Wednesday, March 6, 2024

Diagnosis for 3.6.24: Checking the pulse of Florida health care news and policy

Christine Jordan Sexton

March 6

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

—T-minus hours and counting —

Within the next two days, the 2024 Legislative Session will come to a close and bring an end to another year of countless tugs-of-war over health care policy.

The signature health care bill for the Session — the "Live Healthy" package — passed last month. The price tag for SB 7016 is $717 million, with funds being directed toward graduate medical education (GME) programs at hospitals, qualified health centers and clinics. The bill also beefs up hospital Medicaid reimbursements by $135 million.

The Live Healthy initiative didn't contain any funding for nursing home — that was appropriated in the 2024-25 General Appropriations Act. After a back-and-forth of offers, with the Senate initially offering no rate increases, nursing homes walked away with a $247.8 million increase.

While they were the big winner, they weren't the only winners. The Legislature included in its budget a $43 million increase for physicians providing pediatric services and a $29 million bump in rates for the Program for All-Inclusive Care for the Elderly or PACE. Federally qualified health centers and rural health community centers also received a $19 million rate increase.

The budget also includes an additional $40 million for cancer innovation grants, $10 million for rural hospitals, and $10 million for sickle cell research and treatment.

The GAA is the only must-pass bill of the Session and the state Constitution requires that before a final vote is taken it "cool off" for 72 hours.

That 72-hour period expires Friday at 11:48 a.m.

*Just hours remain in the 2024 Legislative Session, but there are still a few health care bills in play.*

Meanwhile, there are some health care bills still in play including SB 362, which raises maximum allowable reimbursement rates for workers' compensation providers and also increases payment rates for physicians who testify as medical experts. The House amended the bill, which could be voted on as early as today. But the amendment means the bill must bounce back to the Senate for approval.

Additionally, the Governor's office has intimated that SB 932, supplemental breast examinations, also could still be in play. The Department of Health bill (SB 1582) addressing medical marijuana licenses for Black farmers is too, as is SB 330, which creates behavioral health teaching hospitals and is one of several bills Passidomo considers to be a part of her Live Healthy initiative.

Hold on, there's not too much longer to go.

I welcome your feedback, questions and especially your tips. You can email me at SextonHealthNewsletter@gmail.com or call me at 850-251-2317.

— Not losing sleep —

Senate President Kathleen Passidomo remains adamant that optometrists shouldn't be able to advertise themselves as doctors but says if her priority legislation (SB 1112) doesn't pass "she's not going to lose sleep over it."

Gov. Ron DeSantis vetoed Passidomo's 2023 bill she muscled through the reluctant House which is why the Legislature once again is addressing the issue.

And once again the House is reluctant to do what Passsidomo wants.

"This is a continuation of the eyeball wars," Passidomo told reporters Tuesday afternoon. "And the optometrists objected to the bill last year. We passed it; it was vetoed. They lobbied hard. They are wrong."

With just two days left in the 2024 Session, the fate of Passidomo's legislation remains in flux after the House amended the Senate bill with the language from HB 1295 instead.

*Kathleen Passidomo isn't losing sleep over the 'eyeball wars.'*

Passidomo, whose late father was an ophthalmologist, spoke passionately about the bill with reporters Tuesday.

"I have a lot of constituents that are elderly. And when they go in to see someone wearing a white coat with a sign that says 'DR period and the last name, they believe they are (seeing) a medical doctor who went to medical school. They believe they are a medical doctor who went to medical school. So what this bill does, it basically provides in your advertising, if you will, in the information you put out, what you wear, how you talk, you should tell your patients what your degree is. I think it's wrong to infer or leave it silent that you have a degree you don't have," she said.

—No bare butts—

Offices where physicians perform Brazilian butt lifts (BBLs) will be required to carry medical malpractice insurance or obtain an irrevocable letter of credit under a bill (HB 1561) passed by the Florida Legislature Tuesday night.

Specifically, the bill requires offices where gluteal fat grafting procedures, referred to as BBLs, are performed to secure and maintain medical malpractice coverage in an amount not less than $250,000 per claim, with a minimum annual aggregate of not less than $750,000.

The coverage cannot be used for litigation costs or attorney's fees for the defense of any medical malpractice claim.

*The office that employs this surgeon will need to start carrying malpractice insurance.*

The mandate applies to the office where the surgery is being performed and not the physician but is a significant policy change.

There is no requirement for physician offices to have medical malpractice insurance or to maintain irrevocable letters of credit.

