by Shelly M. Reese - Medscape Internal Medicine -April 7, 2021
When Traci Purath, MD, a Wisconsin neurologist, decided to leave the
health system where she worked and go into private practice in 2012, she
faced a major stumbling block: the noncompete clause in her employment
agreement precluded her practicing within a 15-mile radius of either of
the health system's facilities for at least 18 months.
Purath's lawyer said fighting the contract would cost about $50,000,
and she wouldn't be able to practice medicine until the case was
settled. Undaunted, Purath opened a clinic in a small town about 30
miles away.
But because her noncompete agreement restricted her
ability to advertise, her patients didn't know what had become of her.
When they called her former employer, they were sometimes told that she
had moved out of state or was no longer practicing.
Purath
ultimately landed on her feet — thanks to Google, many of her patients
eventually found her, and when her noncompete clause expired, she moved
her practice closer to home.
Her struggle is far from unique. In a recent Medscape poll
of 558 physicians, more than 9 out of 10 respondents said that they
were either currently bound by a noncompete clause or that they had been
bound by one in the past that had forced them to temporarily stop
working, commute long distances, move to a different area, or switch
fields.
Some healthcare executives debate whether noncompete
agreements are good or bad. Despite the blistering anecdotes, there are
some defenders.
The Good and the Bad
Over the last few
decades, noncompete clauses have become ubiquitous. Often used by
employers to protect intellectual property and proprietary information,
consolidation in the healthcare industry has made them a common element
in physician employment contracts. Having invested heavily in acquiring
physicians' practices and in recruiting and training physicians,
hospitals and health systems use them to prevent doctors from leaving
after a short time and setting up a competing clinic down the street.
Getting
out of a noncompete agreement can be difficult. Almost a quarter (23%)
of survey respondents said that they were unsuccessful when they tried
to negotiate their way out of a noncompete agreement. Another 30% did
not even try.
As a result, many, such as Purath, are forced to
make accommodations to abide by the terms of the contract. Forty-two
percent of physicians who left a job while under the terms of a
noncompete agreement found work similar to their previous work outside
of the noncompete area. Six percent found work of a different type, and
4% did not work during the time in which the noncompete agreement was
active.
"In my market, noncompete clauses are still very much
respected," writes a family physician in Indiana who commutes 45 minutes
daily to comply with the 25-mile noncompete radius stipulated in her
previous employer's contract
.https://www.medscape.com/viewarticle/948871
Our View: Closing disparities in health care critical to Maine’s well-being
Mainers face health challenges based on race, gender and which part of
the state they live in. A new office within the Mills administration can
help.
The Editorial Board - Portland Press Herald - April 12, 2021
Mainers face health challenges based on race, gender and which part of
the state they live in. A new office within the Mills administration can
help.
When COVID-19 hit Maine early last year, it didn’t hit everyone the
same — by June, Black residents represented 27 percent of all cases
while making up just 1.4 percent of the general population, the biggest racial disparity in the country. Latino and Indigenous residents were disproportionately hurt, too.
But that was only a more dramatic and visible example of the
disparities that exist in health care at all times, not just during a
global pandemic. Factors specific to certain groups, often based in
discrimination and bias, lead to problems with access and substandard
care — for not only Mainers of color, but women, LGBTQ residents, rural
Mainers and those with disabilities.
That’s why we support the new Office of Population Health Equity, established recently by the Mills administration within the Maine Center for Disease Control and Prevention.
The office’s job will be to monitor health inequities in the state
and intervene to ensure all Mainers have access to the care they need. A
similar office, under different names, existed within state government
for years before then-Gov. Paul LePage dissolved it in 2015.
It would be ridiculous to think such a change by itself could solve
the systemic racism and bias that limits health care access. But the
office should play an important role in that effort.
The office’s very existence is a much-needed acknowledgement that the
disparities are real and must be addressed in order for all Mainers to
have the opportunity to improve their well-being and live healthy lives.
The problems are not hard to find if
you look. The disparities in health for Black Mainers did not begin
with COVID; they have existed for years, driven by bias and lack of
economic opportunity. Black women in Maine are found to have much less access to prenatal care and higher rates of infant mortality. Across the U.S., minorities face higher rates of chronic disease and premature death.
