A great deal is revealed about the fortitude and resilience that lies within when we are faced with challenges that were previously unimaginable. We are happy to see the dedication shown by our medical community over the past two years is being recognized by our community. You truly deserve to be commended for your professionalism and dedication under such trying circumstances. Having said that, we recognize the extreme strain the pandemic has had on clinicians and understand that recovery will not be easy. The DCMS and DCMS Foundation continues to pursue expansion of our LifeBridge program and other resources to more local medical professionals.

Your DCMS is in a stronger position to help our physician community as we close 2021 than we have been in recent years. The pandemic has brought community organizations, elected officials, patient advocates, and the business community closer together as we coordinate our response. Your DCMS is actively engaged in strategic planning with other community stake holders and are collectively delivering care and trusted information to populations throughout the community. While forced together through necessity, the pandemic has shone a light on what is possible when we collaborate more purposefully.

Under the guidance of our new President, Dr. Mark Dobbertien, the DCMS leadership is committed to expanding these enhanced collaborative initiatives through outreach with local hospital medical staff and administrative leaders. We will also be doubling-down on our efforts to engage local elected leaders as we build a more resilient and healthy community.

These efforts to advance medicine in the community are not possible without the foundation of a strong organization. The DCMS is in a more financially strong position today than it was before the pandemic. A great deal is owed to our physician leaders for steering the organization through these troubling times as well as the ongoing support of our physician members.

The long-term damage from the pandemic will be revealed in future years. While we are uncertain of what lies ahead, the DCMS will proudly stand up to those challenges and represent our physicians with the dedication and passion that we have for the past 168 years. As we head into 2022 our staff feels more honored than ever to work on behalf of each of you.

Happy New Year from all of us at the DCMS!
-Fraser Cobbe, DCMS Executive Director

Click here for a summary of the key components of each of the three bills. The DCMS was part of a coalition of all of the major medical associations in the state that fought against these expansions. There was also a broad coalition of special interest groups there were supportive of one or more of these bills. That coalition included representatives of the business community, insurance, hospitals, and of course the pharmacists and nurses.

Our message has been consistent throughout the process, that the state can address manpower and access to care issues without lowering the standard of care available to our patients, especially those in underserved areas. It will be important moving forward that physicians and patients demand a single standard and a high standard of care from non-physician practitioners that take on the obligation of caring for patients outside the traditional physician-led team.

A Legislative Update from Fraser Cobbe, DCMS Executive Director

The DCMS would like to thank all of our members that were able to reach out to members of the Senate concerning the Independent Practice Amendment that was proposed for Senate Bill 1676 by Senator Albritton. Unfortunately, the amendment was added to the bill and the amended bill did pass out of the Health & Human Services Appropriations Subcommittee this week. 

This is a significant development as this is the first time the Senate has moved any language related to independent practice for APRNs. The bills are very different at this point which sets up behind the scenes negotiations between the leadership in both chambers. Both bills have hearings next week in their final Committees in either chamber. The Senate Bill is a lot more limited than the House Bill. The Senate Bill currently does not include PAs, limits independent practice to primary care in underserved areas, and primary care will be defined by the Board of Medicine and overseen by a Council that includes 3 MDs, 3 DOs, and 3 APRNs. The bill does not allow insurance carriers to force patients to see APRNs and requires physician supervision in hospitals and nursing homes. The House Bill is a very broad independent practice for APRNs and PAs without many limitations.  

The next week will be revealing to see if the Senate bill continues to move toward the House Bill. We remain concerned with establishing a lower standard of care in underserved communities, with the potential for increased overall health care costs due to more frequent referrals, admissions, and use of imaging and ancillary services by APRNs and PAs, and the ability of facilities and insurers to utilize independence to reduce patient access to physicians. 

Our organization will be focused on communicating our concerns with the proposed legislation with members of the Senate. Please look for additional Calls to Action to be released over the coming days.

On behalf of the talented and dedicated team of professionals at Cobbe Consulting & Management, I would like to share our sincere appreciation for the opportunity to represent the oldest Medical Association in Florida, the Duval County Medical Society. Our organization has been retained by the Board of Directors to provide administrative and executive support for the DCMS as of January 1st.  Inheriting an organization on the rise, we are extremely thankful for this opportunity and the many contributions made by the outgoing CEO, Bryan Campbell.  We wish Bryan well in his new position with the Colorado Medical Society and look forward to building upon the foundation created by previous leaders and administration.

The First Coast community should expect the same level of dedicated service and representation from the DCMS through this transition in administrative leadership.  We are extremely pleased to announce the entire staff of the organization has been retained and will continue to serve the organization.  The physicians throughout this region have been extremely well represented by Marissa Saftner, Sallie Baumann, and Kristy Williford. I am thrilled to have them join our team.

Our Association Management Company also has a proud history of representing physicians in Florida. With experience that ranges from the FMA to County Medical Societies and Specialty Societies, our diverse staff has wide ranging expertise in association management that will elevate the programs and services available to our DCMS members.