BBLs involve two steps: the liposuction of fat from the abdomen or back, and the injection of the purified fat into the subcutaneous layer of the buttocks, which is below the skin but above the gluteal muscle.

The Legislature in 2023 passed a law that requires office surgery sites to register with the state if the procedures performed at the locations involved the removal of 1,000 cubic centimeters of fat or more.

In addition to the financial responsibility requirement, the 2024 legislation requires clinics to register whether the removal of the fat is temporary or permanent. The change was needed because some businesses were arguing that the fat wasn't being removed during a BBL just relocated.

—Welcome aboard—

Florida will let the faculty and staff working at the state's 28 colleges to get their health insurance coverage through the state group health insurance program.

House and Senate budget negotiators over the weekend agreed to set aside $80 million to let college employees join the state workers and university employees who already receive health insurance coverage through the state-run program.

A stand-alone education budget bill says that open enrollment should begin as soon as possible but no later than July 31, 2025. The legislation also says that colleges have to agree to participate in the state group health insurance program for at least three years.

*State college employees will soon be able to get the same health coverage as their peers in the state university system.*

It was Senate Republicans who pushed to let colleges join the state group health insurance program even though economists projected that the trust fund that pays for the benefits is in danger of running into a deficit during the 2024-25 fiscal year.

To help erase the projected deficit, budget negotiators agreed to add $550 million to the trust fund. The proposed budget includes $350 million of general revenue and $200 million in federal money that has been redirected from previous expenditures.

This is the third year that the Legislature agreed to infuse hundreds of millions into the state employee health insurance trust fund to keep it solvent. Despite the deficits the Legislature has not increased the monthly health insurance premiums they and other state workers covered by the plan pay for the benefit.

—Not this year—

The most tracked bill of the 2024 Session is officially dead.

An effort to increase the amount of money the government can be required to pay in civil lawsuits officially died Tuesday night after the Senate removed the bill (SB 472) from the calendar that will dictate which bills would be debated for the last two days of Session.

It's one of several health care-related tort bills that died during the 2024 Session along with proposals to crack down on third-party litigation financing, to change Florida's wrongful death laws, and restrict lawsuits against assisted living facilities.

Passidomo, who is a real estate attorney and not a trial attorney, said all the issues were distinct but offered this sentiment.

"Some of them went too far, some of them didn't go far enough," she said. "We had such a robust package of tort reform issues last Session, I think that a lot of members were just like 'Enough's enough. Can we take a break?'"

*Last year was the torts year and legislative leaders are fine with taking a break.*

Passidomo, like House Speaker Paul Renner, said she thinks the current caps should be raised.

"The problem is some people want it raised to an outrageous amount, which I don't agree with. I think a reasonable amount I do agree with," she said.

The Senate sovereign immunity proposal would have increased the caps — currently set at $200,000 for a single person and $300,000 per incident — to $300,000 and $500,000, respectively.

According to a mid-Session report released by the legislative tracking service LobbyTools, the sovereign immunity bills were the most tracked pieces of legislation for the 2024 Session.

— Q&A —

With lawmakers buttoning up work on the 2024-25 state budget, Florida Politics sat down with KPMG's Chad Poppell, a former DCF Secretary under DeSantis, to get his take on the health care spending plan.

FP: Gov Ron DeSantis unveiled a $114 billion budget. How does that reflect conservative spending principles?

Poppell: The hallmarks of conservative spending plans are that they reduce the tax burden on citizens and businesses, drive for smaller government through efficiency and deregulation, and create minimal debt. While Florida's state budget has certainly grown over the past decade, those conservative characteristics remain firmly in place.

*The Governor's 2024-25 budget compared to prior years.*

Florida finds itself in a unique position where the state continues historic population growth, averaging nearly 1,000 new residents a day. This, of course, has growth implications for the budget, particularly in areas like health care, transportation, and education. While there are many data points worth observing, because of continued growth and our status as one of the largest states, the metric I find most informative is spending on a per capita basis, which remains among the lowest in the nation. Our policymakers have shown their commitment to fiscal resiliency and responsibility with their continued focus on reducing debt and lowering taxes this Legislative Session.

FP: Specifically, how can state leaders work to lower costs in health care?

Poppell: Over the last several years, Florida has put laws in place to protect health care consumers and dampen the rising budget. Pricing transparency, balanced billing protections, value-based payments and prescription drug access and controls, to name a few, are recent legislative efforts that should have a positive effect, and by harnessing emerging technology such as AI, these efforts can lead to even further progress.

