Diagnosis for 8.24.23: 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.

— Worth watching —

Florida’s 15-member Physician Workforce Advisory Council meets at the end of the month to take a look at the latest results of the state’s annual physician workforce survey.

Established in law, the council advises the State Surgeon General and the Florida Department of Health (DOH) on current and future physician workforce needs in this state based on the findings from an annual physician survey conducted by the DOH.

Given the attention legislative leadership is paying to health care workforce issues leading up to the 2024 Session, the meeting may be worth a watch.

To better track the number of licensed physicians in the state, physicians must complete a survey every time they renew their license once every two years.

There currently are 61,116 licensed physicians, more than half (31,489) of whom are specialists, according to a Kaiser Family Foundation analysis. Physicians are asked to provide information regarding the frequency and geographic location of practice within the state, their practice setting, the percentage of time spent in direct patient care, their specialty or certification and any anticipated changes to their license or practice status. The survey also includes questions about the availability and trends of critical obstetric care, radiological services, and physician services for hospital emergency departments and trauma centers.

The DOH must evaluate and report on the supply and distribution of medical and osteopathic physicians and maintain a database to serve as a statewide data source concerning the physician workforce.

The DOH must analyze the physician survey results, report the number of physicians who practice in the state and plan to reduce or modify their scope of practice. The DOH must also report on physicians by geographic area and specialty; the number of physicians who deliver babies, read mammograms and perform breast-imaging-guided procedures in this state; provide emergency care on an on-call basis for a hospital emergency department; plan to reduce or increase emergency on-call hours in a hospital emergency department; or plan to relocate outside the state.

The annual report is due to the Governor, the Senate President, and the House Speaker by Nov. 1.

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

— First to be sued —

A pair of advocacy groups are suing Gov. Ron DeSantis’ administration in federal court, alleging the state’s Medicaid unwinding efforts violate state and federal law and people’s due process rights.

It’s the first lawsuit in the nation to be filed related to improper Medicaid terminations in the wake of the COVID-19 public health emergency’s expiration. The DeSantis administration has called the lawsuit “baseless.”

The National Health Law Program and the Florida Health Justice Project filed the legal challenge in Jacksonville against the Agency for Health Care Administration (AHCA) and the Department of Children and Families (DCF) on behalf of three individuals told they were losing their Medicaid coverage.

The lawsuit contends the notices are confusing and do not adequately explain why coverage is being dropped. For example, some notices say that those on Medicaid were receiving assistance from another program without saying whether individuals were referred to a different health care program. Additionally, the lawsuit said the process state officials use does not provide an opportunity to challenge the redetermination.

“It is critical that people who have had Medicaid throughout the COVID-19 pandemic understand why DCF thinks they are no longer eligible and how to challenge their termination if it’s incorrect,” said Miriam Harmatz, founder and director of advocacy of the Florida Health Justice Project. “The current notices are incomprehensible to most recipients, and we hope that this lawsuit brings immediate relief to those who have been deprived of their due process rights.”

The three individuals listed in the proposed class-action lawsuit include a Jacksonville mother, her 2-year-old child and a 1-year-old child from Miami-Dade County. The lawsuit could potentially impact as many as 182,000 people deemed ineligible for Medicaid since the state began the unwinding process.

In a statement, DCF Deputy Chief of Staff Mallory McManus downplayed the litigation.

“This is a baseless lawsuit, and while the state cannot comment on pending litigation, we offer the follow (sic) indisputable facts: Our letters to recipients are legally sufficient. In fact, CMS approved the department’s redetermination plan based on their regulations. There are multiple steps in the eligibility determination process and the final letter is just one of multiple communications from the department. Our department continues to lead on Medicaid determinations and being fiscally responsible,” the statement reads.

— Looming threat continues —

Florida’s health insurance plan for state workers will remain in the black over the coming year after state legislators used a $200 million injection of taxpayer money to help stabilize it.