Transgender and other LGBTQ residents face similar barriers.
In a large state with little public transit, and a lot of
infrastructure unfriendly to their needs, Mainers with disabilities can
struggle to get around.
The loss of hospitals, and maternity clinics specifically, in rural
parts of the state mean residents there are at a disadvantage compared
to their urban counterparts, with women traveling hours to deliver a baby.
The fact is, the health care system was built, intentionally or not,
by the majority for the majority; it just doesn’t account for everyone.
Great organizations have come in to fill the cracks, to advocate and
care for the populations that have to struggle to get what comes easily
to others.
But what we are doing now clearly is not enough. Maine has to look
harder at the places where access to care and positive health outcomes
depends on where you were born or how you look.
As long as those disparities exist, Mainers won’t be as healthy as they can be — and neither will Maine.
https://www.pressherald.com/2021/04/12/our-view-closing-disparities-in-health-care-critical-to-maines-well-being/
Mainers implore lawmakers to pass drug pricing bills, saying it’s a matter of life or death
by Evan Popp - The Beacon - April 14, 2021
One simple slip of the hand. That was all it took to put Sarah Lukianov’s life at risk.
Lukianov, a type 1 diabetic from
Bath, said she relies on two different insulins to survive. When she
accidentally dropped one of those supplies on the floor, shattering the
vial, she begged her insurance company to send her an emergency supply.
But the company said she should go to a pharmacy to buy insulin, which
would have cost Lukianov over $300.
She decided to ration her supply
rather than pay that exorbitant cost. Within days, she started suffering
symptoms of Diabetic ketoacidosis (DKA) as a result of going without
insulin. She described the feeling as “both excruciating pain and
absolute terror. You feel like you’re dying. And that’s because you
are.”
Lukianov survived the experience. But
for others, the story has ended differently. “I’m lucky that DKA didn’t
kill me like so many others who had to ration insulin because of the
cost,” she said.
Lukianov’s story was told during a
public hearing Tuesday before the Maine Legislature’s Health Coverage,
Insurance and Financial Services Committee on a package of bills
introduced by Democratic lawmakers to help rein in the cost of drugs
like insulin — which is cheap for drug makers to produce but sold at an exorbitant cost — and ensure that Mainers have access to life-saving medication and affordable health care.
Those bills come as big pharmaceutical companies continue to raise prices for life-saving treatments beyond what many can pay while raking in massive corporate profits, with a study
by the nonpartisan research organization RAND Corporation finding that
prescription drugs in the U.S. cost an average of 2.5 times more than
the same drugs in other Western nations.
The slate of legislation put forward
by Maine lawmakers includes two measures introduced by Senate President
Troy Jackson (D-Aroostook). One would
prohibit “excessive price increases for generic and off-patent
prescription drugs” sold in Maine and allow the state attorney general
to pursue action against drug manufacturers that violate the law. The
bill defines excessive as when a price increase exceeds 15% of the
wholesale acquisition cost of the previous calendar year, 40% of the
wholesale acquisition cost of three years prior or if the price increase
exceeds $30 for a 30-day supply of the generic or off-patent drug for
treatment that lasts less than 30 days.
Jackson’s other bill
would establish the Office of Affordable Health Care within the
legislature, which would be tasked with making recommendations “on
methods to improve the cost-efficient provision of high-quality health
care to the residents” in Maine.
Another bill,
introduced by Sen. Ned Claxton (D-Androscoggin), would make
prescription drug manufacturers subject to fines for selling drugs in
Maine “identified as having an unsupported price increase.” Determining
what amounts to an unsupported price increase would be “based on whether
there was no, or inadequate, new clinical evidence to support the price
increase” as demonstrated by the annual analysis of prescription drugs
by the Institute for Clinical and Economic Review.
An additional measure,
sponsored by Sen. Cathy Breen (D-Cumberland), would establish “an
insulin safety net program” in Maine, modeled after a program in Minnesota
created after 26-year-old Alec Smith died because he couldn’t afford
the insulin he needed. The measure in Maine would require manufacturers
of insulin to make the product available to pharmacies to dispense to
people who are “in urgent need of insulin or who need access to an
affordable insulin supply.” The bill would allow pharmacies to dispense a
30-day supply to eligible people and would cap the copay a pharmacy
could collect at $35.
