Diagnosis for 11.10.22: 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.

Gov. Ron DeSantis this week easily secured another term in office. But how many top state officials — including those who head up major health care agencies — are going to stick around to the inauguration?

There’s a big reason that some — including Agency for Health Care Administration Secretary Simone Marstiller and Department of Children and Families Secretary Shevaun Harris — may be considering hitting the exit door: A law that imposes a six-year lobbying ban on agency secretaries and executive directors of state agencies is scheduled to take effect Dec. 31.

Voters first approved a six-year lobbying ban back in 2018 and called for it to kick it at the end of this year. During the regular 2022 Session state legislators passed a law that made it clear what executive branch officials were covered by the ban as well as created penalties for someone found violating the new ban.

Current law only requires top state officials to wait two years before they can lobby their former employer. The new lobbying ban also contains a much wider prohibition on lobbying as well so that former agency heads are not only barred from lobbying their former employer but are also banned from lobbying the Legislature.

Many top officials routinely leave state government and join prominent lobbying and legal firms in Tallahassee where they have been able to lobby the Legislature immediately. But that is no longer allowable at the end of the year and could trigger an exodus.

Marstiller was appointed AHCA secretary back in February 2021 and before that had been in charge of the Department of Juvenile Justice. Marstiller, who once was an appeals court judge, had spent several years with the Gunster firm law firm where in 2018 she registered to lobby the executive branch on behalf of Associated Industries of Florida.

Harris worked at AHCA for nearly 20 years before joining DCF in 2021. Though she worked as part of a larger team Harris is largely credited with the successful re-procurement of the Medicaid managed care program.

I welcome your feedback, questions and especially your tips. You can email me at [email protected] or call me at 850-251-2317.

— Again —

Organizers of another attempt to expand Medicaid in Florida are pointing to South Dakota to suggest that it could still happen here.

Reliably Republican South Dakota became the latest to agree to expand who is eligible for Medicaid after 56% of voters approved an initiative Tuesday. The program will take effect in July 2023.

Voters agreed in South Dakota even though Gov. Kristi Noem and others opposed expansion. That gives hope to those who want to put Medicaid expansion before Florida’s voters in 2024.

“While the prevailing election story coming out of Florida is of its solidification as a red state, the results in South Dakota make it clear that the political tendencies of any state do not eliminate the bipartisan appeal of Medicaid expansion,” said Jake Flaherty, campaign manager for Florida Decides Healthcare.

Medicaid expansion has been available for years, but the GOP-controlled Legislature continually rejected it while raising questions about the cost — although the federal government supplies most of the funding.

So, backers of Medicaid expansion hope voters will mandate expansion.

But the big obstacle: Getting a citizen initiative on the ballot.

Organizers behind the Florida proposal need to gather nearly 900,000 petition signatures by early 2024 to make it a reality. Legislators have put new restrictions on petition gathering that tripped up organizers trying to get measures on this year’s ballot. Plus, it usually takes millions in funding to gather the needed signatures.

And an amendment needs a supermajority — 60% — to pass. Three amendments put on this year’s ballot by the Florida Legislature fell short of the mark and were rejected.

Flaherty acknowledged that’s a tall order.

“We really had to rework how we go about getting something on the ballot,” he said. “As time goes on, we learn what we need to do to be successful at this, and we are getting to a place where we are ready to do that.”

He also conceded it would take an infusion of money, but he contended that doesn’t mean it can’t eventually happen.

“At this point, it’s just a matter of getting the funds together to make it happen,” Flaherty told Diagnosis. “Overall, the goal is to get expansion in Florida. It’s a need that’s not going to go away. We have people in Florida who have needed this since it was available, and we will continue to need it until this happens.”

— Good deal —

The Florida Department of Health (DOH) has scheduled a two-hour workshop next week to begin discussing rules for a new program that will reduce student loan debt for health care providers willing to work in medically underserved areas across the state.

According to the DOH, physicians could qualify for up to $20,000 annually; advanced practice nurses working independently could be eligible for up to $15,000, PAs and other advanced practice nurses could qualify for up to $10,000 annually; and LPNSs and RNs could qualify for up to $4,000 annually.

Dubbed the Florida Reimbursement Assistance for Medical Education (FRAME), the program aims to incentivize health care providers to work in medically underserved areas by providing doctors, advanced practice registered nurses, physician assistants, registered nurses (RNs), and licensed nurses (LPNs) annual payments intended to offset the loans and educational expenses.

