The AGs had claimed that Invidior used 'product hopping' to block competition from generics for its opioid treatment drug.
Drugmaker Invidior PLC says it will pay $102.5 million to 41 states and the District of Columbia to settle antitrust allegations related to the marketing of its opioid recovery drug Suboxone.
Invidior CEO Mark Crossley says the settlement amount is in line with the original provision of $290 million for the multi-district litigation. Payment is expected to be made this month, with funds coming from the Invidior's existing cash.
"Indivior is focused on helping those who suffer from substance use disorders," Crossley says in a media release. "We take our role as a responsible steward of medications for addiction and rescue extremely seriously. Resolving these legacy matters at the right value allows us to further this mission for patients.”
Indivior got Food and Drug Administration approval for Suboxone in 2002. The prescription drug is used by recovering opioid addicts to reduce or avoid withdrawal symptoms. Along with the FDA approval, Indivior was granted an exclusive seven-years window to sell the drug. In 2010 — a year after Indivior's exclusive right to the Suboxone tablet expired and generics were set to compete — the company switched from tablet to sublingual film, alleging safety concerns.
In response, the AGs sued Indivior in 2016, claiming the company blocked competition by with a scheme known as “product-hopping”, where drugmakers retain a monopoly on profitable drugs by slightly reformulating them to block generics without delivering new therapeutic benefits for patients.
California Attorney General Rob Bonta, whose state will get $7.1 million from the settlement, says high drug costs are a big problem for Californians, “and Indivior contributed to that problem by preventing lower cost generics from competing with Suboxone.
"Opioid addiction treatments should be accessible to everyone — especially our most vulnerable populations that need them for their recovery,” Bonta says. “With today's settlement, we're holding Indivior accountable and ensuring it doesn't engage in similar anticompetitive conduct in the future."
In addition to requiring Indivior to pay $102.5 million:
Indivior must provide the states with information and reasons for any reformulated versions of Suboxone;
Indivior must leave the Suboxone on the market for a limited period if generic alternatives are brought out, thus allowing doctors and patients to choose which formulation they like better;
If Indivior files an FDA Citizen Petition to delay generic competition, it must also submit any data or information underlying that petition to the FDA and the states.
The Missouri-based health systems hope to complete the deal by the end of the year.
BJC HealthCare of St. Louis and Saint Luke's Health System of Kansas City say they're exploring a merger that would create the largest health system in Missouri, serving "two distinct geographic markets."
The boards of directors at the systems this week unanimously approved a non-binding letter of intent to form an integrated, academic health system that they claim will expand "healthcare access to high-quality patient care for more than six million residents in Missouri and beyond."
The systems hope to finalize the merger by the end of 2023, assuming regulatory approval.
The systems are based in Missouri's two biggest cities, with headquarters located about 250 miles apart. The 28 hospitals and scores of clinical venues created by the consolidated system, if approved by state and federal regulators, would serve "two distinct geographic markets," the systems say.
It is not clear how a consolidated healthcare system would affect consumer costs, but numerous studies have shown that healthcare consolidation -- including hospitals, physician practices, drug makers, and payers – usually lead to higher prices for consumers.
If the merger is consummated, the systems will continue to serve their "two distinct markets," maintain their existing brands, and operate from dual headquarters in St. Louis and Kansas City
The merged system's C-suite and board of directors will include representation from both BJC and Saint Luke's. BJC President and CEO Richard Liekweg will be CEO of the consolidated system, with the inaugural board chair coming from Saint Luke's.
Liekweg says the hoped-for merger addresses challenges created by "the rapidly changing healthcare landscape."
"With an even stronger financial foundation, we will further invest in our teams, advance the use of technologies and data to support our providers and caregivers, and improve the health of our communities. These are opportunities that we can better achieve together," Liekweg says.
Saint Luke's President and CEO Melinda Estes, MD, says the two systems enjoy "well-established reputations for delivering exceptional care and elevating the health of the people we serve."
"Through our decade-long relationship as a member of the BJC Collaborative, we've established mutual trust and respect, so the opportunity to come together as a single integrated system that can accelerate innovation to better serve patients is a logical next step," she says.
BJC is one of the nation's largest nonprofit health systems with 14 hospitals, including Barnes-Jewish and St. Louis Children's Hospital, an affiliation with Washington University School of Medicine, and dozens of care venues serving greater St. Louis, southern Illinois and southeast Missouri.