But the latest estimates state economists drew up this month show the state employees’ group health insurance trust fund will drop back into the red by increasingly large amounts in the next 2-5 years with a whopping deficit of nearly $1.5 billion projected for the fiscal year ending June 30, 2028.

The prospects of large deficits over the next few years could pressure state legislators to increase health insurance premiums for state workers, which have remained unchanged for years.

The latest numbers project the trust fund used to pay for state workers’ health insurance will finish the 2023-24 fiscal year with a balance of $313 million — an amount reached largely by a $200 million transfer from the state’s general revenue account.

But expenses are expected to exceed revenues over the next several years, starting with a projected $348.5 million negative cash balance at the end of the 2024-25 fiscal year. That means this is a problem with which legislators will grapple during the annual Legislative Session starting in January.

Nearly 350,000 people — including subscribers and dependents — rely on state group health insurance coverage. The program’s overall cost is expected to be almost $3.3 billion at the end of the 2023-24 fiscal year.

The primary source of revenue for the state group health insurance program — more than $2.1 billion — comes from premiums paid by state agencies on behalf of employees. Premiums paid by state workers are expected to generate about $161 million in the current fiscal year.

Rank-and-file career service workers pay $180 a month in premiums for family coverage, while higher-ranking employees — including those in top positions in state government — pay $30 a month in premiums for family coverage.

— Smiles and basketball —

Florida Atlantic University (FAU) wants to enroll 45 students to work in underserved and rural areas in its proposed College of Dentistry. Next year, it needs $113 million from the Legislature to help make it happen.

The money will be used to hire 40 faculty, 70 staff and 10 adjunct preceptors. Finding qualified staff won’t be a problem, according to a document filed with the Board of Governors.

“Remarkably, many qualified practitioners across America are interested in relocating to Florida for such a prestigious opportunity. Much of the interest has been accelerated by the recent success of (the) FAU basketball team,” reads a May document detailing FAU’s recruiting and retention plans for the College of Dentistry.

FAU has been in discussions with state university system schools closest to rural and underserved areas regarding a potential pipeline of pre-dental students, with the goal of inking a memorandum of understanding with Florida A&M University, the University of North Florida and the University of Central Florida, according to one document.

Lawmakers this year included $10 million in operational funds and $30 million in fixed capital outlay for FAU and its College of Dentistry. Lawmakers agreed to the funding after the BOG in January gave FAU the green light.

The BOG’s approval was contingent on several factors, including FAU securing funding from the Legislature and accreditation for the program, something the university believes it can accomplish by 2026.

If successful, FAU would operate the state’s second college of dentistry, with the first located at the University of Florida.

In opening a new college of dentistry, the university hopes to increase access to dental care in Florida. A 2019 Health Resources and Services Administration report shows that 25% of Florida residents live in areas with a shortage of dentists, more than any other state. Moreover, data from Wellbeing Florida shows that in 2021, hospitals billed more than $620 million in preventable emergency room visits and hospital admissions stemming from oral health issues.

“The university will again work with its champions and leadership in the Legislature to secure the additional funding needed to continue on our journey of establishing Florida’s second public college of dentistry,” the proposed legislative budget request reads. “The 2024 Legislative Session is scheduled to conclude Friday, March 8, 2024. Once the Governor has reviewed and approved the budget, the university will know how much additional funding has been secured and how much funding we will need to seek during the 2025 Legislative Session,” documents submitted to the BOG show.

— Way to Go, Noles —

The Princeton Review has ranked Florida State University Counseling & Psychological Services at No. 13 on its 2024 list of Best Student Support and Counseling Services.

Called CAPS, the program offers FSU students access to free licensed and professionally trained staff through immediate triage services, one-on-one sessions, couples’ sessions, group sessions and round-the-clock crisis intervention services through its help line (850-644-TALK).

Princeton also ranks FSU’s University Health Services among the best in the nation, placing it at No. 14 on its list of Best Health Services.

FSU has a fully accredited, on-campus primary care facility where students can access health care services.