On a personal note, having witnessed the strength and leadership of the DCMS from afar over my past 20 years working in organized medicine, it is truly an honor to be given this responsibility. These turbulent times for medicine demand that we seek new avenues to represent the profession and provide tools for our members to succeed personally and professionally. I strongly believe we have the physician leadership and staff skills to address our challenges and chart an exciting future course for organized medicine on the First Coast. 

We greatly appreciate your ongoing support and membership in the DCMS.  We look forward to exceeding your expectations and continuing the legacy we inherit.

Should you have any questions or concerns, please to not hesitate to email me or call 813-215-7140.

Click here for a summary of the bills and their impact.

Click here to learn more about the bills passed this week.

No, this has nothing to do with the Florida St. Seminoles or even sports for that matter.

The Florida Legislature will NOT be ending session tomorrow as scheduled, and that’s because the House and Senate were unable to come to a resolution on the state budget in time. By Florida Law, that means they will head into an extra day of session on Saturday to finalize the budget and last minute issues. Many of those issues, including the budget, have a direct impact on healthcare here in Northeast Florida

The Budget

This is an area that has some of the greatest impact here in Northeast Florida. The $91.1 billion state budget will likely be approved on Saturday, and will change a part of the formula that funds safety net hospitals such as UF Health Jacksonville. The budget removes $9.5 million from the “automatic rate enhancements” fund, which supplements Medicaid reimbursements for these hospitals. The Senate originally proposed to redistribute the entire $318 million in the fund, but settled on the 3% reduction as a compromise.

Scope of Practice

Several bills were considered this year which would have dramatically changed Scope of Practice in Florida. HB 111 would have given pharmacists the ability to diagnose and treat flu and strep throat. That bill passed the House but was not heard in the Senate. Another bill that passed in the House but stalled in the Senate was HB 821 which allowed for Nurse Practitioners and Physicians Assistants to practice without the supervision of a physician. Other bills sought to give pharmacists prescribing and consulting rights, and prescribing authority to psychologists. All of these bills were defeated.

Electronic Prescribing

Put away those prescription pads and make sure your EMR skills are up to date. HB 831 requires that all prescriptions be submitted electronically. The exception would be in the case of an outage or technical problem with your e-prescribing software, and noted in the patient’s file.

Certificate of Need

HB 21 greatly modifies the Certificate of Need process for approval of new medical facilities in the state. This means fewer barriers to the opening of many types of medical facilities.

Telehealth

HB 23 established some official rules for Telehealth in Florida. Primarily, it established the definition of telehealth as “the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.”

While this definition is important, the two primary issues concerning telehealth we have been monitoring have been out-of-state licensure and reimbursement. A registration has been established that an out-of-state provider with an active medical license in good standing in their state may pay an annual fee to practice medicine in Florida. They will be subject to the prevailing Board in their licensing state, but must comply with several Florida-specific regulations.

In terms of reimbursement, the law states that insurance companies and physicians must voluntarily agree to enter a contract which covers telehealth, and that any provision in the contract which differentiates in the reimbursement rate between telehealth and the same services provided without telehealth MUST be initialed by the provider in the contract.

Summary

This is a brief summary of the actions of the 2019 Florida Legislature, and as of the time of this writing (1:45pm, Thursday May 2, 2019) there are still at least two days of session, so things may yet change. Next week, we will provide to you a more comprehensive breakdown of the session, including response from local hospitals and representatives to the Legislature. Keep in mind, all of the passed bills still require the Governor's signature.

Physicians have the highest rate of suicide among all professions in the United States.

It’s important to let that fact be set aside and resonate. How is it that the profession that is dedicated to improving quality of life and saving lives can also be stricken with an epidemic of stress and burnout?

The most recent Medscape Lifestyle Report indicated the following as the most prominent causes for stress among physicians:

1.      Too many bureaucratic tasks

2.      Spending too many hours at work

3.      Feeling like just a cog in a wheel

4.      Increased computerization of practice

5.      Income not high enough

As you can see, all of those top five issues deal with external pressures and changes on the medical field. Physicians love to care for their patients, they don’t love it when a torrent of external factors makes it difficult or impossible to do so in the way they were trained.

More than half of all physicians report signs of burnout. That number is growing rapidly, increasing by more than 10% in just four years.

As a result, a number of resources have been created to address physician wellness, including mindfulness seminars, yoga classes, and more. Unfortunately, physicians have been reticent to seek the type of professional care they need to address their signs of stress or burnout.

Until now.

Introducing LifeBridge: Confidential Physician Wellness. LifeBridge is provided to all members of the Duval County Medical Society via the DCMS Foundation. LifeBridge is a safe and confidential program to help get you back to feeling like yourself.