The 140-year-old, faith-based Saint Luke's Health System includes 14 hospitals and campuses and more than 100 primary care and specialty offices, treating patients in 67 counties in Missouri and Kansas.
Northwell specialists will also provide support for DOS pre-deployment medical clearances and clinical case reviews.
Northwell Direct has been picked as the subcontractor to provide 24/7/365 telehealth consulting services for clinicians who provide care for U.S. State Department of State workers and their families posted overseas.
"Telemedicine is a unique area of opportunity for Northwell Direct to provide support and expertise to the Department of State," says Jonathan Berkowitz, MD, medical director of center emergency medical services at Northwell Health.
"We are virtually leveraging the collective expertise of our health system in innovative ways," Berkowitz says. "The breadth and depth of services we have across our network, coupled with our advanced telehealth and integrated technology platform, allows us to extend our reach and impact far beyond the traditional borders of the health system and appropriately support the Department of State."
The DOS has about 13,000 foreign service employees, 11,000 civil service employees, and 45,000 locally employed staff at more than 270 posts worldwide.
Northwell specialists will also provide support for DOS pre-deployment medical clearances and clinical case reviews. More than 100 specialties across medical, surgical, psychiatry and pediatrics will be made available to DOS providers, with the most consulted specialties including orthopedics, cardiology, radiology, neurosciences, dermatology, and emergency medicine.
"Northwell Direct is proud to be working with the United States Department of State and doing our part to ensure that the employees and family members who serve our country have access to the highest quality healthcare services while serving abroad," says Northwell Direct CEO Nick Stefanizzi. "The broad range of services we have deployed to meet the unique needs of the DOS are representative of the wholistic approach Northwell Direct takes to support all of its employer clients both domestically and internationally."
The bill would permanently expand telehealth services that were adopted during the coronavirus pandemic.
A bipartisan coalition in the U.S. House has filed legislation to make permanent the coverage for telehealth services under Medicare that was expanded during the recently ended Public Health Emergency.
The bill, Protecting Rural Telehealth Access Act is cosponsored by U.S. Rep. Chris Pappas (D-NH) and Republican Representatives Lisa McClain of Michigan, Jake LaTurner of Kansas, Marcus Molinaro of New York, Alex Mooney of West Virginia, and Zach Nunn of Iowa. A companion bill was filed the U.S. Senate by Jeanne Shaheen (D-NH) in 2021.
If enacted, the bill would permanently expand telehealth services that were adopted during the coronavirus pandemic, including continuing to allow rural health clinics and Federally Qualified Health Centers to provide telehealth services, and expanding coverage of audio-only services for certain conditions.
"Access to quality healthcare should not be a luxury reserved for urban areas. Rural communities matter and deserve the same level of care and convenience," Molinaro says. "This bipartisan legislation makes permanent telehealth flexibilities that were originally implemented during the COVID-19 pandemic. In doing so, we will ensure Upstate New Yorkers have access to the care they need, regardless of their zip code."
Pappas says the expansion of telehealth under the PHE has greatly benefited his constituents, particularly those who live in rural areas.
"Being able to access care virtually has ensured more people can receive the right care at the right time while saving them both time and money by eliminating transportation costs,"Pappas says. "Making coverage of telehealth services permanent is a practical proposal that benefits patients and providers alike."
A 2022 policy paper by the National Rural Health Association notes that 77% of rural counties in the United States have a shortage of primary care clinicians, which adversely affects about 60 million people. The statistics are even worse for specialists.
"It is imperative that Congress permanently extend the telehealth flexibilities enacted at the beginning of the COVID-19 public health emergency," NRHA says in the paper. "Coupling the continuation of flexibilities with investments in rural broadband is crucial to expanding access to care for rural patients."
The NRHA has also called on the Centers for Medicare and Medicaid Services to evaluate clinical care outcomes for telehealth visits compared to in-person visits, and to allow flexibility and standardization within telehealth to ensure consistency post-PHE.
In addition to the National Rural Health Associate, the bill is supported by more than 20 stakeholder organizations, including the Alliance for Connected Care, the American Academy of Family Physicians, the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, America’s Essential Hospitals, the American Medical Group Association, the American Telemedicine Association, and the Medical Group Management Association.
GI docs say the payer is using AI to move large volumes of services through prior authorization.
