News from Tallahassee for 12/20/14

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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PolitiFact's Lie of the Year is exaggerations about ebola posted on 12/16/14

by Angie Drobnic Holan, Aaron Sharockman | PolitiFact

Thomas Eric Duncan left Monrovia, Liberia, on Sept. 19, for Dallas. Eleven days later, doctors diagnosed Duncan with Ebola.

Eight days after that, he was dead.

Duncan’s case remains one of two Ebola-related fatalities in the United States, and since Duncan traveled to Dallas, more Americans -- at least nine, and likely many more -- have died from the flu.

Yet fear of the disease stretched to every corner of America this fall, stoked by exaggerated claims from politicians and pundits. They said Ebola was easy to catch, that illegal immigrants may be carrying the virus across the southern border, that it was all part of a government or corporate conspiracy.

The claims -- all wrong -- distorted the debate about a serious public health issue. Together, they earn our Lie of the Year for 2014.

PolitiFact editors choose the Lie of the Year, in part, based on how broadly a myth or falsehood infiltrates conventional thinking. In 2013, it was the promise made by President Barack Obama and other Democrats that "If you like your health care plan, you can keep it." While no singular line about Ebola matched last year’s empty rhetoric about health care, the statements together produced a dangerous and incorrect narrative.

PolitiFact and PunditFact rated 16 separate claims about Ebola as Mostly False, False or Pants on Fire on our Truth-O-Meter in 2014. Ten of those claims came in October, as Duncan’s case came to the fore and as voters went to the polls to select a new Congress.

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Florida is No. 32 in health rankings posted on 12/11/14

by AP

ORLANDO, Fla. (AP) -- A new report places Florida as the 32nd healthiest state in the nation.

The report released Wednesday by UnitedHealth Foundation says that in the past year the percentage of Floridians who smoke decreased slightly, from 17.7 percent to 16.8 percent.

The percentage of adults who binge drink also dropped, from 16.5 percent to 15.5 percent.

However, more than a quarter of Floridians are physically inactive, slightly higher than the national rate. The report also says about 1 in 12 babies in Florida are born underweight.

Hawaii was ranked the healthiest state, and Mississippi was ranked the least healthy one.

Report: Hospitals Could Lose Billions posted on 11/12/14

by staff | Health NEws Florida

A report released Monday by Florida Legal Services, a non-profit legal advocate for the poor, says hospitals that treat large numbers of patients without health insurance stand to lose billions because of the Florida Legislature’s refusal to expand Medicaid, the Miami Herald reports.

Jackson Health System in Miami-Dade County, with 160,000 people in the Medicaid gap, could lose more than $570 million a year, the Herald reports. That’s because hospitals that treat uninsured patients will soon begin to lose funding for uncompensated care under the Affordable Care Act, and without Medicaid expansion there will be no other funds to offset that cost, according to the Herald.

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Hospital Loses Appeal on Medicaid Overpayments posted on 11/7/14

by News Service of Florida

An appeals court Thursday sided with the state Agency for Health Care Administration in a dispute about whether Florida Hospital Orlando was paid too much for treating some Medicaid patients.

The agency in December issued an order requiring the hospital to repay $22,138 in Medicaid overpayments, along with a $500 fine and $7,635 in costs. That order followed a recommendation from an administrative law judge, who heard arguments about payments for the care of patients such as a 3-year-old child who had a form of leukemia and needed chemotherapy treatments, according to case records.

Florida Hospital Orlando appealed to the 1st District Court of Appeal. At least in part, it argued that AHCA's auditor improperly looked at patients' entire files to determine whether inpatient admission was a "medical necessity" -- a key factor in determining Medicaid payments, the appeals-court ruling said.

The hospital contended that the audit should have focused only on information available at the time of admission, not entire patient files. A three-judge panel agreed with the hospital about that legal issue but, nevertheless, said Florida Hospital Orlando "has not shown that AHCA and its auditor relied on hindsight information in penalizing the hospital's admission decisions.

Rather, the record supports the administrative law judge's finding adopted by AHCA that the claims were 'described and evaluated based upon the medical documentation available to the treating physician at the time the services were rendered.' "

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