·         LifeBridge is like no other physician wellness program out there. The service provides up to six free in-person sessions with a counselor to discuss any issue which is causing you stress or burnout. It doesn’t matter if it’s a troublesome co-worker, marital issues, or difficulty dealing with a bad outcome. You get the help of a licensed professional at no charge to the physician.

·         LifeBridge does NOT create a medical record. Unfortunately, physicians have expressed concern that seeking appropriate help from a mental health professional will create a medical record and could impact their licensure. LifeBridge has been designed in conjunction with the Florida Board of Medicine specifically to be a pre-clinical program that does not create a medical record.

·         LifeBridge is completely confidential. From the moment you call our LifeBridge Hotline, your personal information is protected. Only your counselor will know your personal information, so it can never be reported to the DCMS, your employer, or any other group.

·         LifeBridge has a diverse panel of counselors who have committed to making themselves available for an appointment within 24 hours of your call to the wellness line. They are specially trained to work with physicians, and have confidential office space located across the metropolitan area.

LifeBridge is the path to get you back to the life you want to be living. I encourage you to write down the number, even if you don’t need it today. You may have a friend or colleague who needs it now or in the future.

How to access LifeBridge:

• Call our confidential wellness line at (904) 631-1446.
• Visit our website for more information at dcmsonline.org/lifebridge

Now that HB21, the new Opioid Prescribing Bill, has been in effect for more than a week, your practice should be up to speed with all of the new information required in the law. Several physicians have asked if there are resources available beyond the state-mandated CME which can increase the effectiveness of safe opioid prescribing in their practice.

Today, thanks to a partnership with Drug Free Duval, the Duval County Medical Society is able to provide two new resources which may prove invaluable to you.

1.       Pathways Interactive Training  – This is a virtual practice simulator developed by the National Institutes of Health. It allows anyone in your office the opportunity to see a case with a patient from multiple perspectives and interact with various potential outcomes to understand the impact of decision points in adhering to safe prescribing guidelines. Many practices are already using this tool as staff training around the new law. 

2.       Harvard Opioid Education – This is a resource available for free to all Duval County Medical Society members that can provide up to 24 free CME on the area of opioids and opioid prescribing. This does NOT meet the criteria for the state-mandated opioid CME course, but it’s a significant source of either simply free CME, or more importantly, practice specific education for physicians who deal with a large number of opioid prescriptions. The Harvard class comes in three separate CME courses of 8 CME each:

a.       Understanding Addiction: Fundamentals about the nature of addiction for practitioners seeking to learn more about opioid use disorder (8 CME Credits)

b.       Identification, Counseling and Treatment of OUD: Current best practices for the identification and management of opioid use disorder (8 CME Credits)

c.       Collaborative Care Approaches for the Management of OUD: Collaborative strategies for ongoing management of opioid use disorder (8 CME Credits)

And if you are looking for some of the tools we’ve already shared about getting your office adjusted to the new law, be sure to check out:

·         The DCMS Quick Guide to the Opioid Bill

·         The FMA Opioid Bill Fact Sheet

·         “Is Your Practice Breaking the Law?” Checklist

As always, if you have questions, feel free to reach out to me at bcampbell@dcmsonline.org or by calling our Advocacy Hotline at 904-353-7536.

On July 1, HB 21, the new Opioid Prescribing Law went into effect. And based on the number of calls and feedback we are receiving at the office, a number of practices may not be in full compliance with the law. Here’s a quick eight question checklist.

• Are you checking E-FORCSE for every Schedule drug prescription?
• Are you limiting opioid prescriptions to a 3-day supply?
• If you are writing opioid prescriptions up 7 days, are you writing “Acute Pain Exception” on the script?
• Are you documenting the specific reason for the Acute Pain Exception in the script and chart?
• Does every member of your staff who accesses E-FORCSE have their own individual login?
• When prescribing Schedule II drugs for traumatic injury with Injury Severity Scores greater than or equal to 9, are you prescribing an opioid antagonist?
• Are you seeing patients in your office and checking E-FORCSE for every prescription for Schedule drugs (including chronic pain)?
• If you have experienced down time with E-FORCSE, are you documenting the event and limiting that script to a 3-day supply, regardless of the Schedule of the drug?

If you are able to say 100% YES to all of these questions, then congratulations, you are in compliance with the new law. If not, you might inadvertently be breaking the law. You’ll want to familiarize yourself and your practice quickly.

Click here for the DCMS Quick Start guide for your practice.

Click here for the comprehensive guide prepared by the Florida Medical Association.

Click here to access the E-FORCSE website to register a provider or extender.

To take the state-mandated 2-hour CME course on opioid prescribing online, select one of the following sources:

• Florida Academy of Family Physicians
• Florida Medical Association
• Florida Osteopathic Medical Association

As always, if you have questions, feel free to call our Legislative Advocacy hotline at 904-353-7536.

DCMS Members Dr. William Palmer, Dr. Ferdinand Formoso, and Dr. Sunil Joshi were presenters at the free opioid CME presentation at Mayo Clinic Tuesday evening.

