Diagnosis for 2.14.22: Checking the pulse of Florida health care news and policy

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

The House and Senate this week are expected to approve rival spending plans for the 2022-23 fiscal year and should be in a position to begin negotiating the differences in their proposals by the seventh week of the Session, which is on par for a timely Sine Die unless the Chambers are unable to reach an initial deal on top-line spending, often known as “allocations.”

— BENJAMINS —

Follow the money. That can be tricky when it comes to the state budget, but we will try to break it down right here. As state legislators head into budget negotiations, both chambers have agreed to eliminate additional “critical care” funding for hospitals that treat the most Medicaid patients. Those dollars are used to give automatic rate enhancements to those hospitals. And Gov. Ron DeSantis, in his budget recommendations, included recurring funding for the hospitals.

But House budget writers didn’t just eliminate the so-called critical care fund. In addition, the House recommended removing $100 million in state money (which is matched with federal Medicaid funds) that is also currently used to reimburse hospitals and steer the money instead to help train future nurses. All told, it’s a nearly $252 million reduction to hospital inpatient and outpatient reimbursement rates and a $100 million bump to higher education.

House leaders defend making this move because hospitals are getting money from a new supplemental Medicaid financing program called Direct Provider Payment or DPP. DPP is allowable under a federal waiver and allows hospitals to use funds to bridge the difference between Medicaid reimbursements and their costs of providing the care. Florida does not contribute any state dollars to the DPP program. Instead, it is funded with local tax dollars generated by hospitals.

“They are contorting themselves because they believe they never should be cut,” said House Speaker Chris Sprowls, who pointed out that hospitals had their “second best year” last year because of the enhanced funding they received. “They have a significant influx of money … and all we hear is ‘oh the sky is falling.’”

Sprowls also said it’s time to act because the state has a “significant nursing shortage,” and hospitals should have “skin in the game” to solve the problem.

Florida Hospital Association President and CEO Mary Mayhew, whose association commissioned the report that identifies the current and looming shortfall, said the goal to increase education funding is laudable. Hospitals currently partner with colleges and universities to train staff, she said. But, she noted, increasing education funding “really shouldn’t be supported at the state level through a cut to hospitals.”

Mayhew also said she is worried about the state’s commitment to helping fund the Medicaid program. Medicaid is administered and funded jointly by the state and federal governments. Mayhew said removing $100 million in general revenue is troubling.

She said just 4% of the general revenue in the current state fiscal year budget was spent on hospital funds.

“We are not driving general revenue (commitments),” she said, adding, “What is the problem we are trying to fix with all the money? There’s no hole; there is no general revenue hole in the state budget,” Mayhew said. “I recognize they are looking over the entire state budget, but I have to raise awareness around the consequences of cuts to hospitals and the care they provide to Medicaid patients.”

But amid all this, House budget writers include nearly $51 million in recurring revenue to help cushion proposed cuts to Tampa General Hospital, Johns Hopkins All Children’s and Plantation General, which are three facilities that did not participate in the DPP program in the Fiscal Year 2021-2022 but did receive “critical care dollars” because of the amount of Medicaid patients they treat.

Two of the three facilities happen to be in Sprowls district and also are the regional facilities that residents in Senate President Wilton Simpson‘s district would be sent to if necessary.

Tampa General Hospital, which stands to lose more than $22 million in critical care funding, would be offset by more than $26.5 million in increased payments. Johns Hopkins/All Children’s could lose $25.7 million in critical care funds if lawmakers eliminate the fund, but that would be offset under the House plan, which would provide the facilities $26.3 million in enhanced payments. Plantation General in Broward also would benefit under the House proposal but not to the degree of the other hospitals. The Broward facility would lose $332,435 if the critical care fund were eliminated but would receive $168,389 in enhanced payments bringing its loss to more than $164,000.