The final bill,
introduced by Sen. Eloise Vitelli (D-Sagadahoc), aims to increase
transparency around drug pricing by requiring greater public notice when
a manufacturer implements substantial increases to the price of a
drug.
In his testimony in support of his
bills and the others in the package, Jackson told the story of a woman
in his district who was diagnosed with cancer. When she found out what
her treatment would cost, the woman’s first thought was that she was
going to die because she couldn’t afford it.
“There’s no reason why we shouldn’t
have basic protections for Maine people when it comes to medication,”
Jackson said. “Pharmaceutical companies shouldn’t be allowed to exploit
Maine people, who rely on live-saving medication, to pad shareholders’
pockets.”
‘We are human beings, not bank accounts’
Being able to access medication is a
huge issue for many Mainers, with 219,000 people in the state unable to
afford drugs or medicine that a doctor prescribed, according to a survey from October 2020.
Many people spoke to that struggle
during the public hearing Tuesday, urging the legislature to pass the
group of bills. Bonnie Deane from Appleton told the committee about her
son, who was diagnosed with severe Crohn’s Disease and juvenile
arthritis when he was 14. To treat his conditions, he began receiving
Remicade infusions every six to nine weeks, without which he would die,
Deane said. Each infusion of Remicade costs $78,000, she said. But even
after signing up for a discount program with the drug manufacturer,
Deane said she and her husband have medical debt that has grown to
six-figures.
“If you’re really sick and you need a
drug like Remicade to survive, you’re going to lose everything — and
there’s something wrong with that. I don’t want anyone else to ever go
through what we continue to go through,” Deane said during her
testimony.
The exploding cost of prescription
drugs can sometimes have fatal consequences. Catherine Begin of
Waterville told the committee about her son, who was diagnosed with type
1 diabetes and struggled to afford the insulin he needed because of the
exorbitant cost, often rationing it as a result. In 2017, Begin’s son
died.
“It wasn’t his fault he couldn’t
afford his insulin,” Begin said, noting its cheap cost of production and
the expensive price paid by those who need it. She said a bill like
Breen’s to create an insulin safety net program could have saved her
son’s life.
Another person who testified at the
hearing was Patricia Taniashvili of Surry, who spoke on behalf of her
husband. Taniashvili said her husband has type 2 diabetes. The best drug
to treat his condition is a medication called Trulicity, she said.
However, he has been without that drug for the last two years because it
costs $600 a month, even with his health insurance plan through the
Affordable Care Act marketplace. Taniashvili said her husband can’t
afford that cost, as his only income is a once-a-month Social Security
check for just over $1,000.
The lack of the medication has had a
dire impact on her husband’s health. His blood sugar is over 200
regularly, Taniashvili said, and he often doesn’t have the energy to get
out of bed.
Taniashvili urged the legislature to
take action to address such situations, describing it as immoral for
drug companies to jack up the prices of medication.
“We feel like we are being squeezed,”
she said. “If you as legislators have the capacity to control these
drug prices in some way, which it appears you would with this package of
bills, it is your duty. We are not the only ones suffering. There are
children and adults with type 1 diabetes in the same dire situation and
this is patently unfair to them and us. We are human beings, not bank
accounts.”
https://mainebeacon.com/mainers-implore-lawmakers-to-pass-drug-pricing-bills-saying-its-a-matter-of-life-or-death/
Biden officials rescind Trump’s okay for Texas’s $100 billion-plus Medicaid plan
The
decision is seen as an effort to push Texas officials toward expanding
Medicaid under the Affordable Care Act to cover more low-income
residents
by Dan Diamond - Washington Post - April 16, 2021
The
Biden administration on Friday rescinded approval for changes to
Texas’s Medicaid program granted by the Trump administration, saying
that federal Medicaid officials “materially erred” by speeding approval for the state’s $100 billion-plus request in January.
The
decision was characterized as an effort to push state officials toward
accepting the Affordable Care Act’s Medicaid expansion, which would
cover more low-income residents, said two federal health officials, who
spoke on the condition of anonymity to discuss private conversations.
Texas, which has more uninsured people than any other state, is one of
12 that have not expanded the program.
