News from Tallahassee for 9/19/14

Taking children to the wrong trauma center can be a deadly mistake posted on 9/12/14

by Kris Hundley and Alexandra Zayas | Tampa Bay Times

One April evening two years ago, 9-year-old Justin Davis dashed into a busy Jacksonville street, headed to a convenience store for snacks.

When paramedics arrived minutes later, they found the boy lying on the road, unconscious. The impact of a car had fractured his skull and his brain was swelling and bleeding.

Paramedics knew they had to act fast.

Instead of taking Justin to the pediatric trauma center 13 miles away — the only place in Jacksonville equipped to handle his injuries — they drove him in the opposite direction, to a new adult trauma center a few miles closer.

If they thought they were saving time, they were wrong.

Doctors there couldn't treat Justin's brain injuries. They called for a helicopter to take the boy back across town to the pediatric trauma center.

It wound up taking more than 80 minutes to get the boy to specialists who had been less than 20 minutes from the scene of his accident.

Justin never woke up.

Under Florida guidelines, children who suffer traumatic injuries are supposed to go straight to a trauma center that specializes in pediatric care. Studies show that gives them the best chance of survival.

But dozens of children each year aren't getting that chance, a Tampa Bay Times investigation has found. Instead, paramedics are taking them to adult trauma centers that may be closer but aren't equipped to help them.

This is an unintended consequence of the recent expansion of Florida's trauma system.

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Sarasota Memorial Hospital considers offering trauma care posted on 9/11/14

by BARBARA PETERS SMITH | Herald-Tribune

During four years of a costly statewide legal conflict among hospitals over the right to treat trauma patients, Sarasota Memorial Hospital's leaders quietly watched from the sidelines.

Now that the dust has settled, they are considering a leap into this competitive — and crowded — arena.

Sarasota Memorial's board has been discussing the idea of applying to become a state-approved Level II trauma center. If it opts to move forward, the public hospital will directly compete with Bradenton's Blake Medical Center when it comes to treating the region's most critical and life-threatening injuries — mostly from traffic accidents, gun violence or head wounds.

Pivotal to Sarasota Memorial's decision is a recent rule change by the state agency that approves new trauma centers, which allocates two possible sites for the region that includes Sarasota, Manatee and DeSoto counties.

Blake — owned by the for-profit HCA health care chain — has occupied one of those spots since November 2011. The other is apparently up for grabs.

Sarasota Memorial CEO David Verinder said Tuesday that he is consulting with the hospital's medical staff before proceeding. The possibility of trauma center status is something the hospital has regularly reviewed, he added.

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Health Care Spending Pace May Speed Up posted on 9/4/14

by AP

The nation's respite from troublesome health care inflation is ending, the government said Wednesday in a report that renews a crucial budget challenge for lawmakers, taxpayers, businesses and patients.

Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend, according to the report published online by the journal Health Affairs.

Projections by nonpartisan experts with the Health and Human Services department indicate the pace of health care spending will pick up starting this year and beyond. The introduction of expensive new drugs for the liver-wasting disease hepatitis C also contributes to the speed-up in the short run.

The report from the Office of the Actuary projects that spending will grow by an average of 6 percent a year from 2015-2023. That's a notable acceleration after five consecutive years, through 2013, of annual growth below 4 percent.

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Florida HCA hospital charged exorbitant fees for scans, X-rays, lawsuit claims posted on 9/4/14

by Keith Morelli | Tampa Bay Tribune

TAMPA — A pair of unrelated car wrecks in South Florida last year has resulted in what may be a far-reaching lawsuit filed in Tampa. The suit accuses a holding company that owns 80 hospitals across the state, including several in the Tampa area, of grossly overcharging for medical services.

According to the suit, JFK Medical Center and its owner, HCA Holdings, charged exorbitant fees for emergency room radiological services. The overcharges sapped the Personal Injury Protection coverage limits of the patients and left them with thousands of dollars of uncovered bills they had to pay out of their pockets, the suit says.

The four-count, 38-page lawsuit was filed in Hillsborough County Circuit Court and seeks class-action certification.

Theodore J. Leopold, a lawyer with the Palm Beach Gardens-based law firm of Cohen Milstein Sellers & Toll that filed the lawsuit, said HCA hospitals gouged patients with PIP coverage and the insurance companies that offer it.

“We estimate overcharges or up-charges can be from 400 to 700 percent,” he said. “And the patient has no money left over for the rest of their care.”

HCA’s local list of hospitals include Brandon Regional Hospital, Memorial Hospital and Town & Country Hospital, St. Petersburg General Hospital and Regional Medical Center Bayonet Point.

The lawsuit does not mention any medical facility except the JFK Medical Center in Atlantis, a few miles south of West Palm Beach. Attorneys filing the action say their clients, two women who were in unrelated traffic accidents in April and May 2013, were victims of “unreasonable, unconscionable and unlawful pricing and billing practices.”

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Pediatricians in Florida could see relief from low Medicaid payments posted on 8/19/14

by Nick Madigan | Miami Herald

caduceusAfter years of hearings and delays, the possible resolution this fall of a class-action lawsuit against Florida health and child-welfare officials could mean that physicans will at last receive what they consider to be adequate compensation for treating children of the poor.

The lawsuit, filed in 2005 by pediatricians, dentists and nine children against the Agency for Health Care Administration, the Department of Children and Families and the Department of Health, claimed that Florida violated federal law by providing inadequate Medicaid services to children, and that their care had been hampered by low Medicaid payments to doctors. A federal judge is expected to rule on the case in October.

Medicaid payments to pediatricians — and to primary-care doctors in general — were bumped up for two years by the Affordable Care Act. But that will end Dec. 31, and the Florida Legislature’s passage of $3.4 million in increased Medicaid payments to pediatricians for the coming fiscal year doesn’t come close to achieving parity with federal Medicare levels for comparable services.

If the lawsuit goes the plaintiffs’ way, the state might have to come up with about $227 million a year, according to AHCA, to permanently increase payment rates to pediatricians and dentists — although an appeal would likely delay the change.

That leaves some physicians in Florida in a state of limbo, not knowing how much they will be paid or when.

“I can’t be playing games with the government,” said Bruce Eisenberg, a Miami Beach pediatrician who, like many doctors in Florida, reduced his Medicaid caseload over the years to less than 10 percent of his practice because of the traditionally low payments. He and other physicians say they usually operate at a loss when they treat patients under Medicaid.

“I sort of do it as a service to the community,” said Eisenberg, who has been a pediatrician for 25 years. Before the ACA hikes went into effect, he said, Medicaid rates paid to Florida doctors for most procedures were about half as much as those set by Medicare, the federal health insurance program for people aged 65 or older. Many physicians have elected to stay out of the system altogether, leaving low-income families with little option but to turn to emergency rooms or urgent-care clinics when they are ill.

If the payment rates are not permanently improved, “I definitely won’t be increasing my percentage of Medicaid patients,” Eisenberg said. “I could be seeing a lot of other patients who could be paying fairly for my time. My time is valuable.”

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