On Tuesday night, nearly 500 Mayo Clinic physicians and DCMS members gathered on the Mayo Clinic campus to receive, at no cost, the newly state-mandated 2-hour Opioid CME course.

As you know, the new Opioid Prescribing Law goes in to effect this Sunday, July 1. At that time, you will need to follow the strict rules on 3-day prescribing for opioids and accessing the E-FORCSE program for all Schedule drug prescriptions.

To download our one-page info sheet on the bill, click here.

To access the detailed bill summary from the Florida Medical Association, click here.

If you were unable to attend Tuesday’s event and would like to take the CME online right now, you may do so my accessing one of the following organizations' websites. Prices vary for members and non-members of each organization:

• Florida Academy of Family Physicians 
• Florida Medical Association

As always, if you have any legislative questions, you can reach me at bcampbell@dcmsonline.org or by calling our Advocacy Hotline at (904) 353-7536.

I've received dozens of emails over the past few weeks from DCMS members with questions about the new opioid prescribing law that goes into effect on July 1st. I've compiled your most common questions and answered them below.

As always, don't hesitate to reach out to me with follow-up questions or concerns at bcampbell@dcmsonline.org or by calling (904) 353-7536. The DCMS is here for you!

-Bryan Campbell
DCMS Chief Executive Officer

Your Questions Answered:

Does the “Acute Pain Exception” include post-op care? This is the most frequent question we received. The answer is yes. You need to be sure that you include in the chart for the patient that the pain from the surgery is likely to necessitate Schedule II opioids for greater than three days, but you still may not write for more than 7 days of a Schedule II opiate.

What about prescriptions given inpatient?  Inpatient administration of drugs are legally different than "prescriptions" and are not limited by the new law.

What are the guidelines for the “Injury Severity Score”? – For more information on Injury Severity Scoring, go to http://www.trauma.org/archive/scores/iss.html. 

What more does my staff need to do? Are they only involved in the PDMP accessing if I write a script in my office but the meds are filled elsewhere? Staff members can be used as extenders to access the PDMP with their own logins. You should create an appropriate protocol to ensure that each patient is checked and that the check is recorded appropriately. You should also stay tuned to the DCMS for updates, as implementing regulations are currently being written. Over the next few months, as the bill moves closer to being implemented as law, there will be several administrative rules that can change the current implementation in minor or major ways.

Can I get my Mandatory CME from the DCMS? – The DCMS is currently working to partner with the approved CME providers in order to allow DCMS members to fulfill this requirement quickly and inexpensively.

My employer has an institutional DEA license. Does that exempt me from the mandatory CME requirement? No. If you prescribe under a DEA license in Florida, whether it is held by you or an institution, you are required to take the CME course before January 31, 2019, and before each subsequent renewal.

Sunday, the Florida Legislature ended its 2018 Session two days late, thanks in part to a number of high-profile issues directly related to healthcare in the state of Florida.

The primary reason for the weekend closing date was due to disagreements over the state budget and funding for safety-net hospitals like UF Health-Jacksonville. The budget proposed by the Senate would have eliminated the automatic rate increases to hospitals like UF Health-Jacksonville and other safety-net hospitals who see a higher percentage of poor, disabled, elderly and pregnant cases in Medicaid. Ultimately, the final version of the budget kept those automatic payments in place.

Another healthcare issue was also center stage on the budget debate. At issue, increased funding for nursing homes and their patients. The budget includes a $130 million bump in Medicaid payments to these systems, as well as an increase of personal needs monthly stipends of 25% for nursing home residents.

What Passed

Opioids – As anticipated, the much discussed opioid bill was approved on the final day of the session after disagreements over aspects of the bill related to Medical Assisted Treatment. In the end, here are the key takeaways for your practice:

• Prescriptions of opioids will be restricted to three days for acute pain
• Chronic pain, terminal cancer, and palliative care are exempt
• Surgery is NOT exempt
• Physicians may extend the three day limit to seven utilizing an “Acute Pain Exemption”
• The Prescription Drug Monitoring Program (PDMP) currently known as E-FORCSE must be checked for each prescription
• Nearly a million dollars was added to the budget to upgrade the system
• It will now have access to patient records from other states
• Each physician with a DEA License and a Florida Medical License must complete a two-hour CME course on safe opioid prescribing for each Florida License renewal

Direct Primary Care – Florida physicians who choose to operate in a Direct Primary Care model will no longer be subjected to report to the Florida Office of Insurance Regulation.

What Did Not Pass

• Pharmacists to Diagnose and Treat Flu and Strep
• PAs and ARNPs to Sign Documents as Physicians
• Restricting facilities from using M.O.C. for Licensure or Privileges
  

I will have more thoughts on the Legislative Session in the coming weeks. Considering the number of attacks on scope of practice and your rights to practice medicine, this was a relatively successful 2018 Legislative Session. The opioid bill will be onerous for some, but there was no stopping the political will behind the bill, and while there are certainly things we hoped would have been included in the final language, it does closely mirror CDC guidelines. Next year’s legislative session will not be in an election year. That often means a slower pace and the chance to reflect on existing policy. My best guess is that there will be many efforts to improve and/or expand this law next year.

