Diagnosis for 12.6.23: 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.

— The wait is over —

Thursday morning, Senate President Kathleen Passidomo will unveil her “Live Healthy” initiative, a proposal to gird the state against health care workforce shortages in the coming years.

Sens. Gayle Harrell and Colleen Burton are expected to be on hand as Passidomo discusses her high-priority legislation with the Capital Press Corps.

For months, Passidomo has discussed the need for changes to ensure the state is doing what it can to ensure residents can access primary care, including behavioral health, across the state, including in rural areas.

Those changes – contained in two yet-to-be-published proposed bills 7016 and 7018 — will be discussed by the Senate Health Policy Committee Dec. 12.

The legislation will likely change how the state educates and trains physicians — a recent report by the Office of Program Policy Analysis and Government Accountability — suggests that physicians educated in state medical schools and trained in Florida residency programs are more likely to practice in the Sunshine State than physicians who come from out of state for a residency program.

Passidomo also has stressed the need to explore awareness and innovation to address real-time challenges in health care through technology.

These recommendations will cost money to implement, something that Passidomo seems willing to do.

The proposal has been floated by the House, and Speaker Paul Renner appears to be on board.

“I like a lot … the Senate President’s got some amazing, great ideas on health care,” Renner told reporters Tuesday. “ She spent a lot of time — really thoughtful time—and there’s things I’m really, really excited about.”

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— History in the making? —

For the first time in recent history — or perhaps ever — the Florida Board of Medicine isn’t being chaired by a Florida-licensed physician.

Melbourne attorney Nicholas Romanello was voted in as BOM Chair at its meeting earlier this month. Amy Derick, a dermatologist who has contributed to DeSantis’ political efforts, was voted Vice Chair.

Romanello has served on the Board of Medicine since 2016 and is the senior vice president and chief legal officer at Health First Rockledge. He previously was the chief legal officer for the Health Care District of Palm Beach County and the general counsel at the Florida Department of Health.

The vote to make Romanello the Chair of one of the state’s medical boards indicates that no other physician member could muster the support needed to take the reins. The current BOM Chair, Dr. Scot Ackerman, offered to serve a second term but ultimately supported Romanello.

BOM member Hector Vila, first appointed to the board by former Gov. Rick Scott in 2016, also was mentioned as a possible Chair. Vila, the medical director at Tampa Bay Office Anesthesia, has served as Vice Chair but has yet to Chair.

As Vice Chair, Derick will most likely be named Board Chair next year.

The majority (12) of the 15-member board must be Florida-licensed physicians in good standing engaged in practicing or teaching medicine for at least four years immediately preceding their appointment.

One of the physicians must be in private practice and on the full-time staff of a Florida teaching hospital. One physician must be a graduate of a foreign medical school. Three members must be consumers, one must be a licensed health care risk manager, and one must be at least 60 years old.

— Nurse Botox shots? —

Let’s switch from the Board of Medicine to the Board of Nursing.

Registered nurse Maria Schafer petitioned the board late last month asking whether “it’s within the scope of practice” for her to administer a Botox shot under the direct supervision of a physician who examines the patient, orders the Botox, and specifies the dosage and muscles that should be injected.

Schafer asks whether Florida’s law regarding “advanced or specialized nursing practice” allows the board to approve the performance of advanced-level nursing acts which, by “postbasic specialized education, training, and experience, are appropriately performed.” Additionally, advanced nurses “may perform acts of nursing diagnosis and nursing treatment of alterations of the health status …” and “acts of medical diagnosis and treatment, prescription, and operation as authorized within the framework of an established supervisory protocol.”

The Florida Society of Plastic Surgeons lobbyist Christopher Nuland said his clients aren’t opposed to the petition, noting that it would apply to nurses under “direct supervision” who have orders with dosage amounts and detailed information about which muscles to inject

A copy of the Petition for Declaratory Statement may be obtained by contacting Joe R. Baker Jr., Executive Director, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, 32399, [email protected], or by telephone at (850) 245-4125.