Other hospitals that receive critical care funds and also participate in DPP aren’t as fortunate under the House budget. Jackson Memorial Hospital would lose $71.7 million in critical care funds and another $12.5 million for a total $84.2 million hit. Lee Memorial Hospitals could lose nearly $2.4 million in critical care funds and reductions to their Medicaid reimbursement.

Sprowls, however, defends the extra payments to the three hospitals. He says all three wanted to participate in the DPP program, but they were “blocked” because it requires all the facilities in a region to join, and that didn’t happen in those two areas.

He said they were “left on the beach.” “We’re actually treating them completely fairly,” Sprowls added.

— WHAT’S IN A NAME? A LOT, IF IT’S A TRUST FUND —

If you recall, legislators last year voted to dissolve the long-standing trust fund that was named after Gov. Lawton Chiles, the state’s last Democratic Governor who died in office back in 1998. That fund, established with payments tobacco companies made as part of a landmark settlement with Florida, must have all of its assets liquidated by this summer and transferred into the Budget Stabilization Fund.

The logic from House Republicans was that it made more sense to roll that trust fund into one of the state’s main reserve accounts to create more flexibility into the future.

Flash forward, and now … the House wants to create a new $2 billion trust fund that could be used to augment any budget items whose cost has gone up because of inflation. Oh, and what’s the name of this fund? The Budgeting for Inflation that Drives Elevated Needs Fund — or yes, the BIDEN Trust Fund. Rep. Jay Trumbull, the chair of House Appropriations, acknowledged this week that he came up with the name for the new trust fund.

The legislation creating the fund — which a three-fifths vote must approve — doesn’t have any in-depth criteria on what the money can be spent on. It just says money in the fund can be used to cover any budget item that has seen its overall cost go up because of inflation. So theoretically, this means this money could be used for any budget expense, including presumably those in the health care area.

Some Democrats — while saying they recognize the need to make sure the state can handle ongoing inflation — have raised questions about the need for the fund. Rep. Joe Geller noted this past week, “I don’t think we need another slush fund for the Governor.”

Trumbull, however, insisted that any withdrawals would still need approval from the Legislative Budget Commission.

This is another item that will have to be worked out during budget negotiations in the next few weeks because there is not a similar proposal moving through the Senate.

— STILL SAILING —

Florida’s lengthy legal battle with the Centers for Disease Control and Prevention over COVID-19 related cruise line restrictions is finally coming to an end.

But the tug-of-war over whether cruise lines can require passengers to show proof of vaccination is still churning through the judicial system and doesn’t look like it will be decided any time soon.

Norwegian Cruise Lines last summer sued then-State Surgeon General Scott Rivkees over the state’s blanket ban on vaccine passports that the Legislature passed at the urging of DeSantis. The cruise line won in the first go-round and got a preliminary injunction in early August that blocked the state from enforcing the law against Norwegian. The injunction allowed Norwegian to require vaccination proof for all passengers sailing from Florida ports.

The state appealed the injunction to the 11th Circuit Court of Appeals in Atlanta, but it hasn’t moved quickly. The court late last month announced that it would hold oral arguments on the case in Miami during the week of May 16.

In April of last year, Florida and the CDC got locked in a legal battle over CDC cruise line restrictions. Florida won its own preliminary injunction, which the CDC then appealed. But as the legal battle dragged on, the CDC decided to let its conditional sailing order — which required most crew and passengers to be vaccinated — expire Jan. 15. A few days later, the federal agency dropped its appeal altogether.

Attorney General Ashley Moody finally responded last week by asking for the lawsuit to be dismissed, and she proclaimed victory over federal authorities who had imposed the cruise line restrictions.

Norwegian, meanwhile, stated last month it plans to voluntarily follow CDC guidelines for cruise ships, which includes letting federal authorities know the vaccination rates of passengers.