Finally, as I’ve mentioned before, there were more than 100 bills that impacted delivery of health care in some way, shape or form. If you’d like to know more about a particular bill, please don’t hesitate to call or e-mail me at any time.

-Bryan Campbell
Chief Executive Officer
Duval County Medical Society
p: (904) 353-7536
c: (904) 626-2915
e: bcampbell@dcmsonline.org

The Florida Legislature this week is coming closer to passing sweeping reform in an effort to fight the opioid epidemic here in the state, and the ramifications of the bill will have an impact on almost every practicing physician in the state of Florida.

The bill will have three major impacts on your practice.

1. Prescriptions for opioids for acute pain will be limited to three or seven days. There are exemptions for chronic pain, cancer treatment and palliative care, but NOT for surgery.
2. Every prescription for a Schedule 1-4 drug will require the physician to look up the patient in the Prescription Drug Monitoring Program, E-FORCSE.
3. Every physician with a DEA license in Florida will be required to take a two hour CME course on safe opioid prescribing for every license renewal.

In addition, you have likely received the notice that the E-FORCSE system will be upgraded this April. This bill funds that upgrade and improves the system so that the PDMP lookup includes data from more than 40 other states. However, it will still be a separate login. There is the ability to have it integrated directly into your existing EHR, but you will need to work directly with the vendor, Appriss Health, in order to coordinate that. We are currently pushing for that clinical integration to be covered in the state budget, but if we are unsuccessful, that will likely be a cost of approximately $50/physician.

Finally, I want to let you know that the DCMS Task Force on Opioids has been closely monitoring this bill and is working to ensure that you and your practice have the most up-to-date information and access to the necessary education as soon as possible, and definitely in advance of the July 1 effective date of this bill.

To learn more about the bill, you may read it here.

To learn more about the opioid crisis and the local role in making a difference, please join us at the Future of Healthcare Conference on May 21-22 at the Prime Osborn Convention Center.

Senate Bill 98, which limits certain types of information from being required for prior authorization, and which requires insurance companies to publish information pertaining to prior authorization procedures passed the Senate today.

The companion bill, House Bill 199, has passed one committee and now rests in the Health Innovation Committee. 

We are nearing the halfway point of the 2018 Florida Legislative Session, and SB 8/HB 21, bills which would change rules for prescribing opioids in Florida, continue to move forward. Right now, each bill has passed two committees in the House and Senate, and face one more committee stop before hitting the floor for a final vote. As a reminder, here are the key provisions of the bill:

• A 3-7 day cap on opioid prescriptions for opioid-naïve acute pain patients
• Mandatory checking of the Prescription Drug Monitoring Program for every prescription of opioids
• Mandatory 2 credit hour CME course required on renewal for physicians writing opioid prescriptions

Here are some frequently asked questions I receive on a daily basis about the bill:

So my cancer patients need to come in to get a new script every 3 or 7 days?

-No, this limit is only for opioid-naïve, acute pain patients.

Will E-FORCSE be easier to use?

-Yes and no. The system will be upgraded to a newer, more intuitive system that also pulls data from multiple states, so you will be able to see if a patient is shopping across state lines. Georgia is one of the states you will be able to access. However, at this time it will still be a separate login into the system. There will be an option to do a single sign-on integration with your existing EMR, but there will be a fee associated with that.

When will these rules take effect?

-The bill, if passed, would go into effect on July 1, 2018

There are other bills we are continuing to monitor in Tallahassee as well.

SB 80/HB 37 – This bill would allow a physician to operate a Direct Primary Care model without needing to adhere to several of the Florida Insurance Code requirements which are currently in place for this model. This bill has already passed the House and is in its final committee stop in the Senate.

SB 628/HB 81 – This bill would prohibit the use of MOC as a condition of licensure, credentialing or admitting privileges in Florida. Unfortunately, this bill has not moved at this time in either house.

SB 162/HB 217 – This bill would prohibit insurance companies from retroactively denying claims in certain circumstances. This bill has moved in the Senate but has not in the House.

SB 1876/HB 1165 – This bill would allow for the state to eliminate the current cap on number of trauma centers in the state, would approve certain pending trauma centers, and would change the formula for future trauma center development.

The Florida Legislative Session is scheduled to end on Friday, March 9, so we will see the fate of these bills decided in the coming weeks, and we will continue to monitor them for you

A Legislative Message from CEO Bryan Campbell:

Tuesday marks the beginning of the 2018 Legislative Session in Florida. As in past years, the Legislature will be looking at a number of proposed bills that could impact the delivery of healthcare in Florida.

