It’s doctors vs. hospitals on noncompetes

The ideas and innovators shaping health care

Jun 22, 2023 View in browser   By Erin Schumaker, Carmen Paun, Evan Peng and Ben Leonard FOLLOW THE MONEY The AMA says doctors who work for hospitals shouldn't have to sign noncompete agreements. | AP Photo/John Minchillo The American Medical Association is wading into the Federal Trade Commission’s debate over whether to ban noncompete agreements. Why it matters: A large share of doctors — 45 percent in group practice and likely many more in other areas of medicine — are currently bound by noncompetes. But even as many individual doctors wrote to the FTC to support its proposed noncompete ban and hospitals, on the other hand, asked for an exemption, the AMA didn’t take sides. Hospitals argue that restricting their ability to retain doctors would compromise patient care and threaten their competitive edge. At its annual meeting this month, the AMA’s House of Delegates voted to oppose noncompetes imposed by hospitals and staffing companies. “Allowing physicians to work for multiple hospitals can enhance the availability of specialist coverage in a community, improving patient access to care and reducing health care disparities,” Ilse Levin, an AMA Board of Trustees member, said in a statement. Even so: The AMA will continue to oppose only “unreasonable” noncompetes imposed by private practice physicians. “We must keep in mind that owners of private practices often invest heavily when hiring and training physicians, and those owners may believe that they need to use reasonable noncompete agreements to compete with large hospital systems or other dominant institutional employers,” Levin said. What’s next? The AMA’s decision could have an impact at the FTC, where commissioners are still reviewing more than 26,000 comments on their proposed rule, as well as a recent Government Accountability Office report.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     WELCOME TO FUTURE PULSE Trongsa, Bhutan | Evan Peng This is where we explore the ideas and innovators shaping health care. If you’ve taken that occasional nap after lunch while working from home, don’t feel guilty. Regular daytime napping could delay aging by between three and six years, according to a study from researchers at University College London. They recommend keeping naps to less than 30 minutes. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Katherine Ellen Foley talks with Robert King about Georgia's plan to implement work requirements for Medicaid beneficiaries — and how other conservative states are looking at it as a model. Listen to today’s Pulse Check podcast WASHINGTON WATCH Burgess wants buy-in for expanded Medicaid coverage of substance use disorder. | Rules Committee/YouTube The landmark law known as the SUPPORT Act is up for reauthorization this year five years after Congress passed it to boost public health and law enforcement in the fight against opioids. But lawmakers are already sparring over a key issue: whether to allow states to use Medicaid funds to pay for addiction treatment in large mental health institutions. The backstory: States can’t typically do that now because of a provision Congress included in the 1965 law that created Medicaid. The reason: Congress wanted states to have primary responsibility for funding inpatient psychiatric services. Congress loosened the rule in the 2018 opioid-fighting law, offering federal matching funds to state Medicaid programs to treat substance use disorder in large mental health institutions for up to 30 days over a 12-month period. That provision expires at the end of September. But lawmakers disagreed on the merits of a bill that would permanently allow states to use Medicaid to pay for substance use care in mental health institutions during a House Energy and Commerce Health Subcommittee hearing on Wednesday. Reps. Michael Burgess (R-Texas) and Ritchie Torres (D-N.Y.) want the next version of the SUPPORT Act to include their bill to permanently allow states to use Medicaid funds to pay for the treatment. They argue that it would extend the treatment options for people who are in a mental health crisis and often end up in emergency rooms. Diverse interest groups support the idea, including the American Hospital Association and National Alliance on Mental Illness. Even so: The legacy of ill treatment of patients within psychiatric institutions persists. New Jersey’s Frank Pallone, the ranking Democrat on the Energy and Commerce Committee, said he was worried the bill would create financial incentives to institutionalize people with substance use disorder instead of offering them treatment in their communities. Compromise? Rep. Tony Cárdenas (D-Calif.) proposed guardrails, such as requiring that mental health institutions have to provide a certain standard of care to receive Medicaid reimbursement. “I'm worried that by maintaining a broad exclusion we’re leaving out most middle-income and low-income families across our country,” he said.   SUBSCRIBE TO POWER SWITCH: The energy landscape is profoundly transforming. Power Switch is a daily newsletter that unlocks the most important stories driving the energy sector and the political forces shaping critical decisions about your energy future, from production to storage, distribution to consumption. Don’t miss out on Power Switch, your guide to the politics of energy transformation in America and around the world. SUBSCRIBE TODAY.     CHECKUP Patients' biases harm home health care workers. | Joe Raedle/Getty Images Congress wants to bring more care into the home as a way to reduce Medicare costs and bolster outcomes. But after surveying 450 home health care companies, MissionCare Collective, a home care firm, found patient biases stand in the way, including discrimination based on: — Age. Eighty-three percent of home health companies surveyed said they had staffing challenges because patients won’t accept younger workers. “Given the wage pressure in home care, younger individuals might be more willing to accept these positions,” the survey found. — Race. About 4 in 5 home health companies said patients make “race-specific caregiver requests,” exacerbating workforce shortages. “This issue is particularly concerning as 63 percent of the direct care workforce consists of people of color,” the firm said. Overall, about 9 in 10 of the firms said they had to say no to potential clients due to workforce shortages. PANDEMIC Levine says long Covid can cause mental health problems and patients should be screened for them. | Getty Images Mental health effects of long Covid can be serious and should be treated with evidence-based approaches, the Department of Health and Human Services says. A new HHS advisory, issued through the Substance Abuse and Mental Health Services Administration, notes that many long Covid patients and their caregivers develop mental health conditions, which can include depression, anxiety, obsessive-compulsive and sleep disorders. The advisory also provides evidence-based resources to treat those symptoms. Why it matters: According to HHS, at least 10 percent of people who get Covid go on to experience at least one symptom of long Covid, and even those whose initial Covid infections were asymptomatic can develop the condition. Still, long Covid remains poorly understood, both by researchers and medical providers. “We know that people living with Long COVID need help today, and providers need help understanding what Long COVID is and how to treat it,” said HHS Assistant Secretary for Health Rachel Levine in a statement. “This advisory helps bridge that gap for the behavioral health impacts of Long COVID.” What’s next? The advisory is part of a larger effort by the Biden administration to address Covid’s long-term effects.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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