Effective June 1, UnitedHealthcare will require prior authorization for nearly half (47%) of gastrointestinal (GI) endoscopies. The payer says the move is needed to curb costs related to alleged overuse of some GI procedures by physicians.
Physicians counter that the move is the latest evidence that UHC is tapping artificial intelligence to move large volume services through prior authorization.
The news does not sit well with GI docs, who believe that the prior authorization process is often abused by payers to create a hurdle for patients and providers to clear when filing claims and getting paid.
HL: Has UHC explained to you why it is imposing this new PA mandate?
Hennessy: UHC says geographic variation exists in the use of endoscopy services but refuses to share any further information about that variation. For example, we have asked whether the variation is confined to certain regions or certain codes within certain geographic areas. With more information, ASGE can engage in education and outreach to ensure that gastroenterologists are familiar with endoscopy guidelines and encourage them to participate in quality improvement activities.
Many of the CPT codes covered by the GI endoscopy prior authorization program are low volume and, therefore, could not be considered over-utilized. On several occasions, the GI societies have asked UHC to share its own de-identified, aggregate data that show recent evidence of over-utilization. Our requests have been denied. UHC instead has referred to studies they claim suggest over-utilization in GI endoscopy. To date, we have received no information from UHC that substantiates over-utilization for any GI endoscopic or capsule endoscopy procedure.
What GI and other specialties are experiencing is payers using artificial intelligence (AI) to move large volumes of services through prior authorization. With the help of AI, payers have little-to-no economic downside to increase the number of services, including low-cost services, that are subject to prior authorization. If payers are going to increase the burden of prior authorization on physicians and other providers, they should be required to be transparent about the need for prior authorization and the method of review on a service-by-service basis.
HL: Why do you object to this PA requirement?
Hennessy: Physicians are overwhelmed with prior authorization requirements. The process of prior authorization is not transparent and denials and appeals for medically necessary services oftentimes result in patient harm. Further, UHC has not been transparent with evidence of over-utilization or geographic variation for the endoscopy services for which prior authorization will be required beginning June 1.
ASGE is on record supporting "Gold Card" programs which exempt physicians and other health care providers from a payer's prior authorization requirements if they meet certain eligibility requirements. For example, when a physician has high rates of prior authorization approvals for a particular service, including when that service is initially denied and approved on appeal.
In a March 9, 2023 news release, UHC promised to ease prior authorizations and announced that in early 2024 it would implement a national Gold Card program for certain provider groups, "eliminating prior authorization requirements for most procedures."
When ASGE asked UHC why it would not delay a new prior authorization program for GI endoscopy services and instead wait to utilize a Gold Card program to mitigate provider administrative burden, UHC representatives said the exact timing for the Gold Card program is unknown and that the Gold Card program and prior authorization for GI services are on "different trajectories."
UHC's decision to require prior authorization for nearly 50% of all endoscopy codes makes their public promise to reduce prior authorization burden on physician practices appear disingenuous at best.
HL:What specific patient health fallout would be expected with these new PA requirements?
Hennessy: The experience of ASGE members is that prior authorization delays patient access to recommended services. The expectation is patients who do not have a confirmed diagnosis of a GI disease or disorder but visit a gastroenterologist because they are experiencing abnormal signs or symptoms will suffer the most because physicians expect they will have to work harder to justify to UHC why the patient should receive an endoscopic procedure. Sometimes patient symptoms do not fit in an algorithm or may be limited in nature. Patients with limited English language proficiency might have difficulty articulating their symptoms. In these types of situations, a physician must interpret the symptoms and make the most appropriate recommendations regarding testing and treatment options. Those are the types of cases that are most likely to get spit out of an AI algorithm with a denial because the service requested does not match a diagnosis code.
Clinics that serve underserved areas may not have staffing to meet the demands of a new prior authorization program. At the same time UHC is implementing this program, which lacks any clear benefit to patients and that will require increased physician practice staffing, our health care system is experiencing a staffing crisis.
HL: Is there an average per patient cost/charge for endoscopies requiring PA, vs. endoscopies NOT requiring PA?
Hennessy: There is not a difference in the cost or charge to the patient for endoscopies requiring prior authorization versus those that do not. The physician practice incurs the staff cost associated with obtaining prior authorization — a cost that does not get passed onto the patient.
Insurance companies have no "skin in the game," especially with the use of AI when it comes to requiring prior authorization. We would like to see the tables turned and require payers to compensate physician practices for the cost associated with prior authorization when a service is initially denied and eventually approved on appeal.