Among the many bills that will be considered this year, the opioid crisis in Florida is perhaps the most critical topic that will come before lawmakers. Governor Rick Scott addressed this issue during his State of the State address this morning, saying that he wants to spend $53 million to fight opioid abuse.

The DCMS is taking a leading role in combating this crisis in Florida. The DCMS Opioid Task Force is bringing together physicians to address education and an implementation process for safe prescribing guidelines. In fact, representatives from the County Medical Society will be in Tallahassee this week to advocate on behalf of physicians regarding this issue.

The Duval County Medical Society will be following this and many other healthcare issues throughout the next two months. As always, we’ll be working to provide you with timely updates in every edition of your DCMS e-newsletter throughout the Legislative Session.

Should you have any questions or concerns about legislative issues, please feel free to contact me at bcampbell@dcmsonline.org or by calling (904) 353-7536.

It’s impossible to discuss medicine this week without acknowledging the efforts of the medical professionals in Las Vegas who responded to the most deadly mass shooting in American history Sunday night. While 59 people were killed by a gunman, more than 500 were injured and treated by the medical teams there. Using tragedy as an opportunity to learn and prepare, doctors from Orlando who responded to the Pulse Nightclub shooting of 2016 actually helped to prepare Las Vegas for handling a situation like this. Read more from Health News Florida.

Closer to home, two rulings from the courts will impact delivery of healthcare right here in Northeast Florida. The first is a decision by the Supreme Court not to take up an appeal by Baptist Health System in a case involving the disclosure of medical records in malpractice cases. The Florida Supreme Court previously ruled that medical records must be disclosed in such cases, despite the argument that these records were protected by the 2005 Patient Safety Act.

The second decision by a Federal judge will block the implementation of a 2016 Florida law which would have required anyone who counsels women about abortions to provide an explanation about the procedure, including alternatives, before making referrals or assisting in obtaining abortions. In his opinion striking down the law, U.S. District Judge Robert Hinkle said, “The statute is a naked effort to impede speech on a disfavored topic promoting a disfavored but legal viewpoint.”

Finally, the state continues to wrestle with the roll-out of marijuana for medical use. There has been cognitive dissonance between the Charlotte’s Web laws passed in previous years, and the Constitutional Amendment passed in 2016. Just last week, the state missed a deadline to add additional licenses to distribute. Now, one of the companies who is already cleared to distribute in Florida is asking the state to put forth rules to allow the sale of medical marijuana to patients. A law allowing the sale, presuming the products are not geared toward children, was passed in June. However, sale is prohibited until the administrative rule is finalized.

Today the only two things clear about the Future of Healthcare are that the latest effort to repeal and replace the Affordable Care Act/Obamacare has failed, and that (shameless plug) we will be diving deep into the issue at our Second Annual Future of Healthcare Conference on May 21-22, 2018.

The Graham-Cassidy bill failed to gain support in the Senate despite throwing extra funds to the states of Senators considered on the fence. The measure, if approved, would have cost Florida nearly $10 billion in Federal funds over the next six years, according to a study from the Kaiser Foundation.

The fight over ACA is overshadowing a much more time-sensitive matter for Florida. The state budgeted for nearly $700 million in CHIP (Children’s Health Insurance Progam) funding for 2017. However, Federal funding for the CHIP program is set to expire on September 30, and without renewal, more than 340,000 children in the state could lose access to medical care.

Closer to home, the Baptist Health System also is fighting a battle in Washington, D.C.. Yesterday, the U.S. Supreme Court was expected to consider a case involving when medical records are shielded from disclosure law. They are petitioning the high court to overturn a ruling from the Florida Supreme Court.

Finally, on behalf of the DCMS Board of Directors and our entire membership, I would like to offer congratulations to Dr. Leon Haley, who was announced as the next CEO for UF Health Jacksonville. Dr. Haley has served as the Dean of the College of Medicine at UF Health Jacksonville since January of this year and has been a tireless advocate for the hospital and its patients.

Dear Duval County Medical Society member,

Hurricane Irma has impacted each of our lives in a way that will never be forgotten. As the First Coast struggles to resume life as normal, we know that many of you are dealing with significant impact on your medical practices due to storm damage.

To help us better assess how we may be of assistance to our membership, I'm asking you to just send us a quick note indicating whether your practice is up and running, seeing patients, or if you are closed for repairs or other Irma related factors.

Your feedback will help us to be the most effective in coordinating assistance where possible. My email is bcampbell@dcmsonline.org and you can also call our office at (904) 355-6561.

Thank you,

Bryan Campbell
CEO
Duval County Medical Society

A few weeks ago, I wrote asking for your help. Several local practices have been experiencing extraordinary problems with the VA Choice program, either through prior authorization or extreme delays in reimbursement.

Because of your feedback, U.S. Congressman John Rutherford met with the Director of the North Florida/South Georgia Veterans’ Health System and asked for immediate action.