— Budget news —

DeSantis’ $114 billion proposed budget for state fiscal year (FY) 2024-25 earmarks nearly $34.8 billion to the Agency for Health Care Administration, $3.8 billion-plus to the Department of Health, $4.6 billion to the Department of Children and Families; $2.4 billion to the Agency for Persons with Disabilities; $464 million to the Department of Elder Affairs; and $199.3 million to the Department of Veteran’s Affairs.

DeSantis recommended $303.4 million in increased Medicaid rates for nursing homes, hospitals and other providers in his proposed spending wish list this week.

That news was met with support from groups that represent nursing homes and hospitals.

Florida Health Care Association said that the 1% increase in rates DeSantis recommended for nursing homes recognizes “challenges in our state nursing centers.”

Safety Net Hospital Alliance CEO Justin Senior noted DeSantis included nearly $117 million for maternal care and neonatal intensive care units. He called the funding a “major investment” to “save lives and improve health care outcomes for the most vulnerable Floridians.”

The proposed budget also increases Medicaid physician rates to $79.1 million and $8.6 million to redesign a reimbursement model and to reimburse collaborative care between primary and behavioral health providers to better serve Floridians’ behavioral health needs.

Nevertheless, except for APD, DeSantis’ proposed spending recommendations for health and human service agencies and departments are reduced from the current year’s spending levels.

— More budget news —

DeSantis wants to transfer the administration of the managed care plan for children with complex medical needs from the Department of Health (DOH) to the Agency for Health Care Administration (AHCA), effective July 1, 2024.

Under the bill, DOH would maintain a CMS division. It would assist AHCA in developing specifications for use in the procurement of vendors and the model contract, including provisions relating to referral, enrollment, disenrollment, access, quality-of-care, network adequacy, care coordination, and service integration.

Additionally, DOH would continue to conduct the clinical eligibility screening for children and youth with special health care needs who are eligible for or enrolled in Medicaid or the federal children’s health insurance program, which in Florida is known as Florida KidCare.

Other DOH budget highlights include:

— $219 million in cancer funding, including $60 million for the Florida Cancer Innovation Fund for cancer research and $788,642 to improve cancer data collection through Florida’s Cancer Data System.

— $7.3 million to support infants and toddlers with, or at risk of, developmental delays through Early Steps.

— $5.3 million to improve diagnoses and treatment for HIV, hepatitis C, and syphilis by expanding routine screening in emergency departments.

— $2.3 million to expand children’s access to behavioral health care by training pediatricians to provide or refer children to mental health care services through Behavioral Health Hubs.

— $1 million for the Florida Stroke Registry, which is instrumental in helping Florida’s health care providers improve stroke care through data utilization and developing and sharing best practices.

— RULES —

The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling proposes amending Rule 64B4-3.081 regarding new applications. More here.

The Board of Nursing Home Administrators proposes developing an amendment to Rule 64B10-11.002 to update eligibility requirements for licenses. More here.

The Board of Nursing Home Administrators proposes developing an amendment to Rule 64B10—12.001 regarding fees. More here.

The Board of Nursing Home Administrators proposes developing an amendment to Rule 64B10—15.001 regarding updates to the rule language regarding continuing education for licensure renewal. More here.

The Board of Nursing Home Administrators proposes developing an amendment to Rule 64B10—15.021 regarding the status of preceptors. More here.

— LOBBYISTS —

Christopher Carmody, Robert Stuart, GrayRobinson: Project Opioid Initiative

Gangul Gabadage, Continental Strategy: Family First Homecare

Jeff Hartley, Smith Bryan & Myers: Conklin Davis Center for the Visually Impaired

Jonathan Kilman, Cynthia Henderson, Paul Lowell, Gerard O’Rourke, Converge Public Strategies: Milan Laser Hair Removal, Sumitomo Pharma America

Robert Schenck, The Legis Group: Access HealthCare

— ETC —

— AHCA received an expedited CON application from HC Nursing and Rehab Center to transfer CON #10718 from Riverview Nursing and Rehab Center to the applicant to establish a new 67-bed community nursing home.