To qualify, the health care providers must accept Medicaid and be employed by or affiliated with a rural hospital or an area health education center in an area that has no more than 100 people per square mile. Also, the provider could work for a hospital in a taxing district that encompasses no more than 100 people per square mile and qualify for the funds.

According to a DOH website, the state wants the program implemented and in place by mid-Winter. The funds will be directed to lenders. The DOH virtual meeting is scheduled for Nov. 14.

— It’s not too late —

The bad news is flu activity in Florida is on the rise.

The good news? There’s still time to get the flu shot.

As flu activity in Florida continues to pick up, Sunshine Health Plan Senior Medical Director Dr. Maria Samerson wants its Medicaid, Medicare and Florida KidCare members to learn about the flu shot and its effectiveness and to roll up their sleeves and get vaccinated.

Samerson is a board-certified pediatrician who had worked for the Hillsborough County Health Department and a federally qualified health center in Tampa before joining the managed care plan in 2014. As such, she says she’s “very passionate about prevention.”

“As a pediatrician, that’s one of our focuses,” she told Florida Politics. “So certainly, the flu vaccine and flu season is no exception because there is a lot we can do to prevent illness in the first place.”

Oct. 2 marked the start of Florida’s 2022-2023 flu season, which lasts through May 20, 2023.

Florida residents traditionally haven’t been good about getting vaccinated for the flu, according to a Centers for Disease Control and Prevention data review. Just under 47% of Florida children between 6 months and 17 years old were vaccinated in Florida during the 2021-2022 flu season, according to the CDC.

While lower than what it should be, it is far better than the percentage (40.3%) of adults in Florida who were vaccinated against the flu last year.

“There’s definitely room for improvement, opportunities for improvement,” Samson said. “That’s why we think education is important; it’s half the battle.”

Influenza (flu) is a respiratory infection caused by various flu viruses spread primarily by droplets made when infected people cough, sneeze or talk. Influenza-like illness (ILI) is defined as the presence of fever and cough or fever and sore throat without a laboratory-confirmed etiology.

According to Florida Department of Health data, the percentage of hospital emergency room visits with flu discharges is increasing across the state. About 9% of the emergency room visits in northwest Florida for the week ending Oct. 30 were flu-related, higher than any other region in the state. That’s followed by hospitals in the north-central region, where about 8% of the emergency room visits for the week ending Oct. 30 were flu-related.

Eight counties reported flu outbreaks to the DOH for the week ending Oct. 30, with Walton County reporting four episodes, more than any other county in the state.

— Salute —

The Florida Association of Nurse Anesthetists is honoring veteran certified registered nurse anesthetists and their lifesaving work both in and outside the military.

“It takes special Americans to serve in our nation’s military; people willing to serve in critical roles — often in stressful life-or-death situations that provide safety and security,” said FANA President Michelle Canale and Director of the Nurse Anesthesiology Program at the University of South Florida. “That passion fuels all of our CRNAs who are dedicated to protecting the health and well-being of Floridians.”

In honor of Veterans Day, FANA is sharing stories from four Florida CRNAs and military retirees who provided front-line health care: Army Lt. Col. Kathryn Jansky; Naval Reserves Lt. Cmdr. Jason Duprat; Navy Cmdr. Jeff Naggatz; and Air Force Cpt. Paul Safara.

In honor of Retired Lt. Col. CRNA Michael Sexton, my late uncle and Godfather, I am sharing their stories here.

— ROSTER —

— Joe G.N. “Skip” Garcia, M.D., has been named the University of Florida’s Herbert A. Wertheim professor of Inflammation Science and inaugural director of the Center for Inflammation Science and Systems Medicine. Garcia will work out of the UF Scripps-based research center in Jupiter. A pulmonologist, the National Institutes of Health have funded Garcia continuously since 1988. He has an expansive portfolio of NIH-sponsored research and has authored or co-authored more than 600 peer-reviewed publications and more than 40 book chapters.

— Jena Hill, DNP, CRNA; Tatyana La Torres, DNP CRNA; Gregory Buck, MS, CRNA; Ryan Shores, DNP CRNA; and Sabrina Nelson-Winters, DNP, CRNA, have been appointed to the Florida Association of Nurse Anesthetists board of directors. The appointments were announced at the FANA annual convention. Other board appointees include the Association’s immediate Past President William L. Self, and Justin Otis, president of the Florida Association of Student Nurse Anesthetists and a resident registered nurse anesthetist.