Patients are increasingly encountering roadblocks to accessing recommended or prescribed care due to prior authorization and other utilization management tools that insurance companies claim are necessary to lower the cost of health care; yet, insurance premiums keep rising.
HL: What are the specifics of the "47%" of GI endoscopies requiring PA?
Hennessy: UHC is placing 61 endoscopy codes under prior authorization. These 61 codes represent roughly 47% of all endoscopy codes.
HL:How are they different from the (presumably) 53% of endoscopies that do NOT require PA?
Hennessy: The codes that will be subject to prior authorization are codes typically provided in the outpatient/ambulatory setting. The UHC prior authorization requirements are not applicable to services provided in the emergency room, urgent care centers, hospital observation units and the hospital inpatient setting.
The other 53% of codes include, but are not limited to advanced endoscopy procedures, such as ERCP and EUS, colorectal cancer screening, and capsule endoscopies codes.
HL:What action, if any, can your association take to oppose these PA requirements?
Hennessy: The ASGE has been working alongside the American College of Gastroenterology and the American Gastroenterological Association to oppose implementation of UHC's prior authorization program for endoscopy services on June 1. We have met with UHC and have presented them with a number of operational questions and have requested data that justifies this sweeping program. The request for data has been denied and many operational questions and concerns remain unanswered.
Earlier this month, ASGE and 171 other patient and provider organizations sent a letter to UHC asking the company to not implement the GI endoscopy prior authorization program, stating that it will limit access to care for vulnerable populations, delay diagnosis of colorectal cancer in younger populations, and needlessly increase physician and practice burden. There has been no response to the letter to date.
ASGE and the other GI societies are also meeting with congressional offices, and we are pleased the House Energy and Commerce Committee and the Senate Permanent Subcommittee on Investigations have launched inquiries into the use of AI for prior authorization by the nation's largest payers.
HL: What are you recommending your association members do in response to this new PA mandate?
Hennessy: ASGE and the other GI societies have asked their members to contact their state lawmakers with a request that they encourage state regulators to look into UHC's decision to move forward with the prior authorization program for endoscopy services with just 90 days advance notice and no transparency of data that support the implementation of such a sweeping program.
UHC Responds
HealthLeaders reached out to UnitedHealthcare about the new PA requirements, and received this response:
"We have made no changes to our policy regarding screening colonoscopies for preventive care, and this policy does not impact screening colonoscopies. We are asking physicians to follow the guidelines and evidence-based practices developed by their own gastroenterology medical societies to help ensure our members have timely access to safe and clinically appropriate care. The physicians who will be most affected by this new policy are those who are not already following these evidence-based practices, which again, were developed by gastroenterology-related medical societies."
"Our electronic submission process allows for immediate approvals for physicians who have a history of following evidence-based guidelines for the requested procedure. For procedures that do not receive immediate approval, decisions are typically made within two business days after receipt of all required clinical information needed for our GI specialists to review the case – well within the average wait time to schedule a service included in this policy."
However, the poll responses skew against older adults with annual household incomes below $60,000, Blacks or Hispanics, all of whom generally have lower rates of portal use, and are less likely to say they're comfortable using a portal, than respondents who are higher-income or non-Hispanic White.
Variations also were reported among older adults who say they're in fair or poor health physically or mentally are more likely to say they're not confident about their ability to log in and navigate a portal.
Even among older adults who use portals, the poll shows many prefer phone calls for scheduling or medical questions. However, portal users in general say they prefer the portal to the phone when getting test results and requesting drug refills.
The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine.
The jump in portal use between polls done in 2018 and 2023 coincides with the rise of telehealth visits during the COVID-10 pandemic, says Denise Anthony, Ph.D., the U-M School of Public Health researcher, which prompted providers to supplement video visits within their secure websites and apps.
"This change makes access to secure portals even more important for older adults who want to see their doctors and other healthcare providers virtually. It also makes the disparities we found in our poll even more troubling," says Anthony, chair the Department of Health Management and Policy.
"Improving the functionality and accessibility of portal systems, as well as providing more outreach and training to help patients understand and use portal systems, will be crucial to improving equity," Anthony says.
Many portals allow patients who have created their own accounts to also grant a loved one access to some or all of their information, so they can help manage their healthcare. The new poll shows
The polls shows that nearly half (49%) of portal have granted access to their portal accounts to a spouse, partner or relative , users have done so, up from 43% in 2018, with 48% of men doing so compared with 32% of women.