— In workers’ compensation news, the Department of Financial Services issued a memo announcing that the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after Jan. 1, 2024, is $1,260.

— ROSTER —

— HCA Florida Oak Hill Hospital in Brooksville appointed Samuel Boadi as COO. Boadi joined HCA Florida Oak Hill Hospital from HCA Florida Lake City Hospital, where he also served as COO.

— Florida Lake City Hospital announced Walter Long as its new COO. Long previously served as vice president of operations at HCA Florida West Hospital in Pensacola

— Florida Highlands Hospital in Sebring announced Henry Capote has been named its CFO. Capote most recently served as CFO of Coral Gables 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.

‘Free kill’: Bipartisan efforts are again underway to rectify a unique Florida law that prevents lawsuits in many cases of deadly medical malpractice. Senate Democratic Leader Lauren Book, Rep. Mike Beltran, and Rep. Johanna López have refiled twin bills (SB 442, HB 129) to overturn the state’s so-called “free kill” law. In general, the law bars family members of people who died due to medical malpractice from suing doctors or hospitals when the victim is an unmarried adult. The law applies to anyone over the age of 25. Florida is the only state in the nation with such a restriction on its books. The law applies to anyone seeking medical help in the state, including residents and visitors.

Strong support: A University of North Florida poll found that 62% of all respondents would vote “yes” on the proposed amendment abortion rights amendment while 29% oppose the proposal. Nine percent didn’t answer the question. Florida requires that constitutional amendments receive approval from 60% of voters to pass. The numbers from the poll, which has a margin of error of 4.37%, show that the amendment is hovering around the margin it needs. Organizers pushing the proposed amendment — which would prohibit the Legislature from banning abortion before viability, generally around 24 weeks — have until February to collect enough voter signatures to make next year’s ballot. Election officials have certified nearly 500,000 signatures, but it takes close to 900,000 signatures to qualify.

Same great price: DeSantis is proposing to spend an additional $338.2 million in general revenue to keep the state from increasing costs for the employees who rely on the state group health insurance plan for their health care coverage. According to state estimates, as of June 30, 342,939 people relied on the state group health insurance program for their coverage, of which 167,488 were employees or former employees. State employees haven’t had an increase in their health insurance premiums in nearly 20 years. Earlier this year, economists projected a nearly $349 million shortfall in the trust fund used to pay the health care costs of state employees. If changes aren’t made, that deficit will increase to $910.3 million by June 2026.

Doc stock: On average, between 2008 and 2015, 42% of physicians who graduated from out-of-state medical schools, came to Florida, and started residencies ultimately stayed in the state to practice medicine, according to the report from the Office of Program Policy Analysis and Government Accountability (OPPAGA). By contrast, 75% of physicians who graduated from one of the 10 Florida-based medical schools and completed in-state residencies chose to remain in the state and launch their practices. A national report ranked Florida fifth best in the nation for retaining state-educated and trained physicians. The national analysis ranks Hawaii No. 1, with that state retaining 87% of its state-educated and trained medical school graduates. California ranked No. 2, having 82% of its state-educated and trained physicians. Texas ranked third with an 81% retention rate.

Prep work: In Florida political circles, the COVID-19 response has become something many would like to forget. But Mayhew, president and CEO of the Florida Hospital Association, said looking back is critical. She said the public health disaster tested the hospital infrastructure in Florida and worldwide. That stress showed how the system is prepared for disaster and where it falls woefully short. Regardless, the system can always do better, she suggested. “We’ve got to keep looking at those opportunities to improve the efficiency, to reduce barriers, to improve health status, and to embrace these new models of care,” Mayhew said.

Cutting edge: The University of Florida (UF) is providing nearly $11 million for a program enhancing access to cancer screenings, a center for advancing cell and gene therapies, an AI learning platform for mathematics, and a digital humanities lab as part of its third round of strategic funding. UF President Ben Sasse announced the latest round of $10.9 million in funding, saying the initiative is designed to advance interdisciplinary scholarship and enhance student experience. “These exceptional initiatives will not only elevate UF’s standing as a national research leader but also transform lives here in Florida and around the world,” Sasse said.

