The Year in Review
It is time. Time to glance back at where we have been as we ride forward into the future.
When not on the road as President representing the American Academy of Family Physicians, which was quite frequent considering I stayed in hotels over 125 nights this year, my daily schedule remained fairly consistent. After my early morning workout
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I would jump into the limousine…
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and make the short ride to my office.
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There I would make some early morning phone calls
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and sign off on executive orders.
After that I see patients as I have for the last 40 years. Despite my commitments serving the AAFP it was important that I maintain my connection to the clinical practice of Family medicine. So every day whether in the office or traveling I was still refilling prescriptions, working on prior authorizations, reviewing labs and completing chart notes.
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Billy is still my patient. I just saw him last week. When I see him whether we mention it or not I am aware of the loss of his wife.
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Whenever I walk in the room Marilyn always greets me with “I love you!”. The man sitting behind her, her faithful husband Robert who has taken care of her for so many years, is perhaps the closest thing to a saint that I have met in person.
Seeing patients kept me centered. It kept me connected. It reminds me of our purpose.
So over this past year I really was able to get into a rhythm. Whether going to my presidential office or to my regular office I could tell I was getting into a flow. Even in my travels whether in front of the House of Representatives
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or the Senate
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I got into a comfort zone. Having my suitcase already packed with all the essentials that I would need, airlines arranged, travel apps updated, hotels checked into and Delta agents at the local airport who knew me and Lisa by name, everything became natural to me. There was the occasional stumble where I found that the hotel key for room 414 would not work on room 312 which is where I stayed the previous night. Nevertheless, it was obvious I was grooving. I didn’t know what I was feeling at first, because I had never felt this before.
You heard two years ago from what was supposed to be a reliable source that “Dr. Furr ain’t got no rhythm gene.”
I’ve come to believe that might’ve been mis-information.
For those of you’ve known me for many years, you are sure to doubt that there’s any presence of a rhythm gene, no matter how recessive, without visual proof.
I will provide that proof now.
First, let’s have a little mood music.
(“You Got It” by Roy Orbison plays)
Things like that happens when you have rhythm.
Second, if there are any small children in the Congress I would request that you cover their eyes during the video. It will be short but graphic. The video has been banned on TikTok.
Third, so that you will receive the full visual effect we will show this video both in real time and slow motion.
As they say, seeing is believing.
(Slo-mo video of Dr. Furr and others dancing plays)
I know. That was unbelievable.
Many of you are completely stunned and overwhelmed.
All I can say is
Baby, I got it!
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The question is, “What do I have and is it contagious?”
I have a belief that we are the answer to the question, “How do we fix the American healthcare system?”
We need to change the definition of underserved. Now a large number of Americans are underserved because many of them do not have a family physician as their primary doctor. They seek subspecialty care which could easily be handled in their family physician office. We are a large part of the answer to the lack of subspecialists. The more of us that are seeing patients the fewer visits to the emergency room, hospital and subspecialist and, amazingly, the lower the cost of healthcare.
You are not underserved just because you live in a rural or inner city area. You are underserved no matter where you live if you do not have a family physician.
As the number of general pediatricians and internal medicine physicians continue to dwindle while fewer nurse practitioners seek to do primary care, the reality is family medicine is primary care and primary care is family medicine. We are the only way primary care will survive. We are the only way that children, women, adults and seniors will get the care they need in this generation and the next.
We are the solution, not the problem.
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Some things need to be set in stone so that they can’t be forgotten.
Without a personal family physician, Americans will never be able to get the healthcare they deserve.
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We must continue to make our case whether we have 5 minutes in front of the Senate Finance Committee or direct conversations with our patients helping them make informed decisions.
I’ve traveled a lot over this past year representing the American Academy of Family Physicians. Whether getting up at 2:30 in the morning for early morning flights or arriving at a hotel at 3 AM after another Delta airline meltdown, we sought to represent you and our patients.
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We even stayed in a hotel without electrical power while I watched my fellow family physicians in the dark continue with their CME program.