— TAKING OUT THE TEETH —

The House will consider for the first time this Session a bill that would up the standard for a state licensing board to discipline or threaten to discipline a provider. The House Professions and Public Health Subcommittee will consider a proposed committee substitute Monday that removes from the original version of HB 687 the $1.5 million fine the Department of Health could face if it violated a practitioner’s right to free speech, including posts on social media. The proposed committee bill would continue to make it illegal for the state to reprimand, sanction, or revoke or threaten to revoke a license, certificate, or registration of a health care practitioner unless it can prove beyond a reasonable doubt that the free speech leads to the direct physical harm of a patient. For now, the Senate bill, SB 1184, still contains the $1.5 million fine.

— MOVEMENTS —

Tommy Inzina, CEO and President of BayCare, retires at the end of the year, and the system is launching a nationwide search for a replacement, it announced this week.

Patrick George was named Chief Financial Officer of HCA Florida Woodmont Hospital.

HCA Healthcare North Florida Division appointed Brian Nunn as Putnam Community Medical Center CEO.

HCA Florida University Hospital appointed Steven Vanni as chief of medical staff.

Dr. Charles Andrew Salzberg has joined Cleveland Clinic Indian River Hospital. He most recently was the system chief of plastic surgery at The Mount Sinai Hospital Icahn School of Medicine in New York City, where he directed a large program including eight hospitals and a residency program.

— ICYMI —

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

Save the date — Sen. Ben Albritton told Florida Politics he would meet with AARP Florida and the Florida health care union to discuss their concerns with his bill to reduce the amount of “nursing” hours nursing homes are required to provide. “I’m going to listen to them, and I am going to see what it is, with the caveat that it can’t be, ‘Don’t change anything,’” Albritton said. “That doesn’t work. We have to change something to build balance, or else you have people looking for a bed.”

‘Free kill’ killed — The Senate Judiciary Committee last week postponed considering a bill (SB 262) that would have allowed parents of adult children to win pain and suffering damages in medical malpractice lawsuits. The committee, led by Republican Sen. Danny Burgess of Zephyrhills, had the last of its seven meetings Monday with no further ones scheduled, effectively killing the bill, sponsored by Republican Sen. Ana Maria Rodriguez of Doral. It is possible, but not likely, that the Senate President could authorize another committee meeting unexpectedly.

Restrictions coming — A House panel passed a bill this week that tests the limits of Roe v. Wade — a fact trumpeted by bill sponsors, Republican Reps. Erin Grall of Vero Beach and Jenna Persons-Mulicka of Fort Myers, as well as other proponents. “There is no right to abortion in the federal Constitution or the state constitution,” Grall said. “There is a right to life.”

Partisan all the way — The Senate Ethics and Elections Committee voted along partisan lines to recommend the confirmation of Florida Surgeon General Joseph Ladapo. The vote clears the way for the likely final confirmation of Ladapo, hailed as a “superstar” by Gov. DeSantis, who brought in the doctor last fall from the University of California, Los Angeles. During the confirmation process, Democratic committee members asked Ladapo a broad array of questions, from the efficacy of vaccines and masks to whether he is vaccinated to whether he believes school-aged children should get vaccinated.

— FOR YOUR RADAR —

“Florida hides data showing how many tourists and snowbirds contract COVID-19 in the state” via Chris Persaud and Frank Gluck of the Fort Myers News-Press — When an out-of-stater catches the potentially deadly respiratory disease in Florida, state health officials don’t report it to the public. Instead, they follow guidance from the Centers for Disease Control and Prevention by sending that data to the person’s home state. Officials from the nonresident’s state report the data to the CDC, which adds the case to the home state’s infection tally, not Florida’s. State health officials refuse to say how many nonresidents have tested positive for COVID-19, including how many of them have died since Florida stopped publishing those numbers in June. Experts say that the uncoupling of infection numbers from their origin could complicate public health response by overstating, or understating, infection rates in given areas. It also downplays the risk of coming to a state like Florida, which has fought mask and vaccine requirements, as well as other safety measures, and downplayed the efficacy of inoculations.