— Brian T. Cook has been named president of the HCA Healthcare North Florida Division, putting him in charge of hospitals and affiliated sites from Pensacola to Orlando. Currently, the president of the HCA Healthcare Far West Division based in Henderson, Nevada, the position brings Cook back to North Florida, where he once served as CEO at HCA hospital in Gainesville. He also served as the CEO at HCA hospital in Tallahassee.

— ETC —

— Baptist Health Care Foundation raised more than $43,700 in October to benefit its Mammogram Fund. Since the start of this program 13 years ago, screenings have been provided to 2,645 individuals. As a result of these screenings, 681 required additional testing, 93 required biopsies, and 32 were diagnosed with breast cancer.

— HCA Healthcare Inc. has formed a new hospital group, Healthcare Atlantic Group. It includes five divisions: HCA Healthcare West Florida, HCA Healthcare East Florida, HCA Healthcare North Florida, HCA Healthcare South Atlantic and HCA Healthcare MidAmerica. Richard Hammett has been promoted to president of the newly formed group.

— Florida State University College of Medicine’s Charles Fleisher, M.D., took a team of medical students and faculty to Washington, D.C., to help lead a panel discussion at the American Academy of Family Physicians Family Medical Experience Conference. The goal of the presentation, dubbed “Connecting, Captivating and Cultivating: Engaging with the Next Generation of Global Health Professionals,” was to increase student interest in global health issues and initiatives. Fleisher is an assistant professor in the College of Medicine’s Department of Family Medicine and Rural Health and is the director of the FSU College of Medicine’s Center on Global Health (CGH).

— ICYMI —

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

— Business-friendly benches Voters returned five justices to the Florida Supreme Court and OK’d 28 appellate court judges, keeping intact the composition of the appellate court system recently described as one of the most business-friendly in the nation. Two of the Supreme Court Justices voters approved Tuesday night — John D. Couriel and Jamie Grosshans — were appointed to the state’s high court by Gov. DeSantis in 2020. The other three — Justices Charles T. Canady, Jorge Labarga and Ricky Polston — were appointed to the court by former Gov. Charlie Crist.

— Good news: Florida businesses, on average, will see an 8.4% reduction on their workers’ compensation bill starting next year. David Altmaier, the state’s top insurance regulator, announced he issued a final order approving the proposed 8.4% average rate reduction requested by the National Council on Compensation Insurance (NCCI) this summer.

— That could be confusing: Florida’s medical doctors could have to follow dueling rules about gender-affirming care after the state’s two medical boards voted to adopt different standard-of-care policies. At a joint meeting in Orlando Friday, members of the Board of Medicine agreed to alter the standard-of-care rules to ban doctors from performing gender-confirming surgeries on anyone under age 18 and from providing puberty blockers and hormones to anyone under the age of 18.

— Not surprising: Legal challenges to the state’s $15 an hour minimum wage for “direct care” employees are mounting. The Florida Ambulance Association, Florida Assisted Living Association (FALA) and Home Care Association of Florida (HCAF) filed challenges in state administrative court this week alleging the state Agency for Health Care Administration (AHCA), which has oversight of the state’s Medicaid program, did not go through rule-making process to define who are “direct care employees.”

— Not crying wolf: While it is uncertain whether Attorney General Ashley Moody’s pre-Halloween warnings about fentanyl-flooded candy saved any lives, the AG’s office says “important conversations” were held as a result. Moody held one news conference and did national media hits about how the fentanyl scourge made 2022 “the scariest Halloween in (her) lifetime.” Fentanyl, she said Oct. 25, “is now being manufactured to look like candy,” a choice made to “attract children.”

— FOR YOUR RADAR —

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

—“Florida could surpass record Affordable Care Act enrollment in 2023” via Christopher O’Donnell of the Tampa Bay Times: The window to enroll for health insurance through the Affordable Care Act began this week, with many experts predicting participation in 2023 will likely surpass the record 14.5 million people who signed up for insurance through the federal program this year. Florida, which led the nation with 2.7 million enrollees in 2022, could also surpass that number next year, said Jodi Ray, executive director of Florida Covering Kids & Families, which provides navigators across the state to help people pick and enroll in federal marketplace insurance plans.

