President's Message
Legislative Agenda 2000
How will your elected representative represent you?
A. Allen Seals, M.D., President

Dr. Terrence P. McCoy, Chair, FMA Council on Legislation has recently summarized the FMA's 2000 legislative agenda, approved by the FMA Board of Governors. The following "hot topics" will be discussed in the hallowed halls in Tallahassee, and you just might want to consider the question, "How will my elected representative vote". You can be certain, that numerous other special interest groups are already approaching legislators to sway them in a direction that will probably be adverse to you and your patient's best interest.

Hospitalists: The DCMS is supportive of our physicians that work predominantly in the hospital/ICU setting, however we are adamantly against the mandatory use of hospitalists. The mandatory use of hospitalists is contrary to a patients access to choice in medical care, and interferes with continuity of care. Furthermore, some hospitalists are utilized by managed care companies to look out for its financial interests and not the patients. Patients must be able to choose their physician, both as outpatients and as inpatients.

Expert Witness: The DCMS will work to amend the current law to ensure that only similarly qualified experts are allowed to present testimony for or against defendant physicians. Liberal application of the relative standard rule undermines the requirement that the expert be a "similar health care provider". The most commonly used exception employed by courts is to allow testimony on the basis of "knowledge" acquired only by reading texts or journals in a given specialty. In many cases these "experts" are professional witnesses who are trained to display a favorable personality and demeanor, despite lacking the credentials of a truly qualified expert in the field. A new definition of expert is proposed that would require that during the preceding 5 years, the expert has devoted professional time to active clinical practice, or consulting in the same specialty area of practice that includes the performance of procedures and treatment of similar patients.

Treatment Denials: DCMS supports legislation that would provide that the modification or denial of a treatment plan as well as the making of an adverse determination, constitutes the practice of medicine, and further provide that medical directors must sign adverse determinations. This legislation will help ensure that a licensed physician is involved in any decision by an HMO to deny or modify treatment to a patient.

Medicaid Reimbursement: The DCMS supports increasing the primary care and specialty care Medicaid reimbursement rates for participating physicians. For physicians to continue to provide high quality health care services to the Medicaid population, reimbursement levels need to be raised to a level that more closely reflects the actual cost of providing the service.

Prompt Pay/Downcoding: The DCMS fully supports legislation that defines a "clean claim" and provides physicians with a remedy in the event claims are improperly denied or downcoded by a MCO. This bill will require HMOs to pay all clean claims in a timely manner and establishes an external review mechanism that will provide for an impartial mechanism to review denials.

1.5% Tax on Offices: The DCMS strongly supports repeal of the 1.5% tax on net operating revenues for physician office practices which provide clinical laboratory and diagnostic imaging services. This burdensome tax was imposed to increase funding for the inpatient Medicaid hospital services. While this tax may or may not be justified for hospital services, it is important to realized that hospitals are significantly compensated in terms of funding of dual eligible patients (Medicare patients who are also Medicaid eligible) to offset their cost for the 1.5% tax. For physician's offices, the assessment has not been accompanied by any increase in Medicaid fees (in fact they have often decreased), leaving private physicians to shoulder an undue burden for indigent care.

HMO Accountability: The DCMS supports legislation to hold managed care organizations responsible and accountable for the failure to exercise ordinary care when making health care treatment decisions. Similar to an enacted law in Texas, this measure recognizes that many medical and nonmedical HMO employees make medical decisions and, in effect, practice medicine. This law would extend safeguards to Floridians under existing liability statues to companies who recklessly withhold medical care in order to limit spending and increase profits.

Equal Access: The DCMS supports modification of section 455.667 Florida Statue permitting defense attorneys to speak with the plaintiff's treating physicians in medical malpractice actions without requiring the use to the formal discovery process. Previously, the Legislature amended the medical record confidentiality statue to include language designed to exempt medical malpractice actions. However, this language has been given an extremely limited interpretation. While the plaintiff's attorney is free to discuss the plaintiff's medical condition and treatment with any physician, the defendant's attorney operates under a different set of rules and must resort to the formal discovery process. This modification is sorely needed to "even the playing field" and provide more balance in our current liability environment.

Scope of Practice: While the DCMS acknowledges and respects the work of non-physician health care workers, the DCMS strongly opposes all legislation that would inappropriately expand the scope of practice for any allied health care professionals. The average physician completes a minimum of six years of classroom study, and a minimum of five years of clinical practice before eligible for licensure. Expanding allied health professionals (with far less formal education and training) would be seriously adverse public policy and place patients in direct risk for mistreatment by unqualified persons.

NOW is the time to communicate to your representative by any means you prefer (letter, phone, fax, e-mail, or even in person!). A list of legislators is printed in the DCMS Directory as well as on the following websites: fmaonline.org (FMA) and leg.state.fl.us (Official Guide to the State of Florida Legislature). However, if you prefer to lull in silence under the delusion of cynicism or apathy; don't worry, many other special interest groups will communicate to your Legislators in your absence.