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GLP-1 RAs: When Not to Prescribe
December 31, 2024
This transcript has been edited for clarity.
I’m Tamaan K. Osbourne-Roberts, family medicine physician and lifestyle medicine physician, here to discuss GLP-1 receptor agonist (RA) contraindications — the skinny on when not to prescribe.
It can be hard not to think of GLP-1 RAs like Ozempic and Mounjaro as silver bullets, long-awaited miracle drugs that we should probably be putting in the water. And it’s true they have the potential to help a lot of people.
They include the following:
Patients with a family history of certain cancers. Given that GLP-1 RAs can increase the risk for thyroid cancer, patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 should not take these drugs.
Gut motility issues. Since one of the primary mechanisms of action for these drugs is to slow down the gut, patients with gastroparesis — diabetic or otherwise — or other gut motility issues should avoid these drugs. Patients with inflammatory bowel disease also should not use GLP-1 RAs.
Pancreatitis. These medications can increase the risk for serious pancreatitis on their own, so use in patients who have had pancreatitis already is not recommended.
Renal impairment. An eGFR [estimated glomerular filtrationrate] below threshold, typically around 30 mL/min per 1.73 m2, excludes GLP-1 RAs for some patients. Be certain to check the threshold for individual medications before prescribing.
And finally, pregnancy. These drugs generally should not be used in pregnancy, and people of childbearing age with the ability to become pregnant should use contraception while taking these medications.
GLP-1 RAs are great medications and have the potential to revolutionize obesity medicine, but like all drugs, it’s important to use them safely. Knowing when not to prescribe them is an important step in ensuring patient safety and will help ensure they are available for those who need them.
Tamaan K. Osbourne-Roberts, MD, MBA, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
December 31, 2024
This transcript has been edited for clarity.
I’m Tamaan K. Osbourne-Roberts, family medicine physician and lifestyle medicine physician, here to discuss GLP-1 receptor agonist (RA) contraindications — the skinny on when not to prescribe.
It can be hard not to think of GLP-1 RAs like Ozempic and Mounjaro as silver bullets, long-awaited miracle drugs that we should probably be putting in the water. And it’s true they have the potential to help a lot of people.
They include the following:
Patients with a family history of certain cancers. Given that GLP-1 RAs can increase the risk for thyroid cancer, patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 should not take these drugs.
Gut motility issues. Since one of the primary mechanisms of action for these drugs is to slow down the gut, patients with gastroparesis — diabetic or otherwise — or other gut motility issues should avoid these drugs. Patients with inflammatory bowel disease also should not use GLP-1 RAs.
Pancreatitis. These medications can increase the risk for serious pancreatitis on their own, so use in patients who have had pancreatitis already is not recommended.
Renal impairment. An eGFR [estimated glomerular filtrationrate] below threshold, typically around 30 mL/min per 1.73 m2, excludes GLP-1 RAs for some patients. Be certain to check the threshold for individual medications before prescribing.
And finally, pregnancy. These drugs generally should not be used in pregnancy, and people of childbearing age with the ability to become pregnant should use contraception while taking these medications.
GLP-1 RAs are great medications and have the potential to revolutionize obesity medicine, but like all drugs, it’s important to use them safely. Knowing when not to prescribe them is an important step in ensuring patient safety and will help ensure they are available for those who need them.
Tamaan K. Osbourne-Roberts, MD, MBA, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
December 31, 2024
This transcript has been edited for clarity.
I’m Tamaan K. Osbourne-Roberts, family medicine physician and lifestyle medicine physician, here to discuss GLP-1 receptor agonist (RA) contraindications — the skinny on when not to prescribe.
It can be hard not to think of GLP-1 RAs like Ozempic and Mounjaro as silver bullets, long-awaited miracle drugs that we should probably be putting in the water. And it’s true they have the potential to help a lot of people.
They include the following:
Patients with a family history of certain cancers. Given that GLP-1 RAs can increase the risk for thyroid cancer, patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 should not take these drugs.
Gut motility issues. Since one of the primary mechanisms of action for these drugs is to slow down the gut, patients with gastroparesis — diabetic or otherwise — or other gut motility issues should avoid these drugs. Patients with inflammatory bowel disease also should not use GLP-1 RAs.
Pancreatitis. These medications can increase the risk for serious pancreatitis on their own, so use in patients who have had pancreatitis already is not recommended.
Renal impairment. An eGFR [estimated glomerular filtrationrate] below threshold, typically around 30 mL/min per 1.73 m2, excludes GLP-1 RAs for some patients. Be certain to check the threshold for individual medications before prescribing.
And finally, pregnancy. These drugs generally should not be used in pregnancy, and people of childbearing age with the ability to become pregnant should use contraception while taking these medications.
GLP-1 RAs are great medications and have the potential to revolutionize obesity medicine, but like all drugs, it’s important to use them safely. Knowing when not to prescribe them is an important step in ensuring patient safety and will help ensure they are available for those who need them.
Tamaan K. Osbourne-Roberts, MD, MBA, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
4 Simple Hacks to Get Paid for Lifestyle Medicine
This transcript has been edited for clarity.
As primary care doctors, lifestyle medicine is supposed to be a pillar of our practice. Per the evidence, lifestyle medicine can prevent up to 80% of chronic disease. It’s a real irony, then, that it’s the thing we’re least likely to be paid to do.
Thankfully, though, there are a few hacks to help you keep your patients healthy and yourself financially healthy at the same time.
No. 1: Be as accurate in your coding as possible. We all know working on things like sleep, exercise, and diet with patients takes time, so bill for it. With time-based billing, in particular, you can account for both the time spent in face-to-face encounters and the time spent afterward on documentation and care coordination. Make sure to capture that.
