Wins and Losses from the 2017 Legislative Session
Tuesday, May 9, 2017
Posted by: Bryan Campbell
From the Desk of Bryan Campbell, DCMS Chief Executive Officer:
I really said I wasn’t going to do it this year.
When the most disappointing season of Jaguars football I can remember came to an end in December, followed by the hiring of Doug Marrone as the new head coach, I swore that I was never going to buy season tickets again.
It’s not the first time I’ve made this idle threat, but this time I meant it. I had been so excited for the 2016 season. The offense was going to be explosive and the defense was bolstered by new talent and free agent acquisitions. This was the Year of the Jaguars! Never mind the lack of depth on the offensive line, never mind the youth of the defense… the strengths will overcompensate!
When Florida’s 2017 Legislative Session began in March, my level of enthusiasm was equally high. A number of very important issues for the physicians of Duval County seemed poised to break though and make it into law. Yes, there were also several issues that are troubling to physicians with a great deal of support, but with a strong offense and good defense, we should be able to overcome those issues.
The story of this 2017 Legislative Session was dominated by a power struggle in Tallahassee. Governor Rick Scott set forth a number of priorities. House Speaker Richard Corcoran and Senate President Joe Negron did the same. Unfortunately for physicians, those priorities were rarely aligned, leading to a session marred by political infighting. Governor Scott actually ran television commercials in local markets blasting Representatives in the House who opposed his support of Enterprise Florida.
As the days of the session drew to a close, less attention was paid to the bills being passed, and more on the inability of the House and Senate to agree on a budget. At the end, the session had to be extended by three days just to get a final budget deal approved. Lying in the wake: a great number of bills we’d hoped would pass this session, as well as a great deal more we fought to keep from passing.
It's not quite 3-13, but it feels like it.
The Jaguars brought in Tom Coughlin to be the Director of Football operations, a move that made many who have been long-time Jaguars fans excited about the future of the organization. They know he’s going to force the team to get out there and work for every yard. Big time free agent moves and another exciting NFL Draft have me once again thinking about the possibilities for this team in 2017…
…and yes, I did renew my season tickets.
The Legislature will pick up the pieces of this session very soon. The 2018 Legislative Session will start in January to accommodate the 2018 mid-term elections. That means that committee work on bills will begin as early as September. Many of our top priority bills were fully approved by the House or Senate, so there is a great foundation to work on building support. As we get closer to this time, hearing the voice of physicians will become even more important.
We’ve heard from Legislators that on issues such as making it illegal to mandate Maintenance of Certification in Florida, physicians are either apathetic or in support of MOC. We know that’s not true, so I will be asking for you to lend your voice to the discussion, so that we can show the power of organized medicine and truly stand out as the voice of medicine in Duval County…
…and yes, despite frustrations with 2016, I’ve got my ticket to the 2018 Legislative Session already purchased and I’m ready to get to work, Tom Coughlin style!
Let’s take a closer look at some of the most prevalent issues from the 2017 Legislative Session.
This is the most important issue of any legislative session, and often the most contentious. That was most certainly the case this year, as the Legislature missed the deadline for submitting the budget, which forced the three-day extension. One of the major sticking points in the budget was a proposed cut to hospital funding in Florida. In the final budget bill, there are $520 million in cuts from Florida hospitals.
Those cuts will impact safety net hospitals, such as UF Health Jacksonville, the hardest. The direct impact to the bottom line of UF Health Jacksonville will be more than $12 million.
There is some potential good news here. The Low Income Pool (LIP), a source of Federal income designed to assist safety net hospitals, may be available to help fill some or all of those cuts. The LIP funds were cut by the Obama administration as an effort to force Florida to expand Medicaid, which the Legislature opted not to do. President Trump and Governor Scott announced earlier this year that the LIP funds would once again be available to Florida this year. However, because of rules set in place under the previous administration, there are restrictions as to how those funds can be utilized. We will likely not know until the new rules from CMS on the issue are released, most likely in July.
Permanent Medical Malpractice Cap Fund Extension
This is one of those issues that you hope you won’t ever need to benefit from. When the legislation was passed in 2007 to put the cap on Med Mal, it was set to roll back after three years. That means that in 2010, 2013 and 2016, doctors had to go back to Tallahassee, hat in hand, to extend the cap. This year, a permanent extension to the cap was successfully passed, meaning that this should now be considered a permanent benefit for physicians.