Many thanks to the local physicians and practice administrators who have already shared their problems and concerns. However, Congressman Rutherford has asked that we provide even more supporting cases in order to make a stronger case for corrective action. If you or your practice have experienced these prior authorization or reimbursement challenges with the VA choice program, please share them with me at bcampbell@dcmsonline.org so I can share them with the Congressman.

Thank you for all that you do to provide care to our Veterans. Now it’s our turn to give back to them by ensuring they have the access to care they deserve.

Good afternoon,

The core function of the Duval County Medical Society is to ensure that physicians in our community are able to practice medicine to the best of their ability. This means helping members navigate governmental regulations, attain required Continuing Medical Education, advocate on behalf of physicians and their patients, and work with key stakeholders in order to improve the overall health of the community.

Today, I am specifically requesting your assistance in helping us to improve a situation we have learned is impacting many of your practices collect on thousands of dollars in reimbursement.

The Duval County Medical Society has learned that there is a wide-spread concern regarding reimbursement under the VA Choice program. Several local practices have indicated that they are holding claims Accounts Receivable for as long as a year for VA Choice patients. In addition, attempts to close these claims have resulted in telephone wait times of up to eight hours.

This matter has been brought to the attention of Congressman John Rutherford, who has specifically asked me for your assistance. Congressman Rutherford would like to take swift action to ensure that VA patients continue to have access to care under the VA Choice program, and that physicians and their practices are compensated swiftly and fairly.

If your practice has experienced these or similar issues with the VA Choice program, please let me know ASAP. A few practices are already sharing detailed data regarding A/R timelines, patient volume and wait times. If you are willing and able to share that information, the Congressman would appreciate the ability to use this data to help strengthen the case for quick action. However, if your organization is unwilling or unable to provide such specific data, then please consider sharing general information. The purpose is to demonstrate that this is truly a widespread concern across the region.

If you have further questions, please reach out to me at (904) 353-7536. I am excited that together, we have the opportunity to make an important impact on this issue.

Thank you,

Bryan Campbell
DCMS Chief Executive Officer
bcampbell@dcmsonline.org
(904) 353-7536

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!

3-13.

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.

What Passed

The Budget

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.

PRN Change

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.

Everything Else

Medical Marijuana

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.

Hospital Regulations

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.

Payment Issues

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.

Insurance Changes

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 bcampbell@dcmsonline.org.

Today marks the beginning of the 2017 Florida Legislative Session. Over the next 60 days, the Florida Legislature will be considering a large variety of proposed bills which could have a significant impact on the delivery of healthcare in Florida for years to come.

Every week, we will attempt to provide a high-level summary here for you to quickly get caught up on the week’s activities. We will also be posting almost daily updates on individual measures as they move through the Legislative process. You will find these updates on our Legislative Blog.

While we will be tracking dozens of bills, I wanted to highlight a few that could have a dramatic and immediate impact on Duval County.

Independent Practice for ARNPs

This bill would create a category of Advanced Registered Nurse Practitioner which could operate independent from a physician’s protocol.

Pros: Proponents say that this is a necessary step to provide access to care and meet the demand created by the growing physician shortage in Florida.

Cons: The amount of training a physician receives is significantly different from that of an ARNP. While the nurse is a critically important part of the healthcare team, nurses should continue to work under the supervision of physicians.

DCMS Official Position: Oppose

Legislative Status:

Senate: No Senate Bill filed

House: PCB HQS 17-01 filed by Health Quality Subcommittee (Bill Text)

Right Medicine, Right Time

This bill would provide physicians a pathway to bypass fail first protocols for urgent healthcare services, specifically if a drug class is known to be ineffective, if there is a contraindication, or if the protocol care is not in the best interest of the patient.

Pros: Protects the physician’s ability to make clinical care decisions in the best interest of the patient when a fail first protocol would be detrimental to care.

Cons: Opponents say these protocols are required to maintain affordable care.

DCMS Official Position: Support

Legislative Status:

Senate: SB 530 filed by Sen. Greg Steube (Bill Text)

·         Referred to Banking and Insurance; Judiciary; Rules

House: HB 877 filed by Rep. Shawn Harrison (Bill Text)

·         Referred to Health Innovation; Appropriations; Health & Human Services

Retroactive Denials

This bill states that a health insurer may not retroactively deny a claim because of insured ineligibility at any time if the eligibility of the insured was verified at the time of treatment and an authorization number was provided.

Pros: Ensures that physicians are paid for seeing patients for whom insurance authorization was received.

Cons: Opponents say the Affordable Care Act grace periods make it impossible to maintain up-to-date eligibility.

DCMS Official Position: Support

Legislative Status:

Senate: SB 102 filed by Sen. Greg Steube (Bill Text)

·         Passed Banking and Insurance (9-0) on 2/21

·         Referred to Health Policy; Rules

House: HB 579 filed by Rep. Bill Hager (Bill Text)

·         Referred to Health Innovation; Insurance & Banking; Health & Human Services

Direct Primary Care

Would allow for physicians to enter into a Direct Primary Care model with patients which is not regulated like an insurance contract.