Lisa and I spent Valentine’s Day and our wedding anniversary at an Academy function. My milestone birthday was at a state Academy meeting. So it was important that we do something special for Lisa’s milestone birthday.
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As we began our jungle buggy journey, everybody is happy.
I did not know at that time that the green wristband on my right arm was there so they would be able to identify my body.
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Lisa is now starting to believe this could be her last milestone birthday.
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We have moved from the coast inland and the rising elevation means we’ve entered a tropical rainforest. The keyword in tropical rainforest is the word rain.
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It rains. It rains a lot.
This morning when I lay in the bathtub in my hotel room I was dryer than I was this day in the jungle buggy. I was soaked to the bone.
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I didn’t know what money laundering was but I knew all my money was saturated with rain so I dried it out in the hotel room afterward. I was concerned the housekeeper would walk in and think we were drug dealers.
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Near the end of our journey at a buggy stop Lisa gave me a look. You might be surprised to know that I have seen this look more than once in the past 33 years.
It reminded me of a song by Dusty Springfield from the movie Casino Royale. It’s called the Look of Love. As you listen to this song I do need to caution you because some will be shocked because this is an older song and you can actually understand the words.
Let us now visualize the Look of Love.
(“Look of Love” from movie Casino Royale plays)
Now that you have seen the look of love you will understand
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This is not that look.
Growing up I often heard the term “mad as a wet hen.” I never really fully understood that saying but I now have a deeply visceral reaction to that phrase.
And then the words rang out from Lisa’s lips that I will never forget:
“That’s it! No more jungle buggies!”
So that day I lost my jungle buggy buddy.
Being the obedient husband, I resolved to honor her very specific request.
Fortunately, there are other buggies.
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There are beach buggies.
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There are forest buggies.
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There are even CAT scanned certified buggies.
So still we ride!
Shouting” That’s it! No more!”
No matter what buggy you’re riding in
Whether it’s the employed physician buggy or the independent physician
It’s time for us all to say,
“That’s it! No more!
No more physician payment cuts. Medicare fee for service from 2021 to 2024 has decreased 7.8% and is now projected to decrease 2.8% in 2025. Projections for overhead during that time show an increase of 30 to 35%. That does not include the 2% sequestration cut which has continued for over a decade.
But even then we cannot survive just with no more payment cuts. We have to have inflationary updates as does every other sector of our healthcare.
It’s time for us all to say,
“That’s it! No more!
We must strike down the prior authorization avalanche which we are being buried under.
More than 46 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2022, up from 37 million in 2019.
In 2022, there were 1.7 prior authorization requests per Medicare Advantage enrollee
In 2022, insurers fully or partially denied 3.4 million (7.4%) prior authorization requests
Just one in ten (9.9%) prior authorization requests that were denied were appealed in 2022
The vast majority of appeals (83.2%) resulted in overturning the initial prior authorization denial.
The number of prior authorization requests per enrollee ranged from a low of 0.5 requests per enrollee in Kaiser Permanente plans to a high of 2.9 requests per enrollee in Humana plans.
That is correct, one Medicare Disadvantage Plan had 2.9 prior authorization requests per enrollee.
Just give me the facts ma’am. This is not mis-information.
We can’t wait till 2026. This is a pestilence we must remove.
That’s it! No more will we take responsibility for low immunization rates. It’s failed policies that are directly responsible. Don’t blame us and don’t blame our patients. Vaccines are preferentially supplied to pharmacies rather than to family physicians whom the patient’s trust to make decisions in their best interest. We continue to fail to pay family physicians to administer part D Medicare vaccines in their office and wonder why our immunization rates are so low.
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I wish I could take you back Somewhere in Time, a time when things were simpler.
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But we are continually pulled back into our present age, an age where technology promises so much but so often fails us, technology that was supposed to help us but that has imprisoned us.
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This time we have to get it right as the next wave of technology invades our practice. We must be at the forefront of making technology an ally rather than a curse.
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We’ve got a lot of things we need to clean up. We need to get our trash buggies out so that we can get rid of the things that keep us from taking excellent care of our patients.
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That’s it! It’s time to get in our buggies and ride!
As long as it’s not a jungle buggy!