News from Tallahassee for 12/22/14

Troubled Plans Top Health News in 2014 posted on 12/22/14

by mary shedden | health news florida

Take a look at the top health care stories in Florida in 2014, and it’s clear that the business of Medicare and Medicaid continued to dominate the news.

Good news -- and plenty of bad, too -- topped the most read stories on Health News Florida in the past year. And yes, the glitches and changes tied to new Affordable Care Act rules created plenty of buzz as well.

The competition over coveted Medicaid managed care contracts was a reader favorite early in the year. Meanwhile, Medicare Advantage plans at the top of their game – and those mired in controversy and financial calamities – were attention getters throughout the year.

Some of these important health stories kept going, long after the first headline caught your attention. And we’ll continue to do our best to keep your updated in 2015. But now, here’s a look back at the top 10 stories of the past year:

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31 FL Hospitals to See Medicare Pay Cut posted on 12/22/14


In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals – including 31 in Florida -- for having high rates of infections and other patient injuries, records released Thursday show.

Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa.

One out of every seven hospitals in the nation will have their Medicare payments lowered by 1 percent over the fiscal year that began Oct. 1 and continues through September 2015. The health law mandates the reductions for the quarter of hospitals that Medicare assessed as having the highest rates of “hospital-acquired conditions,” or HACs. These conditions include infections from catheters, blood clots, bed sores and other complications that are considered avoidable...

See a complete listing of Florida hospital scores here.

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Florida’s jails have become ‘the asylums of the new millennium’ posted on 12/18/14

by Jeff Kunerth | Orlando Sentinel

The most dangerous time of day on the Fifth Floor is 6 a.m.Long before nurses make their daily rounds dispensing meds to those suffering from schizophrenia, bipolar disorder and depression, staffers like Greg Dawkins must check to see if anyone has died during the night.They knock on doors, call the person’s name.If there’s no response, they enter.

“I’m waking them up early in their rooms and I’m inside their space,” said Dawkins, who worked the Fifth Floor for years. “I have to be alert and watch them very carefully. When you tap a person to wake them up, they wake up fighting.”

Dawkins works at the largest mental health institution in five Central Florida counties: the Orange County Jail.

In Florida, jails and prisons have replaced mental hospitals. They are “the asylums of the new millennium,” according to the Florida Supreme Court.

And every year, they house and treat more and more people like James Coleman.

“I hear these voices. When I want to kill, I want to kill a lot of people because some people just need it,” said Coleman, 55, a homeless man who says he suffers from schizophrenia.

“I’m angry all the time.”

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Health care secretary Liz Dudek says she’d like to “ride out” Rick Scott’s second term posted on 12/18/14

by Christine Jordan Sexton | SaintPetersblog

Agency for Health Care Administration Secretary Elizabeth “Liz” Dudek just finished implementing a statewide mandatory managed care program for the fifth largest Medicaid program in the nation.

What does she plan to do now?

Dudek rattles off an ambitious “to do” list s that she said she’d like to accomplish in the next four years as she hopes to “ride out” Florida Gov. Rick Scott’s second term in office as agency secretary.

“After that,” Dudek says, “There are probably some other people who should be at the helm.”

In a year-end interview with Saintpetersblog in her Tallahassee office on Monday Dudek said that she’d like to make health care budgeting a little more “cut and dry” by implementing a DRG–or diagnostic related group–reimbursement system for health care services paid for by Medicaid.

Dudek said DRGs could be implemented for hospital outpatient services, nursing home care as well as reimbursement for intermediate care facilities for the developmentally disabled.

Currently Medicaid reimburses for these services using a cost-based per diem system, meaning facilities receive payments based on how much it cost them to treat the patient while in the hospital. Under DRGs, providers are paid a fixed amount based on a patient’s diagnosis. If care can be provided for less than the DRG, then it makes money. If treatment exceeds the DRG, the facilitiy loses money.

DRGs are currently used for hospital inpatient services.

Other things on Dudek’s to-do list include simplifying online licensing in the Division of Health Quality Assurance which regulates 45,000 health care facilities throughout the state and retooling the agency so staff to reflect the changes in the Medicaid program which has been set up to pay and monitor a fee for service delivery system, not a managed care system.

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Health insurance idea for low-income Floridians called “intriguing” by top Republican posted on 12/17/14

by john kennedy | Palm Beach Post

Although a business-backed plan to expand health coverage to low-income Floridians is getting a cool reception in the state House, Senate President Andy Gardiner called the proposal “intriguing” Wednesday.

A Healthy Florida Works has been laid out by business associations and hospital groups. Using private insurers to draw millions of federal dollars, the proposal is aimed at sidestepping the Legislature’s opposition to expanding Medicaid under the Affordable Care Act.

The sweeping proposal is spelled out here:

Gardiner, meeting with reporters Wednesday, gave the idea some loft.

“I think it’s intriguing,” Gardiner said.

But he repeated what has been a frequent concern raised by Republican legislators reluctant to go forward with any insurance plan that could be rejected by federal officials.

Although several states have endorsed plans that don’t really strictly on expanding Medicaid, Gardiner echoed a common complaint from Florida Republicans that the Obama administration wants an “all or nothing” Medicaid expansion.

“That still appears to be a concern,” Gardiner said.

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