News from Tallahassee for 4/23/14

Physician Assistant Bill Passes posted on 4/23/14

by AP

Florida physicians would be allowed to double the number of certified medical assistants under their supervision under legislation (HB 1275that passed the House.

The bill would allow most doctors to supervise eight assistants instead of four. The measure passed 100 to 19.

The measure excludes assistants working for doctors at a dermatological service other than their primary practice location, where the maximum number remains four.

Health Bill 'Train' on Its Way posted on 4/11/14

by Carol Gentry | Health News Florida

The Florida House Health & Human Services Committee passed a megabill Thursday morning that combines three prickly issues, in the hope that packaging them will make it harder for the Senate to kill or maim any of them.

HB 7113 would protect private for-profit trauma centers, allow for independent practice for nurse practitioners and allow out-of-state doctors to participate in telehealth without a Florida license. The Florida Medical Association opposes the latter two.

Such a package is sometimes called a "train" in legislative parlance. The idea of a train is that it's a bunch of connected railcars, and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers have to accept a proposal they don't like in order to get one they really want. One of the creators of the telehealth legislation acknowledged as much.

"It was not my choice for all these things to be in the same bill," said Rep. Mia Jones, D-Jacksonville. "We're going to take some good and some bad and move forward."

A few minutes later, the process was replayed as another combo bill rolled out of the committee. HB 573 heightens oversight of assisted-living centers, allows visitation for grandparents, and enables outpatient surgery centers to expand their services as "recovery care" centers.

The first two parts of that combo brought no opposition to speak of. Disagreement was saved for the third, as both hospitals and nursing homes foresee the loss of some paying patients.

But their lobbyists didn't get to say much. HHS Committee Chairman Richard Corcoran, R-Land O'Lakes, limited public testimony to one minute per speaker, saying the committee had a lot to cover during this, its last meeting.

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Controversial abortion bill moves forward posted on 4/9/14

by News Service of Florida

TALLAHASSEE — Florida lawmakers are moving forward with a controversial proposal that would place additional restrictions on abortions, largely barring the procedures if doctors determine that fetuses have reached viability.

The House is expected to take up its version of the proposal (HB 1047) Wednesday, while the Senate Judiciary Committee approved the Senate version (SB 918) on Tuesday in a party-line vote.

Under current law, abortions in most cases are barred during the third trimester of pregnancy. But the bills would require that physicians conduct examinations before performing abortions to determine if fetuses are viable. If viability is reached, abortions would generally not be allowed — a change that the bills' supporters say could prevent abortions around the 20th week of pregnancy.

The supporters point to medical advances that have enabled premature babies to survive more often. Florida law places the third trimester as the time after the 24th week of pregnancy.

"Because of medical advances, there are babies that are being born at 20, 21, 19 weeks," said Senate sponsor Anitere Flores, R-Miami.

But the proposed restrictions drew intense debate Tuesday, with Sen. Arthenia Joyner, D-Tampa, saying the legislation "ties the hands" of physicians.

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Medicare Pays FL Doctor $21M posted on 4/9/14


Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One West Palm Beach ophthalmologist got nearly $21 million.

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million.

AP's analysis found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud. Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.

Melgen, the top-paid physician in 2012, has already come under scrutiny. In addition to allowing the use of his jet, the eye specialist was the top political donor for Menendez as the New Jersey Democrat sought re-election to the Senate that year.

Menendez's relationship with Melgen prompted Senate Ethics and Justice Department investigations. Menendez reimbursed Melgen more than $70,000 for plane trips.

The issue exploded in late January 2013, after the FBI conducted a search of Melgen's West Palm Beach offices. Agents carted away evidence, but law enforcement officials have refused to say why. Authorities declined to comment on the open investigation.

AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it's working on that recommendation.

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Obama Administration Retreats On Private Medicare Rate Cuts posted on 4/8/14

by Jay Hancock | Kaiser Health News

Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.

After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent.

America's Health Insurance Plans, the main industry lobby, said it was still studying the announcement. While it acknowledged that Monday's action leaves payments higher than what HHS had originally proposed, it disputed the agency's statement that 2015 rates would rise. AHIP had calculated the originally proposed cuts to be nearly 6 percent, not 1.9 percent.

Adjustments to the February proposals "will help mitigate the impact on seniors," AHIP CEO Karen Ignagni said in a statement. "But the Medicare Advantage program is still facing a reduction in payment rates next year..."

Ana Gupte, an industry analyst for Leerink Partners, agreed, saying the rates disclosed Monday will cut Medicare Advantage payments by about 3 percent. Still, that's a smaller reduction than what she calculated to be 5.5 percent in HHS's first proposal, she said in a note to clients.

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought...

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought.

"The industry asked us to use whatever means we could to keep the rates close to parity, to where they are today," Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, told reporters. The rates set Monday are "a little higher than what the industry had recommended," Blum said.

Among other alterations, HHS dropped a plan to abandon the use of home-visit diagnoses for assigning member risk scores that affect payments. That proposal alone would have shaved 2 percentage points off what Medicare Advantage plans get from the government, according to a study commissioned by AHIP.

"There's a little bit for everybody" in the final policy for 2015, said Anne Hance, a lawyer with McDermott Will & Emery who represents insurers. The administration "tried to work with Medicare Advantage organizations and recognize their concerns," she said.

Medicare Advantage costs taxpayers about 6 percent more per beneficiary than traditional Medicare, according to the Medicare Advisory Commission. Reducing or eliminating that gap could save the program billions of dollars, proponents say.

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