“When talking about COVID-19, DeSantis leaves out key facts, experts say” via Steven Lemongello and Caroline Catherman of the Orlando Sentinel — Speaking in Panama City on Jan. 13, DeSantis told reporters, “clearly the vax has not stopped people from being infected with omicron. That is just clear as day.” “They had said it would end COVID,” DeSantis declared. Like many of DeSantis’ comments about the coronavirus, it did not tell the whole story. DeSantis’ statements about vaccine effectiveness and safety, antibody treatments, and the power of natural immunity are cloudy in some cases and absolutely wrong in others, say epidemiologists and other experts interviewed by the Sentinel.

“Why Medicare penalizes some South Florida hospitals that it also gives high ratings” via Jordan Rau and Daniel Change of Kaiser Health News and Miami Herald — Many of South Florida’s largest hospitals are among the more than 750 medical centers nationwide penalized this year by the federal government for having the highest number of patient infections and potentially avoidable complications. The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of patients discharged from the hospital between July 2018 and the end of 2019, according to data analyzed by Kaiser Health News. The Affordable Care Act requires Medicare to assess the punishments on the worst-performing 25% of general hospitals each year, intending to make medical centers focus on reducing bedsores, hip fractures, blood clots and infections that before COVID-19 were the biggest scourges in hospitals. These include surgical infections, urinary tract infections from catheters, and antibiotic-resistant germs like MRSA.

— MISC —

According to findings from Brown University researchers, racial and ethnic minorities enrolled in Medicaid managed care reports reported worse experiences of care than their White counterparts. Researchers reviewed data from the National Committee for Quality Assurance Adult Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Surveys, which are annual enrollee-level surveys that assess the patient experience of care. Survey modes include telephone, mail, and internet, and an NCQA-certified third-party vendor collects all data.

VITAS opens inpatient hospice unit at Sunrise Health and Rehabilitation Center. More here.

— PENCIL IT IN —

Monday

Happy Valentine’s Day …

1:30 p.m. — House Health Care Appropriations Subcommittee meets and considers several bills, including HB 0885 regarding prescription drugs for schizophrenia; HB 1239 regarding nursing home staffing requirements; and HB 1277 regarding mental health and substance abuse. Place: Room 17 of the House Office Building

4 p.m. — House Professions and Public Health Committee meets and will consider HB 687 regarding physicians’ “free speech.” Place: Room 212 of the Knott Office Building.

Tuesday

The University of Florida has its day at the Tallahassee Capitol. An all-day extravaganza of orange and blue.

10 a.m. — Senate Rules Committee meets. It will consider SB 1258 regarding Medicaid managed care performance. Place: Room 412 of the Knott Building.

2:30 p.m. — The House is in Session and will consider HB 5001, the General Appropriations Act, and HB 5003, the budget implementation bill. The House will also consider HB 5, a bill that would ban abortions in Florida after 15 weeks.

Wednesday

10 a.m. — Senate Appropriations Subcommittee on Health and Human Services meets and will consider SB 1950, a Medicaid managed care “modernization” bill; SB 1770, a breastmilk donation bill; and an omnibus bill pushed by the Florida Department of Health, SB 768.

1 p.m. — Senate Appropriations Subcommittee on Agriculture, Environment, and General Government, considers SB 1476, the Senate’s version of a pharmacy benefit manager bill. The House’s version (HB 357) is ready for floor debate. Place: Room 110 of the Senate Office Building.

2:30 p.m. — The House is in Session.

Thursday

8 a.m. — The Board of Pharmacy Probable Cause Panel meets. (888) 585-9008; participant code: 599196982. Agenda here.

10 a.m. — The Senate is in Session. In addition to considering the General Appropriations Act, the chamber also will consider SB 1260, which authorizes the governing body of an independent hospital district to evaluate certain benefits of the potential conversion

Friday

7:30 a.m. — The Board of Dentistry meets. Place: University of Florida Conference Center Gainesville, 1714 SW 34th St, Gainesville.

9 a.m. — The Senate is in Session

2:30 p.m. — The Board of Medicine — South Probable Cause Panel meets. Meeting link here.