Pros: Increases patient choice for alternative payment models and Direct Primary Care contracts.

Cons: Under current Affordable Care Acts regulations, individuals would still need to carry catastrophic coverage.

DCMS Official Position: Support

Legislative Status:

Senate: SB 240 filed by Sen. Tom Lee (Bill Text)

·         Passed Banking and Insurance (8-0) on 2/7

·         Passed Health Policy (5-0) on 2/21

·         Referred to Appropriations Subcommittee on Health and Human Services and Appropriations

House: HB 161 filed by Rep. Daniel Burgess (Bill Text)

·         Passed Health Innovation (15-0) on 2/16

·         Referred to Health & Human Services

Certificate of Need Deregulation

This is a bill which would change the current process by which medical facilities are approved. The current Certificate of Need (CON) process would be replaced by local organizations which would have the authority to set their own approval process.

Pros: Could speed up the burdensome process for hospitals, hospice, and other facilities to be approved.

Cons: There is no demonstration that the current system fails to meet community needs. Could hurt established safety net hospitals or lead to market saturation.

DCMS Official Position: Oppose

Legislative Status:

Senate: SB 676 filed by Sen. Rob Bradley (Bill Text)

·         Referred to Health Policy; Appropriations Subcommittee on Health and Human Services; Appropriations; Rules

House: CS/HB 7 filed by Health Innovation (Bill Text)

·         Passed Health Innovation (10-5) on 2/15

·         Referred to Health Care Appropriations Subcommittee; Health and Human Services Committee

Trauma Center Deregulation

This is a bill which changes the regulatory process for approving new Trauma Centers in Florida, expanding the current cap on facilities.

Pros: Would allow for remote areas to have designated Trauma Centers.

Cons: Would impact the established model, potentially creating market saturation and impacting existing programs.

DCMS Official Position: Oppose

Legislative Status:

Senate: SB 746 filed by Sen. Matt Hutson (Bill Text)

·         Referred to Health Policy; Appropriations Subcommittee on Health and Human Services; Appropriations; Rules

House: HB 1077 filed by Rep. Trumbull (Bill Text)

Maintenance of Certification

This bill would prohibit the Boards of Medicine and Osteopathic Medicine, respectively, and the Department of Health, healthcare facilities, and insurers from requiring certain certifications as conditions of licensure, reimbursement, employment, or admitting privileges, etc.

Pros: Ensures that the onerous Maintenance of Certification is not used at a future time as a form of credentialing.

Cons: Current CME requirements may not be sufficient.

DCMS Official Position: Support

Legislative Status:

Senate: SB 1354 filed by Sen. Dana Young (Bill Text)

·         Not referred to committee at this time

House: HB 723 filed by Rep. Julio Gonzalez, Rep. Ralph Massulo (Bill Text)

·         Referred to Health Quality; Health Care Appropriations; Health & Human Services

Compassionate Use of Low-THC Cannabis and Marijuana

This bill would take into consideration the existing rules for low-THC cannabis and marijuana in consideration with the passage of Amendment 2 in 2016. It would lower the CME requirements and remove some current restrictions to patient access.

Pros: Utilizes the existing system to ensure that Amendment 2 is enacted in a controlled environment.

Cons: Opponents say that there will still be too many restrictions in place.

DCMS Official Position: Support

Legislative Status:

Senate: SB 406 filed by Sen. Rob Bradley (Bill Text)

·         Referred to Health Policy; Appropriations Subcommittee on Health and Human Services; Appropriations

House: No House Companion Bill has been filed

 Pictured from left: Alan Harmon, M.D., Bryan Campbell, Sen. Aaron Bean, Russ Jackson

On Wednesday, October 26, 2016, I was fortunate to take part in a little bit of history, while working to preserve more history at the same time. The photo above is at the conclusion of the first-ever meeting in the conference room at Senator Aaron Bean's new Jacksonville office. I'm joined by former DCMS and FMA President Alan Harmon, M.D. (left) and Russ Jackson on the right.

But this meeting was about much more than grabbing a nice photo in a new office. As you are aware, the elections are less than two weeks away, and in just a few weeks after that, the 2017 Legislative season will begin when Committee assignments are given and work on writing legislation begins.

There are a number of key issues which we will monitor as we move into the Legislative Session. One of particular importance here is the Sowder Public Health Building. This historical structure sits on the site of the Florida Department of Health Lab just north of downtown. The Sowder Building was the home of the first Public Health Department in the state of Florida.

The building has not been used in years, but back in 2002, it was restored and rededicated as a Museum to Public Health. Unfortunately, that plan never came to fruition, and the building sits in decay. You can read about the 2002 dedication here.

The Duval County Medical Society and the DCMS Foundation are now working with the Florida Medical Association and Senator Bean to breath new life into this historic building and revitalize the plan for the Museum of Public Health. As the Legislative Session draws near, stay tuned for further updates on our progress.