Poll director Jeffrey Kullgren, MD, MPH, MS, an associate professor of internal medicine at Michigan Medicine, says that a "growing body of evidence shows that patients who use portals to access their information are more likely to take an active role in their care and stick to the treatment plan their physicians and other providers recommend, which we know is likely to lead to better outcomes."
Kullgren says 27% of the poll respondents who've used a portal in the last year say they want more training. The percentage was higher among older adults who haven't used a portal recently, and those who are Black, Hispanic or have incomes below $60,000.
Kullgren says providers should make an effort to engage and support patients who have not accessed a portal, and to offer training to bolster confidence and encourage sharing access with trusted loved ones.
"This is especially important for patients who have complex health needs or multiple conditions," he says.
Indira Venkat, senior vice president of research at AARP says the increased use of virtual care by older adults is encouraging, but that more needs to be done.
"Research shows that while more older Americans are embracing technology, nearly 22 million older adults still do not have wireline broadband access at home, limiting their access to essential digital healthcare services like patient portals," Venkat says. "Closing the digital divide among older adults is critical to improving their wellbeing, especially for vulnerable communities and individuals."
The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in January 2023 among 2,563 adults aged 50 to 80.
The policy change is expected to significantly raise the wage index in several states.
The Centers for Medicare and Medicaid Services is proposing a policy change for the rural floor wage index in 2024 that could have profound financial effects on urban and rural hospitals across the nation, one expert says.
Under the proposal CMS would treat hospitals with rural classifications the same as geographically rural hospitals when calculating the wage index. The policy change is expected to significantly raise the wage index in several states, according to Health Law News.
While that in itself is not necessarily problematic, the Social Security Act mandates the "Rural Floor Budget Neutrality Adjustment", which prohibits increases in overall Medicare payments.
Milwaukee-based healthcare regulatory expert Joe Krause, an attorney with Hall, Render, Killian, Heath & Lyman, P.C., took time this week to answer some questions about the proposed change in the policy, and how it will affect providers.
What does the proposed rule do?
For the Medicare Program, the wage index applicable for any hospital located in an urban area of a state may not be less than the wage index applicable to hospitals located in rural areas. This is known as the "rural floor.”
In the Proposed Rule, CMS is proposing to change its policy for the rural floor to treat hospitals with rural reclassification (also known as §401 or §412.103 rural reclassification), the same as geographically rural hospitals for purposes of calculating the wage index. Specifically, CMS would include hospitals with §412.103 rural reclassifications and geographically rural hospitals in rural wage index calculations beginning with FY 2024. By doing this, CMS has significantly increased the rural wage index factor for several states, which would also increase the wage index for lower urban areas of the state.
When does it take effect?
The rule would impact the calculation of the wage index starting with inpatient payments on 10/1/23 and outpatient payments on 1/1/24.
What chance does it have to be adopted?
That is hard to say. Ordinarily, a change this big would get finalized unless there is a good basis (legal or otherwise) for CMS to change its decision.
Do you believe it will see significant changes after the public comment period?
No, I think the proposed rule will either be adopted or not adopted, in which case CMS would keep the existing rule in place. I don’t foresee an in-between.
How does it differ from the existing rule.
Currently, CMS only includes the impact of rural reclassified hospitals in the rural floor calculation if the hospital stays in the rural location. For various reasons, most hospitals that obtain rural reclassification subsequently reclassify out of the rural wage index area to an urban area and are not currently included in the rural floor calculation.
Why does CMS think this proposed rule is was necessary?
CMS commentary for this proposed change went through the rural floor policy and recent court decisions that address how CMS treats rural reclassified hospitals for different purposes. Based on that discussion, CMS proposed to reinterpret the rural floor calculation and how they treat rural reclassified hospitals under that calculation.
How will this proposed rule affect providers?
As stated above, this proposed change will significantly increase the rural wage index in many states, which would also increase the wage index for certain urban areas of the state. The Medicare Hospital Inpatient Prospective Payment System ("IPPS”) and Outpatient Prospective Payment System ("OPPS”) adjust a standardized amount for differences in hospital wage levels, which CMS implemented through the wage index system. If hospitals see their wage index go up by this policy, that would lead to increased Medicare payments.