Pediatric Cardiac Advisory Council
This bill requires AHCA to establish a technical advisory panel to develop procedures and standards for measuring outcomes of pediatric cardiac catheterization programs and pediatric open-heart surgery programs. It also establishes additional criteria that must be included in rules relating to adult cardiovascular services at hospitals seeking licensure for a Level One program.
This bill made some changes to the PRN program in Florida. Most notably, it provides that in certain circumstances, an impaired practitioner may be reported to a consultant rather than the Department of Health. It also revises the grounds for disciplinary action to include termination from the impaired partitioned program, under certain circumstances.
Drug Price Transparency
This bill will have AHCA collect data on the retail prices for 300 of the most commonly prescribed medicines in Florida. It will then need to compile and report that data on its website monthly.
One of the most visible fights this legislative session was surrounding medical marijuana. When Florida voters approved Amendment 2 last fall, it required the state to take a closer look at the existing rules in place governing the distribution of medical marijuana in Florida. In order to respond to the overwhelming support of the Amendment, five different bills were introduced to help regulate the burgeoning industry.
Major differences in the bills surrounded the issue of how the drug can be ingested (oil, edible, smoke, etc.) and the number of distributors around the state. At the end of the session, the House and Senate could not reach an agreement and no bill was passed. This means that AHCA will be in charge independently of setting up the rules for the implementation of Amendment 2.
Scope of Practice Expansion
Like a bad penny, this issue continues to come up again and again. This year, three bills which would have dramatically changed the delivery of healthcare in Florida were defeated.
A House bill would have created a new classification of Advanced Independent Practicing Registered Nurse, which would have allowed Nurse Practitioners who received this certification to practice medicine independent of a physician protocol.
Another bill sought to give Optometrists the ability to perform most surgeries.
The final bill would have allowed for physicians licensed outside the state of Florida to receive permission to practice telehealth on patients in Florida, without the oversight of the Florida Board of Medicine.
All three of these bills had tremendous support in the House, and were voted to the floor. We feel fortunate that we had strong support for physicians and patients in the Senate, and these bills did not get to the floor for a vote.
This is definitely an example of no action being a positive outcome, but these issues are already being discussed for the next legislative session, so any victory here is only temporary.
Two different bills proposed this session would have dramatically changed the way that hospitals function in Florida. The first would have eliminated the current Certificate of Need (CON) process for approval of hospitals. It would replace it with a local entity which would oversee the process. That bill was often modified, ultimately removing hospices and other care facilities from the change. Towards the end of the session, it became a bargaining chip between the two legislative bodies and ultimately was not passed.
The second bill would have changed the formula which determines the need for Trauma Centers in Florida. Under the final version of the bill, Northeast Florida would have been found to require two Trauma Centers. This bill would have been devastating to UF Health Jacksonville, which relies on the Level One Trauma Center as a significant source of financial support. The death of the bill is a major blow to Orange Park Medical Center, which opened a Level Two Trauma Center in 2016. Earlier this year, a judge ruled that the center should not have been allowed to open. It is unclear what lies next for that center.
Several priority issues for physicians in this session revolved around physician reimbursement or insurance coverage for their patients.
A fail first/prior authorization bill would have required insurers to provide the procedure to obtain protocol exceptions in writing and on their website. It would also put a timeline on processing exception requests.
Another bill would have prohibited insurance companies from retroactively denying claims under certain circumstances.
The final bill would have allowed physicians to enter into a Direct Primary Care agreement with patients, which would NOT be considered an insurance product. Patients would still be required to carry catastrophic coverage, however.
Each of these issues had tremendous support in one chamber, but got caught up in what we sometimes call a “Train Bill” where several issues are mashed together. Unfortunately, the final Train Bill was unable to get enough support to pass.
Several bills would have changed important insurance policies currently in place in Florida. One would have eliminated the PIP Motor Vehicle Insurance requirement. The other would have made dramatic shifts in the Workers Compensation system. Both were unsuccessful in this session, but we will almost certainly see them in 2018.
Maintenance of Certification
As I stated above, we worked to produce a law which would prohibit any agency from utilizing the Maintenance of Certification as a credentialing condition. There was some initial traction on this bill, but unfortunately, the voices in support of the MOC helped to defeat this measure. In my many talks with physicians around Northeast Florida, one recurring theme is frustration with the escalating cost of MOC, and the frequently irrelevant subject matter in those exams.
As my final plea (for this Legislative Session), I urge you to share with me your stories of frustration with the MOC process. If we do that and share your voices, in 2018 we will get this bill passed.
As always, you can reach me by phone at (904) 353-7536 or by email at firstname.lastname@example.org.