— FOR YOUR RADAR —

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

“Lawmakers say expanding telehealth could make pregnancy safer” via Regan McCarthy of WFSU — The risk of death for mothers during pregnancy or in the year following childbirth is rising, and experts say one of the contributing factors is lack of access to health care. Now, as part of an effort to address the trend, Florida lawmakers are looking into a plan to expand maternal telehealth. A pilot program in Florida has been using remote monitoring tools like blood pressure cuffs and glucose monitors to help ensure women who might otherwise struggle to access care can have healthy pregnancies and recoveries after giving birth. Kenneth Scheppke with the Florida DOH says it’s working so far.

“Prosecutors call Florida nursing school ‘fraud’ ring that handed out fake degrees” via Jay Weaver of the Miami Herald — A former registrar of a Palm Beach County nursing school served as the “right-hand” woman to the school’s owner as both schemed to lure in thousands of students and charge them millions of dollars for fake transcripts and degrees so they could qualify to attain licenses as nurses, a prosecutor told jurors Wednesday during opening statements of a federal trial in Fort Lauderdale. Before trial, the owner of Palm Beach School of Nursing, Johanah Napoleon, pleaded guilty to a wire fraud conspiracy, was sentenced to 21 months in prison, and paid the U.S. government about $3.5 million in financial penalties. Former student services director Gail Russ and two other defendants were accused of recruiting students from the Northeast into the alleged diploma mill scheme.

“Clearwater police no longer arresting protesters over abortion clinic buffer” via Tracey McManus of the Tampa Bay Times — The Clearwater Police Department is no longer arresting protesters who violate a vehicle safety zone at an abortion clinic after the county’s top prosecutor said he would not pursue obstruction charges from the incidents. The City Council enacted the buffer zone in March, which prohibits protesters from entering the driveway of Bread and Roses Woman’s Health Center or the portion of sidewalk within 5 feet of either side of the driveway. The measure responded to the escalation of Saturday demonstrations where some protesters blocked cars and walked up to windows to yell at patients entering and exiting. Police Chief Eric Gandy said officers had been enforcing the ordinance with verbal warnings, then with citations, and, finally, arrests as a last resort for same-day, repeat violators.

“Tampa doctor must pay $1.5 million for part in ‘Pain Hustlers’ scheme” via Christopher O’Donnell of the Tampa Bay Times — A new Netflix movie starring Emily Blunt and Chris Evans shows how an Arizona-based pharmaceutical company persuaded doctors to prescribe a fentanyl-based painkiller by giving them kickback payments disguised as speaking fees. The movie, Pain Hustlers, is based on the story of Insys Therapeutics, whose CEO and president, John Kapoor, was sentenced to 5.5 years in prison for racketeering charges in 2020. According to a Department of Justice news release, Tampa pain management doctor Edward Lubin participated in the scheme. In exchange for prescribing Subsys, a fentanyl mouth spray, Lubin received roughly $160,000 in kickbacks from the pharmaceutical manufacturer, according to the release. The payments were disguised as fees for speaking at sham informational events that lasted a few minutes, never occurred, or merely repeated the same information to the same attendees. It was a model that Insys replicated across much of the country to boost sales.

— PENCIL IT IN —

Thursday

8 a.m. — The House Health Care Appropriations Subcommittee meets. Room 17, House Office Building.

Saturday

Happy birthday to Rep. Webster Barnaby.

Sunday

Happy birthday to Rep. Alex Rizo.

Monday

1 p.m. — The House Health & Human Services Committee will hear a report from the Agency for Persons with Disabilities on the Home and Community Based Services Waiver Pre-Enrollment List. Room 17, House Office Building.

Tuesday

4 p.m. — The Senate Health Policy Committee will discuss two proposed committee bills. Room 412, Knott Building.

Wednesday

1:30 p.m. — The House Healthcare Regulation Subcommittee meets. Room 102, House Office Building.

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