—“COVID-19 cases rise in Florida as new omicron subvariants increase” via Caroline Catherman of the Orlando Sentinel: As new COVID-19 variants continue to gain traction nationwide, Florida sees a slight uptick in COVID-19 cases. There were 23,157 new coronavirus cases recorded over the last two weeks among Florida residents, bringing the cumulative total to 7,172,457. With 365 more fatalities on record, 82,541 Florida residents have died. The death total over the last two weeks reflects a decrease from the 515 reported over the two weeks prior, but deaths can take several days or weeks to be reported.

—“Florida athletics leaders vote to keep menstrual questions on annual form — for now” via Katherine Kokal of the Palm Beach Post: Florida high school athletics leaders voted Monday to keep questions about females’ menstrual history on their annual athlete registration forms despite outrage about whether the questions were appropriate in the post-Roe environment as well as concerns that students’ medical histories were being kept at their schools. Board members of the Florida High School Athletic Association will await advice from their sports medicine committee, made up of physicians and athletic trainers, on whether to remove the optional questions, make them mandatory or change where the medical history section of the form is stored.

—“Florida doctors use saliva test to reveal someone’s future risk for Alzheimer’s” via Cindy Krischer Goodman of the South Florida Sun-Sentinel: Florida doctors are using a new test to determine someone’s future risk for Alzheimer’s disease from a few drops of spit. As the disease’s prevalence rises, the saliva test called genoSCORE analyzes more than 114,000 different genes to provide a score of 0 to 1 for your risk of getting Alzheimer’s. A score of .5, for example, means you have a 50% chance of developing Alzheimer’s at some point in your life. Dr. Jeffrey Gelblum of First Choice Neurology, which has 41 locations in six Florida counties, including Miami-Dade, Broward and Palm Beach, said his medical practice has partnered with Cytox, the UK developer, to start using the tests.

—“Tampa Bay Latinos with diabetes struggle with high insulin costs” via Juan Carlos Chavez of the Tampa Bay Times: Aida Delgado’s health problems began a decade ago with high blood pressure and a kidney infection that required emergency hospitalization. Her recovery was painful and slow, but she thought the worst was behind her. She was wrong. Four years ago, she started to feel tired and weak. Her vision became increasingly blurry. Delgado, 67, was diagnosed with Type 2 diabetes, which causes high blood sugar levels. Her doctor recommended she take insulin, a lifesaving drug, to control her blood glucose level because her pancreas doesn’t produce enough of the hormone. Without health insurance and a steady job, Delgado started paying over $400 each month two years ago for a five-pack of injection pens to manage her blood glucose levels.

— PENCIL IT IN —

Saturday

Happy birthday to Sen. Nick DiCeglie.

Sunday

Happy birthday to Rep. Sam Garrison.

Monday

10 a.m. The DOH is holding a meeting to develop rules for the Florida Reimbursement Assistance for Medical Education (FRAME) Program. Attend via Microsoft Teams or call (850) 792-1375; participant code: 10365823.

10:30 a.m. AHCA hosts a meeting on proposed changes to Rule 59G-4.085 regarding early intervention services. Place: AHCA, 2727 Mahan Dr., Tallahassee. Or attend the meeting remotely here. Meeting ID: 81760639685; passcode: 821651

Tuesday

Happy birthday to Rep. Michael Gottlieb.

Happy birthday to Rep. Will Robinson.

3 p.m. AHCA hosts a public hearing on proposed Rule 59A-3.066, which outlines the licensure procedures related to hospitals. Place: AHCA, 2727 Mahan Dr., Tallahassee, Building 3, Conference Room B. Or call (888) 585-9008; participant code: 998518088.

Wednesday

1 p.m. The Bureau of Emergency Medical Oversight’s Florida Trauma System Advisory Council meets. Place: Tallahassee Memorial Hospital Auditorium, 1300 Miccosukee Rd., Tallahassee. Or attend virtually here.

Thursday

10 a.m. The Division of Health Community Health Promotion, Bureau of Tobacco Free Florida meets. Register in advance to attend the meeting here.

2 p.m. AHCA hosts a meeting to develop proposed Rule 59A-35.115 about patient safety culture surveys. Place: AHCA, 2727 Mahan Dr., Tallahassee, Building 3, Conference Room B.