Megabill Sets Stage For Healthcare Debate
By Jim Saunders, The News Service of Florida // April 12, 2014
HOUSE AND SENATE AT ODDS OVER CONTENTIOUS HEALTHCARE ISSUES
EDITOR’S NOTE: On Thursday morning, the Florida House Health & Human Services Committee passed a megabill that combines three controversial issues in the hope that packaging them will make it harder for the Senate to kill or dilute any of them.
HB 7113 protects private for-profit trauma centers, allows for independent practice for nurse practitioners and allows out-of-state doctors to participate in tele-health without a Florida license. The Florida Medical Association opposes the latter two.
A law packaged like HB7113 is sometimes called a “train” in legislative vernacular. The idea of a train is that it’s a bunch of connected railcars, and it would be hard to cut out one of them without causing them all to derail. In reality, it is a strategy to force some lawmakers to accept a proposal they don’t like in order to get one they really want.
—Dr. Jim Palermo, Editor-in-Chief
THE NEWS SERVICE OF FLORIDA–The House and Senate could be headed toward a collision at the end of the legislative session about major health-care issues, including the continued operation of three disputed trauma centers.
A House committee Thursday approved an omnibus bill that cobbled together a series of controversial issues, including a plan to prevent a potential shutdown of the trauma centers, a proposal to expand the powers of nurse practitioners and an effort to increase the use of telemedicine.
Later in the day, a key Senate committee approved a stand-alone bill dealing with the trauma issue. The House and Senate are taking similar approaches to ensure the trauma centers at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County remain open — despite opposition from major hospitals in the Tampa Bay and Gainesville areas.
But the House’s move to combine the trauma issue with the other controversial issues in what is known as a legislative “train” could lead to complicated negotiations before the session ends May 2. The House and Senate have significant differences on the nurse-practitioner and telemedicine issues, and influential physician groups also are fighting the House’s positions on those issues.
After the House Health & Human Services Committee overwhelmingly approved the omnibus bill (HB 7113), Rep. Mia Jones, the top Democrat on the committee, said creating a legislative train raises questions about whether the Senate would go along. She said she is not sure what will happen with the omnibus bill.
“I’m trying to figure that out as well,” Jones, D-Jacksonville, said.
The trauma issue stems from nearly three years of legal battling that has focused on whether the Florida Department of Health improperly allowed the Manatee County, Pasco County and Marion County trauma centers to open — and whether the facilities should remain open. The trauma centers have faced challenges from Tampa General Hospital, Bayfront Medical Center in St. Petersburg, St. Joseph’s Hospital in Tampa and UF Health Shands Hospital in Gainesville, all of which have long operated trauma facilities.
Though some details in the bills are different, the House and Senate both would allow the three trauma centers to remain open. The HCA health-care chain, which includes the three disputed trauma centers, is lobbying for the bills, while the Safety Net Hospital Alliance of Florida, which includes hospitals with longstanding trauma facilities, is leading lobbying efforts in opposition.
Sen. Denise Grimsley, a Sebring Republican and nurse who is sponsoring the Senate bill (SB 1276), expressed irritation Thursday at the industry battle. She said both sides had made the issue about the hospitals, not patients, a situation she described as “disgusting.”
“As a nurse, I see myself first as a patient advocate,” Grimsley said before the Senate Appropriations Committee voted 15-3 to approve the bill.
Mark Delegal, a lobbyist for the Safety Net Hospital Alliance of Florida, said a major concern is that allowing too many trauma centers would lead to a dilution in quality of care. That is because trauma centers need adequate flows of patients and enough highly trained staff.
“The quality is best if you ensure there are the appropriate number of trauma centers seeing the appropriate number of trauma patients in Florida,” Delegal said.
But supporters of keeping open the three HCA-affiliated trauma centers say they provide quicker access for critically injured patients. Sen. Alan Hays, R-Umatilla, said more trauma centers can reduce transportation times for care.
“I think we need to focus on the benefit to the patient and not worry so much about the hospital,” Hays said.
The omnibus bill approved earlier Thursday by the House Health & Human Services Committee started out addressing only the trauma issue. But it was revamped to also include issues such as allowing nurse practitioners to provide care without physician supervision — a highly controversial idea opposed by major physician groups.
Also, the bill includes a legal structure to try to encourage the use of telemedicine, which involves physicians and other health providers treating patients remotely through telecommunications and Internet technology. Part of the House bill is controversial because it would allow out-of-state doctors to provide telemedicine to Floridians without requiring them to be licensed in Florida.
The Senate has taken different stances from the House on the nurse-practitioner and telemedicine issues and has not lumped all of the issues into one bill.
But backers of the House positions say they are trying to address a shortage of primary-care physicians in the state. The House committee voted 15-2 to approve the omnibus bill.
“We had an access to care issue,” Rep. Cary Pigman, an Avon Park Republican and physician, said while discussing giving additional powers to nurse practitioners.