The Princeton Review lists Best Student Support and Counseling Services and Best Health Services factor in data from surveying 165,000 students at 389 schools.

“Our mission at Counseling & Psychological Services is to promote access to innovative and individualized mental health services throughout our campus community,” CAPS Director Carlos Gómez said. “The most meaningful aspect of this national recognition is that the ranking is grounded in feedback provided by our student community. Our students are our priority, and their acknowledgment of our efforts is incredibly meaningful to us.”

FSU requires students to have health insurance to enroll. Amy Magnuson, director of FSU’s health services program, noted the university was able to increase the number of health insurance options for students to meet that mandate.

“We are so humbled to be recognized again for the amazing efforts of our health care providers, nurses and staff,” she said, adding that the university also has made it even easier for students to access high-quality care through enhanced online scheduling.

“The Princeton Review ranking is a reflection of how our students experience the services and (recognizes) compassionate and capable staff in Counseling & Psychological Services and University Health Services,” said FSU Associate Vice President for Student Affairs Angela Lauer Chong, who leads the division’s health and wellness efforts. “I am thrilled that the departments have been recognized for the value they bring to the Florida State University community.”

While FSU was the only Florida college or university to make the Counseling & Psychological Services list, it had company on the list of Best Health Services for 2024.

Florida International University was ranked No. 4. The University of Miami and Rollins College ranked No. 20 and No. 25, respectively.

— RULES —

— The Board of Osteopathic Medicine proposes amending Rule 64B15-13.001 to update continuing medical education requirements. More here.

— The Board of Chiropractic Medicine proposes to amend Rule 64B2-18.0055 to clarify continuing education requirements. More here.

— AHCA proposes developing Rule 59A-35, which implements a 2023 law regarding facial covering requirements for health care practitioners and providers for infection control. More here.

— AHCA proposes developing Rule 59G-4.002 to incorporate the July 1, 2022, Florida Medicaid fee schedules and billing codes and the Jan. 1, 2023, Florida Medicaid fee schedules and billing codes by reference. More here.

— LOBBYISTS —

Michelle Crimmins: Prime Therapeutics

Rob Bradley, Oak Strategies: HCA Healthcare

— ETC —

—“Elevate” was the theme for this year’s Florida Behavioral Health Association (FBHA) Conference, which drew more than 1,500 people. Attendees included a mix of regulators, clinicians, students, mental health and substance use counselors, MDs, social workers, psychologists, first responders, and students. “We believe that in order to truly make a difference in the lives of individuals struggling with mental health conditions, substance use issues, or other behavioral health challenges, we must push ourselves to new heights,” FBHA President and CEO Melanie Brown Woofter said during her opening remarks. “We must rise above the limitations of traditional methods and embrace innovative strategies. After all, all the important work you do on the front lines makes a difference in the life of a family or a loved one.”

—Just in time for football season, Baptist Health announced the opening this week of its new orthopedic complex across the street from Hard Rock Stadium, home of the Miami Dolphins. It will provide health care to Dolphins players and the public at the 17,000-square-foot facility. It is adjacent to the Baptist Health Training Complex, the Dolphins’ training facility, with clinical areas overlooking the team’s practice field.

—The Florida Health Care Association (FHCA) is partnering with Mercury Public Affairs to raise awareness for the long-term care industry’s “gold standard care and services,” bolster the industry’s workforce initiatives and strengthen the profession to “meet the needs of Florida’s seniors and people with disabilities, today and into the future,” according to a news release announcing the collaboration. Mercury Managing Director Tammy Gordon and Senior Vice President Kristin Whitaker will work on public relations and legislative strategies, respectively. “As the landscape of long-term care evolves, effective communication and community engagement have become increasingly vital to showcase our dedication and advancements within our profession,” said FHCA Chief Executive Officer Emmett Reed. “We are confident that our partnership with Mercury will enhance our ability to share our mission, values, and initiatives and strengthen our efforts to promote the importance of investing in the well-being of Florida’s most vulnerable to ensure their continued access to high-quality long-term care.”