We're in the opening stages of understanding the profound implications of artificial intelligence on health care. KPMG's health care practice works with state governments, payers, and providers across the country to maximize utilization of AI for policy, process, and technology changes that need to occur.

Starting with policies, Florida has made great strides to reduce the complexity of policies that burden the health care system. In the state, we have seen great success in increasing access to care with the use of technology to optimize emergent care operations. With a focus on patient satisfaction and regulations for staffing, KPMG has been able to implement schedule optimization technology to bridge the gap of patient access to care that successfully meets the needs of the state, the provider, and the patient.

Continuing the effort to break down departmental silos and integrate services from the citizens' point of view is critical. The technologies chosen and existing systems can continue to be leveraged across the many agencies that administer health care benefits.

We need to adopt a performance-driven culture by using data to drive decisions that can provide great benefit to the State and Floridians by continuing to invest in programs and technologies that are working to streamline constituents' experience with health care.

— LOBBYISTS —

—Crystal Stickle: Precision Healthcare

—Alan Suskey, Jordyn Sophia Ferguson, John White, Shumaker Advisors Florida: CAN Community Health

— ETC —

—Gerold L. Schiebler, M.D., died March 3 in Amelia Island. Schiebler was a pediatric cardiologist who served as chairman of the University of Florida College of Medicine's Department of Pediatrics from 1968 to 1985, and was influential in the development of the state Children's Medical Services program, which once coordinated and funded health care for economically disadvantaged children with chronic illness or other special needs.

*Dr. Gerold L. Schiebler. Image courtesy of UF Health.*

For decades Schiebler worked in the political arena as the UF Health Science Center's associate vice president for external relations, promoting the interests of the center and Shands at UF, as well as clinics in Tallahassee and Washington, D.C. During that time, he led efforts to establish the state's Regional Perinatal Intensive Care Centers Program, and to establish a state and federal poison-control center network accessible nationwide via a single toll-free telephone number. Schiebler served as president of the Florida Heart Association in 1973-74, president of the Florida Medical Association (FMA) in 1991-92, and president of the FMA's Political Action Committee in 1996-98. An eminent scholar's chair in pediatric cardiology, a lectureship, and a pediatric scholarship/fellowship has been established in his name at UF. Schiebler graduated from Harvard Medical School in 1954 and joined the UF Department of Pediatrics faculty in 1960, becoming the first pediatric cardiologist in North Florida.

—Advanced practice registered nurses (APRNs) and physician assistants (PAs) can receive reimbursement for Medicaid-funded home health services under HB 935, which unanimously passed the Legislature. Home Care Association of Florida Executive Director and registered nurse Bobby Lolley, lauded bill sponsors Sen. Jay Trumbull and Rep. Gallup Franklin for sponsoring the legislation. "Their bipartisan efforts, evident in the unanimous passage of SB 1798/HB 935, underscore their commitment to the well-being of our community. We extend our heartfelt appreciation to the entire Legislature for their steadfast support in championing this vital cause, ensuring that Medicaid-funded home health services remain accessible to those in need. Together, we're forging a path towards a healthier, more inclusive future for all."

—ROSTER—

—Stephen J. Motew, M.D., M.H.A., FACS, has been named president and CEO of the UF Health clinical enterprise, effective April 1. Motew, a practicing vascular surgeon, will lead UF Health's integrated patient care system.

*Dr. Stephen J. Motew. Image courtesy of UF Health.*

—Terry Meek, staff director of the Council of Florida Medical School Deans, announced the 2024 Session is her last and that she will be retiring. Meek has more than 30 years of experience in Florida health care policy, first as legislative staff, then as a lobbyist for emergency room physicians, and then as the staff director at the association that represents all the state's medical schools.

—ICYMI—

In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.

"Report: Less than 1% of hospital admissions, emergency room visits made by undocumented migrants" via Christine Jordan Sexton of Florida Politics — The first official report after Florida's sweeping immigration measures were put in place a year ago shows that less than 1% of all Florida hospital admissions and emergency room visits were from patients who self-reported as not legally residing in the United States.

"Budget deal includes $557K for the state to collect immigration status, nursing home data" via Christine Jordan Sexton of Florida Politics — Florida will spend more than half a million dollars to collect data from hospitals and nursing homes, including the immigration status of people receiving emergency medical service under a new spending deal. Budget documents show the Legislature agreed to spend $557,882 on four positions within the state Agency for Health Care Administration (AHCA) to build a system for the immigration reporting requirements contained in the sweeping 2023 law, SB 1718.

