primary care physician shortage but for a family physician who's interested in becoming more involved, I think one of the great ways is getting connected with their state AAFP chapter and their advocacy efforts.

That's how I got started many years ago. And then on the federal level, the Advocacy Ambassador Program I think is great. I think that was a wonderful thing that AAFP started. And then attending the Family Medicine Advocacy Summit. I think I've gone six or seven times already, and I always really enjoy it.

I think it's a great way to spend time in DC, get up to date on the federal issues, and network with other family physicians who are really interested in advocacy.

That's great. It's a great way to wrap it. And Dr. Duggirala, it's always a pleasure to see you. Thank you for your time, for all the work that you do in your practice and your community, and for always being a really solid and thoughtful partner in our advocacy journey.

So always a pleasure to be with you and look forward to reconnecting with you soon.

Thanks, Dave. I really appreciate it.

Thank you for joining us today. You can find out what the AAFP is doing to advocate for you, your patients, and your practices, and how you can get involved by visiting our website at www.aafp.org/advocacy.

Be sure to check out the show notes below for more links and details to items discussed today. If you've enjoyed today's episode, let us know by dropping a line to aafpnews@aafp.org. Be sure to share the episode with your followers on social media and tag the AAFP. We will talk to you soon.