— ROSTER —

— The Florida Behavioral Health Association announced this week its new board of directors: Melissa Larkin-Skinner, Centerstone of Florida, chair; Scott Burgess, David Lawrence Center, vice chair; Ivan Cosimi, SMA Behavioral Health Services, Inc., treasurer; and Babette Hankey, Aspire Health Partners, secretary.

— Florida Blue, the state’s Blue Cross and Blue Shield plan, recently announced Matt Tierney and Janet Pogar as market leaders for its West Florida team. Tierney will oversee Hernando, Pasco, Hillsborough and Pinellas counties, and Pogar will oversee Manatee, Sarasota, Charlotte, Hardee, Highlands, Glades, DeSoto, Lee, Collier, and Hendry counties. Market leaders are charged with developing and executing local strategies for Florida Blue, including sales, products, analytics, hospital and provider networks, care management, marketing and community relations.

— Gina Temple is no longer the CEO of HCA Florida Bayonet Point Hospital.

— ICYMI —

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

Roundtable: Wilton Simpson and Tampa General Hospital hosted a roundtable discussion this week on the state’s efforts to protect kids from high-potency hemp products. With THC-containing cannabis products only available for medical use, other products, such as high-potency hemp, have become available more broadly. A total of 933 children were exposed to high-potency hemp products in Florida last year. Sadly, many of those children required medical care and hospitalization. “Together with our medical and legislative partners, we have taken significant and meaningful steps to safeguard our children from the risks of high-potency THC products — but our job is not done,” Simpson said.

Done deal: The American Correctional Association (ACA) has reaccredited nine Florida Department of Corrections correctional institutions. The accreditations were awarded at ACA’s 2023 Summer Conference in Philadelphia. The accreditation recognizes practices that ensure staff and inmate safety and security, enhance staff morale, improve record maintenance and data management, and improve facility function at all levels. “It brings me great pride to recognize our staff’s daily pursuit of excellence and unwavering commitment to sustaining our reputation as a national leader in correctional practices,” Florida Department of Corrections Secretary Ricky Dixons said. “Achieving ACA accreditation is a meaningful opportunity to showcase our efforts, build on our strong foundation, and sustain our steadfast commitment to upholding public safety. I want to express my gratitude to our leaders across the state who remain dedicated to our critical mission.”

Pushed back: Florida is postponing when it plans to announce the winners of contracts to manage the state’s health care safety net program. State officials announced a three-month delay for the Medicaid managed care procurement and now said they will announce which organizations won the contracts in February 2024.

Opinion: Consider becoming a CRNA: During these waning days of Summer, as students head back to school or college, many are thinking about their future path in life, and how they can find a rewarding career where they can make a difference in the world. For those students and their parents and advisers, I would like to make the case for considering a career as a Certified Registered Nurse Anesthetist (CRNA).

Come together: U.S. Sens. Marco Rubio and Rick Scott sent a letter to the Veterans Affairs Administration asking why the 1.5 million veterans in Florida have trouble finding consistent, quality care. “Last week, the Miami VA stopped all elective surgeries due to AC maintenance. Not only does this interrupt veterans’ care, but it presents an unsafe working environment for the medical staff at the facility, including nurses reporting mold,” the letter to VA Secretary Denis McDonough reads.

— FOR YOUR RADAR —

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

“Florida hospitals rebound from severe nursing shortage during pandemic” via Christopher O’Donnell of the Tampa Bay Times — After being stretched to the breaking point during the pandemic, the nursing shortage crisis may be over for now in Florida. Across the state, the vacancy rate for registered nurses has fallen in the past year from 22% to 13%, according to a survey of more than 200 hospitals conducted by the Florida Hospital Association. The nurse turnover rate has also plummeted from 32% in 2022 to 20%, and hospitals are reporting that many nurses have returned to their old jobs. The numbers are a relief for hospital executives after the COVID-19 public health emergency severely exacerbated the pre-pandemic nursing shortage.