"Budget conference: Legislature fully funds gambling addiction program for first time" via Florida Politics — You can bet that more compulsive gamblers in Florida will get the help they need this year, thanks to an unprecedented move during the Legislature's budgeting process. For the first time, lawmakers approved infusing the Florida Compulsive and Addictive Gambling Prevention Program with $2 million, the full sum the state collects from eight slot-licensed pari-mutuels yearly.

"Rape kits must be kept for 50 years under 'revolutionary' bill helping victims" via Gabrielle Russon of Florida Politics — The Legislature passed a bill Tuesday that one lawmaker called "revolutionary for our state" in helping rape victims when they are ready to come forward and file a police report. "Under current law, there's no guidance on how long local law enforcement should keep sexual assault kits if a victim does not report the crime right away, and as a consequence, too many of these kits have been thrown away before the victim could come forward," Rep. Rachel Saunders Plakon, a Republican from Lake Mary, said Tuesday on the House floor. "What this bill really does is give the survivor time."

"Lawmakers advance Casey DeSantis-backed cancer research changes, add more funding," viaChristine Jordan Sexton of Florida Politics — First Lady Casey DeSantis' push to continue to bolster the state's effort to combat cancer appears poised to get added funding and new ground rules on how those dollars should be spent. Budget negotiators earlier this week agreed to direct an additional $40 million toward the Florida Cancer Innovation Fund. The Senate also passed a bill (SB 7072) championed by DeSantis, a cancer survivor.

—FOR YOUR RADAR—

Aside from coverage by Florida Politics, these stories are worth your time.

"Bill creating online pregnancy resource hub heads to DeSantis" via Michelle Vecerina of Florida's Voice — A bill that would establish an online pregnancy resource hub for new and expecting parents passed through the Senate floor Tuesday and will head to the Governor's desk after some Democratic lawmakers pushed back on the bill. Rep. Berny Jacques sponsored HB 415, which passed the Senate with a 27-12 vote. Sen. Erin Grall sponsored the Senate version of the bill. Grall explained that the website will contain critical resources for pregnant women ranging from prenatal care and maternal health services, social services, early childhood development resources, and educational mentorship programs specifically designed for fathers.

"'There's no real long term plan:' former Sen. Jeff Brandes sounds alarm on Florida's prison system" via Caden DeLisa of The Capitolist — Florida's prison system faces a crisis of aging facilities, staffing shortages, and a growing inmate population that could overwhelm existing infrastructure within two decades, a report acquired through public record request by former Sen. Jeff Brandes indicates. The report identifies four critical challenges confronting the state: an anticipated rise in the inmate population, urgent requirements for modernization, ongoing issues with staff vacancies and turnover, and security and safety concerns. The plan calls for the construction of new prisons and medical facilities to accommodate the projected increase in the state's incarcerated population, which is not only expected to grow but also age significantly, which demands more medical and ADA-compliant facilities. The report forecasts an inmate population that is projected to potentially surpass the total capacity over the next two fiscal years if no action is taken.

"The computer will see you now: Artificial Intelligence usage grows at Central Florida hospitals" via Caroline Catherman of the Orlando Sentinel — Central Florida's two major health systems, Orlando Health and AdventHealth Central Florida, are widely using artificial intelligence for administrative work and, increasingly, to sound early alarms about potential illnesses, including deadly pancreatic cancer and sepsis. Eventually, some experts think AI could even be used to diagnose patients and make treatment decisions. On one hand, a growing body of research suggests this could make patients safer because the computer software that generates AI doesn't get tired or make mistakes like overworked medical staff. But a lot of people are alarmed by the prospect. A 2023 Pew Research poll found 60% of Americans are uncomfortable with AI being used in their health care.

"Lee Health going private? Talks continue among public hospital leaders" Liz Freeman of the Naples Daily News — Will Lee Health go private? Lee Health could forge partnerships with university-based hospitals if it changes from a publicly run system to a private nonprofit entity. That could help with recruiting physicians and addressing ongoing shortages, according to consultants. The partnerships would provide an avenue for physicians to have sovereign immunity protection against large medical malpractice claims, according to consultants with Kaufman Hall. Lee Health leaders met in a workshop to continue assessing the consultants' report on potentially converting from a public system to a private nonprofit system. The Board started looking last year at making the change. The 10-member publicly elected Board has until June 20 to decide if it wants to pursue a conversion.