“[W]e
are rescinding the approval issued on January 15, 2021,” because it did
not go through the full federal rulemaking process, Liz Richter, the
acting administrator of the Centers for Medicare and Medicaid Services,
wrote in a letter to Texas officials obtained by The Washington Post.
In
its final week, the Trump administration told Texas officials that it
had approved a 10-year extension for its Medicaid plan, which was set to
expire in 2022. The waiver provides more than $11 billion in federal funding per year to the state, meaning that the Biden administration’s decision puts billions of dollars in federal funding to Texas at risk.
Health advocates had described that waiver as an effort to work around the federal Medicaid expansion by setting up alternate funding to help cover the costs of uninsured patients.
In
a statement Friday, Texas Gov. Greg Abbott (R) slammed the Biden
administration decision, saying it was “obstructing health-care access
for vulnerable Texans and taking away crucial resources for rural
hospitals in Texas. … With this action, the Biden administration is
deliberately betraying Texans who depend on the resources made possible
through the waiver.”
The approval for Texas’s changes, known as a Medicaid 1115 waiver, was among a flurry of last-minute activities overseen by Trump health officials in the waning days of the administration. Public health advocates and researchers decried
the moves as inappropriate attempts to grant GOP governors’ requests
and lock in Trump-era changes. Trump officials said that they were
moving to provide stability for health-care providers.
“The
10-year extension permits greater financial certainty for the state and
its safety net providers that serve Medicaid populations,” Seema Verma,
then-administrator for the Centers for Medicare and Medicaid Services,
wrote in a Jan. 15 letter to Texas.
Verma also said there was no need for the approval to go through the standard public notice-and-comment process, citing the coronavirus pandemic. But the Biden administration concluded the decision was a mistake.
“Upon
further review, we have determined that CMS materially erred in
granting Texas’s request for an exemption from the normal public notice
process,” Richter wrote in her letter Friday.
In a
statement, CMS said the agency had “erred in exempting the state from
the normal public notice process — a critical priority for soliciting
stakeholder feedback and ensuring public awareness.”
The
new Democrat-led administration has been unwinding a series of actions
overseen by Trump officials, including the prior administration’s approval of Medicaid work requirements.
The Biden administration also has pushed a dozen holdout states
to accept the federal Medicaid expansion. Medicaid officials said on a
briefing call for state officials last month that if Texas opted in to
the federal expansion, the state would get a $3.9 billion funding boost
over two years and 2.06 million uninsured people would become eligible
for Medicaid coverage, according to a presentation obtained by The Post.
The Texas Medicaid program has been the subject of political disputes
across multiple administrations. Texas officials in 2011 excluded
Planned Parenthood from its Healthy Texas Women program, prompting the
Obama administration in 2012 to cut federal women’s health funding to
the state. But the Trump administration in January 2020 restored the
funds by approving Texas’s Medicaid waiver, which was originally set to run through December 2024.https://www.washingtonpost.com/health/2021/04/16/biden-rejects-texas-medicaid-plan/
Bill Would Extend MaineCare, CHIP Insurance Coverage To Immigrants
by Patty Wight - Maine Public - April 15, 2021
The Legislature's Health and
Human Services Committee is considering a bill on Thursday that would
allow noncitizen immigrants — including asylum seekers — to get
insurance coverage through MaineCare and the Children's Health Insurance
Program, or CHIP.
Assistant House Majority leader Rachel Talbot Ross said that coverage was stripped away in 2011 under the LePage administration.
"Preventing
a child, an adult, an older Mainer, from getting health care because of
their immigration status is wrong. It is discriminatory. And it must
end," she said.
Talbot Ross said immigrants contribute to the
economy and should have access to health care. She said in 2018,
noncitizen immigrant households paid $193 million in state taxes and
more than double that in federal taxes.
During a virtual press
conference on Thursday morning, Crystal Cron of Presente Maine said
immigrants provide labor for some of the largest industries in Maine.
"Even
when they have raked thousands of crates of blueberries, shucked
hundreds of thousands of pounds of lobster, harvested broccoli, packed
potatoes, washed our dishes, cooked our meals, built our houses and
cleaned our toilets, they cannot afford to go to a single check up at
the doctor," she said.