“Next generation of COVID-19 vaccines and therapies gets a $1.4 billion boost” via Jennifer Shutt of Florida Phoenix — The Biden administration Tuesday announced a $1.4 billion investment in developing the so-called next generation of COVID-19 vaccines and treatments. Health and Human Services Secretary Xavier Becerra and Assistant Secretary for Preparedness and Response Dawn O’Connell announced that the funding is part of the $5 billion program they hope will help the country get ahead of any changes in COVID-19. “This is an investment in expanding our country’s ability to respond to the future variants that we might see coming out of COVID,” Becerra said. “It’s an investment in better protecting all of our community, including those who are immunocompromised and who don’t respond well to the existing vaccines.”

“AG Ashley Moody: Pasco, Pinellas hardest hit by fentanyl crisis” via Sarah Blazonis of Bay News 9 — Attorney General Moody marked National Fentanyl Prevention and Awareness Day by joining Pasco County officials to speak about the opioid crisis in Tampa Bay. A Hillsborough County Deputy was hospitalized Aug. 18 after exposure to fentanyl in an inmate’s bunk area. The deputy was discharged from the hospital that same night. When answering reporters’ questions, Moody addressed the incident at the Falkenburg Road Jail. She said more and more, first responders face situations where they not only have to protect their communities while out on calls but also must take precautions for their safety against fentanyl. It’s part of a growing nationwide crisis that Moody said has taken particular hold in the Tampa Bay area. According to the Attorney General, Pasco and Pinellas counties saw 374 fentanyl deaths in the first six months of 2022. She said that’s nearly 100 higher than Jacksonville, the second most-impacted area in the state.

“Some Tampa Bay stores out of COVID-19 test kits after uptick in cases in Florida” via Christopher O’Donnell of the Tampa Bay Times — Home COVID-19 test kits have sold out at some Tampa Bay area stores and pharmacies as Florida recorded an uptick in the number of weekly cases of the virus. It comes as the number of weekly cases in Florida rose to more than 18,000 this month, roughly double the average in July, according to Florida Department of Health weekly reports. Forty-one deaths from COVID-19 were reported in seven days through Thursday. Hospitals have also reported an increase in the number of patients admitted for COVID-19, with more than 1,300 adults and 34 children in state hospitals as of Aug. 5, according to data compiled by the Department of Health and Human Services. That’s up from about 650 in June.

— PENCIL IT IN —

Thursday

8:30 a.m. — The Department of Health Statewide Drug Policy Advisory Council meets. 4052 Bald Cypress Way, Conference Room 301, Tallahassee, 32311

2 p.m. — AHCA hosts a workshop on proposed amendments to Rule 59A-38.007 related to hospice reporting of demographic data. 2727 Mahan Drive, Tallahassee, 32308, Building 3, Conference Room B. Or call (888) 585-9008; participant code: 998518088

Friday

Happy birthday to POLITICO reporter Gary Fineout.

2:30 p.m. — The Board of Medicine — North Probable Cause Panel meets to discuss public disciplinary cases. Meeting link here. Or call (646) 749-3122; participant code: 84119-637.

Sunday

Happy birthday to Rep. Robin Bartleman.

12:30 p.m. — Molina Healthcare of Florida, American Red Cross, WINK-TV’s Weather Authority team, Haitian American Community Coalition of SW Florida and Hallelujah Community Church are hosting Hurricane Preparedness Expo 2023 for members of the Fort Myers community. The event will provide residents and businesses with information on how to anticipate risks associated with extreme weather situations, build a hurricane preparedness kit and plan for an evacuation. Hallelujah Community Church of Fort Myers is at 3208 Central Ave. in Fort Myers. For more information, contact [email protected].

Monday

8 a.m. — 36th Annual Statewide Affordable Housing Conference, Rosen Centre Hotel, 9840 International Dr., Orlando. Register here.

Tuesday

Happy birthday to Rep. Griff Griffitts.

Wednesday

Happy birthday to Rep. Lauren Melo.

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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.