No. 2: Try group visits on for size. Group visit models are great for lifestyle medicine. They give you the flexibility to include longer conversations and deeper lessons on a range of subjects while still getting paid for what you do. Want to host a cooking class? Group visit. Want to bring in a personal trainer or hold a dance class or exercise dance class? Group visit. Meditation, yoga, or even a sleep hygiene class? Group visit.
While there are a few tricks to getting paid for group visits, they’re the same things, such as documenting time and the various parts of the visit, that are key to getting paid for regular visits. They have the bonus of fighting burnout and making your own practice more meaningful as well.
No. 3: Think about joining a value-based care arrangement. While only accounting for 10% of the market right now, value-based care (VBC) is growing rapidly, and it’s easy to see why. By trading quality for the hamster wheel of billing widgets, physicians are freed up to think more about how best to take care of patients, including incorporating more lifestyle medicine. Some VBC models even have their own electronic medical records, freeing you from outdated structures when it comes to documenting patient visits.
No. 4: direct primary care. Direct primary care cuts out the middlemen of payers, letting patients pay physician practices directly for their own care. Like VBC, it opens up possibilities for practicing better medicine, including lifestyle medicine. In addition, it’s often very affordable, with a family of four often paying around $80 a month for a membership for the entire family. It’s a win-win for the doctor and the patient.
Lifestyle medicine is a great way to improve both your patients’ and your own well-being. With a few flexes, it can improve your wallet’s well-being, too.
Tamaan K. Osbourne-Roberts, President/CEO, Happiness by the Numbers, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
As primary care doctors, lifestyle medicine is supposed to be a pillar of our practice. Per the evidence, lifestyle medicine can prevent up to 80% of chronic disease. It’s a real irony, then, that it’s the thing we’re least likely to be paid to do.
Thankfully, though, there are a few hacks to help you keep your patients healthy and yourself financially healthy at the same time.
No. 1: Be as accurate in your coding as possible. We all know working on things like sleep, exercise, and diet with patients takes time, so bill for it. With time-based billing, in particular, you can account for both the time spent in face-to-face encounters and the time spent afterward on documentation and care coordination. Make sure to capture that.
No. 2: Try group visits on for size. Group visit models are great for lifestyle medicine. They give you the flexibility to include longer conversations and deeper lessons on a range of subjects while still getting paid for what you do. Want to host a cooking class? Group visit. Want to bring in a personal trainer or hold a dance class or exercise dance class? Group visit. Meditation, yoga, or even a sleep hygiene class? Group visit.
While there are a few tricks to getting paid for group visits, they’re the same things, such as documenting time and the various parts of the visit, that are key to getting paid for regular visits. They have the bonus of fighting burnout and making your own practice more meaningful as well.
No. 3: Think about joining a value-based care arrangement. While only accounting for 10% of the market right now, value-based care (VBC) is growing rapidly, and it’s easy to see why. By trading quality for the hamster wheel of billing widgets, physicians are freed up to think more about how best to take care of patients, including incorporating more lifestyle medicine. Some VBC models even have their own electronic medical records, freeing you from outdated structures when it comes to documenting patient visits.
No. 4: direct primary care. Direct primary care cuts out the middlemen of payers, letting patients pay physician practices directly for their own care. Like VBC, it opens up possibilities for practicing better medicine, including lifestyle medicine. In addition, it’s often very affordable, with a family of four often paying around $80 a month for a membership for the entire family. It’s a win-win for the doctor and the patient.
Lifestyle medicine is a great way to improve both your patients’ and your own well-being. With a few flexes, it can improve your wallet’s well-being, too.
Tamaan K. Osbourne-Roberts, President/CEO, Happiness by the Numbers, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
As primary care doctors, lifestyle medicine is supposed to be a pillar of our practice. Per the evidence, lifestyle medicine can prevent up to 80% of chronic disease. It’s a real irony, then, that it’s the thing we’re least likely to be paid to do.
Thankfully, though, there are a few hacks to help you keep your patients healthy and yourself financially healthy at the same time.
No. 1: Be as accurate in your coding as possible. We all know working on things like sleep, exercise, and diet with patients takes time, so bill for it. With time-based billing, in particular, you can account for both the time spent in face-to-face encounters and the time spent afterward on documentation and care coordination. Make sure to capture that.
No. 2: Try group visits on for size. Group visit models are great for lifestyle medicine. They give you the flexibility to include longer conversations and deeper lessons on a range of subjects while still getting paid for what you do. Want to host a cooking class? Group visit. Want to bring in a personal trainer or hold a dance class or exercise dance class? Group visit. Meditation, yoga, or even a sleep hygiene class? Group visit.
While there are a few tricks to getting paid for group visits, they’re the same things, such as documenting time and the various parts of the visit, that are key to getting paid for regular visits. They have the bonus of fighting burnout and making your own practice more meaningful as well.
No. 3: Think about joining a value-based care arrangement. While only accounting for 10% of the market right now, value-based care (VBC) is growing rapidly, and it’s easy to see why. By trading quality for the hamster wheel of billing widgets, physicians are freed up to think more about how best to take care of patients, including incorporating more lifestyle medicine. Some VBC models even have their own electronic medical records, freeing you from outdated structures when it comes to documenting patient visits.
No. 4: direct primary care. Direct primary care cuts out the middlemen of payers, letting patients pay physician practices directly for their own care. Like VBC, it opens up possibilities for practicing better medicine, including lifestyle medicine. In addition, it’s often very affordable, with a family of four often paying around $80 a month for a membership for the entire family. It’s a win-win for the doctor and the patient.
Lifestyle medicine is a great way to improve both your patients’ and your own well-being. With a few flexes, it can improve your wallet’s well-being, too.
Tamaan K. Osbourne-Roberts, President/CEO, Happiness by the Numbers, Denver, Colorado, has disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.