However, the Social Security Act requires that the rural floor policy be budget neutral. Increases in wage index from this policy change cannot increase overall Medicare payments. CMS maintains budget neutrality of the rural floor through an adjustment known as the "Rural Floor Budget Neutrality Adjustment,” which is applied to the wage index of all hospitals. Some hospitals would see an increase in wage index and Medicare payments due to this policy change, while others would see a decrease because of the budget neutrality adjustment. But overall, Medicare payments will remain the same. This changes how the pie is divided up.
What should hospitals do to accommodate or oppose this new rule?
Hospitals should consider submitting comments to CMS as to whether they support or oppose this change and those comments are due by June 9th. Hospitals should also let their hospital association know if they support or oppose it.
SEIU, SOC accuse PA's largest health system of widespread abuses of market power.
Unionized workers at UPMC on Thursday filed what they say is a first-of-its-kind formal request with the U.S. Justice Department to investigate alleged wage suppression, onerous staff workloads, and retaliation against workers who complain at the Pittsburgh-based mega-system.
In the 55-page complaint, SEIU Healthcare Pennsylvania and the Strategic Organizing Center allege that "UPMC not only acquired monopolies and their equivalent in labor markets – monopsonies – in several Pennsylvania hospital markets, but also took anticompetitive actions that maintained and expanded those monopsonies over workers, in violation of federal antitrust laws."
"Nowhere has UPMC exercised its dominance more aggressively than in labor markets," the complaint says. "UPMC's monopsony power has enabled UPMC to suppress workers' wages and benefits, drastically increase their workloads, and prevent workers from exiting or improving these working conditions through a draconian system of mobility restrictions and widespread labor law violations that lock-in sub-competitive pay and working conditions."
UPMC did not respond Thursday to HealthLeaders' requests for comment.
Michael Zucker, executive director of the SOC, says the complaint follows a nine-month investigation by the unions and comes as UPMC has grown exponentially in the past 20 years. The complaint notes that UPMC dominates hospital markets in Pittsburgh and other Pennsylvania regions, employing 92,000 workers. Its annual revenue is more than $26 billion, and it owns 40 hospitals and more than 800 outpatient facilities.
"UPMC has created the perfect anti-competitive storm, where it has grown too large and dominant over hospital markets and hospital workers," Zucker says.
The complaint raises questions about UPMC's "potentially anticompetitive acquisitions" of 17 Pennsylvania hospitals in 10 years and reduced capacity, closing four hospitals and downsizing three others and eliminating 353 beds and 1,367 full-time and 433 part-time jobs at those closed and downsized facilities.
"Reducing capacity is a classic means by which monopolists and monopsonists exercise market power anticompetitively," the complaint says.
Wage Suppression
The complaint alleges that UPMC wages have declined over the years, even as the health system has seen exponential growth. The unions cite a study from Econ One Research that shows that UPMC workers across all job categories earn 2% less on average than workers at comparable hospitals.
For some workers, the complaint alleges that the gap is even higher. LPNs had an average wage penalty of $1.31 per hour, direct care contract workers had almost a $9-per-hour wage penalty, and low-wage workers saw a wage penalty of more than $1 per hour.
The wage study also alleged that for every 10% of UPMC's market share, the wage penalty is worse by between 30 and 57 cents per hour. "This wage suppression translates into significant wage gaps for UPMC workers – especially in places where UPMC has 50% and even more of market share, like Pittsburgh, Altoona, and Williamsport," the complaint says.
In addition to the suppressed wages, the complaint alleges that UPMCs staffing ratios have fallen steadily over the last 10 years, even as ratios at other Pennsylvania hospitals have increased. As of 2020, UPMC ratios averaged 19% lower than non-UPMC staffing ratios, were worst in the markets controlled by UPMC, and better where UPMC has less market power.
"If, as we believe, UPMC is insulated from competitive market pressures, it will be able to keep workers' wages and benefits – and patient quality – below competitive levels, while at the same time continually imposing further restraints and abuses on workers to maintain dominance in the markets where it operates," the complaint alleges.
Retaliation
The complaint alleges that UPMC uses its footprint to stifle worker unrest using non-compete clauses, "blacklisting" ex-employees from rehiring, and suppressing workers' efforts to organize, with UPMC amassing 133 separate charges of unfair labor practices since 2012.
UPMC workers in a survey compiled by the unions reported "shockingly high level of concerns regarding potential retaliation for raising issues regarding working conditions."
Three-quarters (74%) of the approximately 600 UPMC workers who responded to the recent survey say they could suffer retaliation for raising issues about working conditions, and 92% of respondents say they may face retaliation for supporting unionization at their job
"Workers have only two ways to compete for jobs: they can leave their current job and look for a better one, or they can stay and try to obtain better working conditions," says Matt Yarnell, president of SEIU Healthcare Pennsylvania. "We believe UPMC is cutting off both avenues of competition, giving it a huge advantage in Pennsylvania labor markets, and harming workers, patients and competition overall. Today we are seeking action to end these abuses."
Patients say they'll tolerate the technical glitches in exchange for engaged screen time with providers.
Low-income Californians generally expressed comfort and satisfaction with their telehealth experiences, but also want the option of accessing in-person care, a new survey shows.
The survey, conducted by NORC at the University of Chicago and commissioned by the California Healthcare Foundation, found that many of the 73 low-income Californians interviewed in the second half of 2022 acknowledged certain "trade-offs" that come with using remote care, such as the occasional audio and video connectivity issues, while at the same time reporting that their providers are more engaged in their care in video visits, which helps them to build trust with their providers and in telehealth.
"Ultimately, many participants who experience both phone and video visits see the value of each visit modality in different situations," the report says.
The survey subjects also told NORC that:
* Telehealth removes barriers to care, such as financial and transportation costs, that can hamstring access to in-person care. "Interviewees appreciate the ease of access and convenience of telehealth visits, especially interviewees with disabilities, those with mental health conditions, and those who identify as transgender or nonbinary," the report says.
* Telehealth helps patients build stronger relationships with providers. "Overwhelmingly, participants report high levels of satisfaction and trust with the care that they receive via phone or video," the report says. "Moreover, many feel that their relationships with providers are strengthened through more frequent and easier contact."
* Telehealth visits with providers proficient in the patients’ language results in high-quality care. "Participants who prefer to receive care in a non-English language who receive such visits report high levels of satisfaction and confidence in their communications with their providers," the report says. "As with other patients, telehealth visits help these participants build trust and strengthen their relationships with providers."
* They want telehealth to play a central role in their future care, with most interviewees saying they would like to receive at least half of their care via telehealth.
* They want to be involved in decisions about the modality of their visits and choosing which type of visit (i.e., phone, video, or in-person) makes sense for their specific health concern. Most of these patients like the idea of partnering with their provider in making this choice.
Leadership at Louisiana's largest health system cites clinical workforce shortages and COVID-related financial strains.
Ochsner Health will eliminate 770 mostly management and nonclinical positions in Louisiana and Mississippi to address workforce shortages and financial stressors, CEO Pete November says Thursday in a memo to employees.
"Healthcare providers across the country have experienced increased labor costs, a shortage of patient care clinicians, high inflation and the end of pandemic relief funding from the government," November says in his memo. "Despite progress and our significant efforts to reduce expenses, we need to do more to ensure we can continue to deliver on our mission and meet the needs of the patients and communities we serve."
"Today, we are taking the difficult step of reducing the size of our workforce by eliminating 770 positions, which represents roughly 2% of our team. Impacted positions are management and primarily non-direct patient care roles."
November pledged in an interview with NOLA.com that the layoffs would be the first and the last contemplated by Ochsner. "We want everyone to know that when we are finished with this round we are done. This is it," November tells the website. "Folks do not have to come to work every day worried about what comes next."
NOLA.com reports that Ochsner's revenues were $6.4 billion in 2022, up from $5.9 billion in 2021. However, the New Orleans-based system lost $96 million last year and its expenses exceeded revenues by 1.5%. It's not clear how many of the eliminated positions are vacant, but the cuts are projected to save up to $150 million annually.
Ochsner operates 47 hospitals and more than 370 care venues in Louisiana, Mississippi, Alabama and the Gulf South. The system employs more than 36,000 people and more than 4,600 employed and affiliated physicians.
For laid-off employees, November pledged to "do everything we can to deliver the resources and support our team needs and treat everyone leaving our organization with the respect and dignity they deserve," including providing up to 65 days of full pay and benefits and other severance packages, career and job-hunting support, and details for applying for other jobs at the health system.
"For those talented professionals who will be leaving us today: this is not the experience we hoped you would have at Ochsner. I want to thank you for all you have done and for sharing your talents with us," November says.
