News from Tallahassee for 9/30/14

Tougher Compounding Rules Finally Law posted on 9/30/14

by MARY SHEDDEN | Health News Florida

Stricter regulations in the state’s compounding pharmacy industry take effect Wednesday -- two years after a national outbreak of fungal meningitis killed 64 people, including seven in Florida.

In 2012, when the New England Compounding Center outbreak happened, the state had hundreds of unregulated, non-resident facilities providing these specialized medications to Floridians. Now, the state will require permits for any pharmacies outside state boundaries that want to ship medications in state.

Efforts to tighten oversight over compounding pharmacies started soon after contamination drugs were discovered in 2012, and state officials found more than two dozen of the 751 people infected by tainted steroid injections lived in Florida.

Eight clinics, in Ocala, Pensacola, Miami, Palm Beach Gardens and Orlando, received lots of the contaminated drug, according to a Centers for Disease Control and Prevention investigation. A total of 25 Floridians were infected and sickened, seven of whom died.

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Damages Reduced in Kickbacks Case posted on 9/19/14

by Carol Gentry | Health News Florida

A federal judge has reduced the punitive damages that a Tampa jury imposed in June on national drug-testing firm Millennium Laboratories after finding that it engaged in unfair competition by breaking anti-kickback laws in Florida and two other states.

But Millennium Labs, based in San Diego, still owes more than $11 million to its rival Ameritox Ltd. after the reduction. In Friday's 29-page order, U.S. District Judge Susan Bucklew called Millennium's conduct "fairly reprehensible."

She denied Millenium's request for a new trial or a set-aside of damages. She did, however, reduce punitive damages by $3.5 million to $8.5 million -- which are in addition to actual damages of $2.7 million.

As Health News Florida reported in June, the jury decided that Millennium Labs gave doctors an illegal inducement -- a kickback -- when it offered them plastic urine-specimen cups with test strips built into them, at no charge. As Millennium had hoped, many of the doctors who had been using Ameritox Ltd. for the lucrative confirmatory follow-up tests switched to Millennium. The cups cost Millennium just $5 apiece.

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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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Scientology-related Narconon rehab center may have violated law posted on 8/26/14

by Joe Childs | Tampa Bay Times

When the Scientology-affiliated Narconon drug treatment center in Spring Hill was told by Hernando County it could not expand its residential facility, the center didn't try to make do with existing space.

Its officers rented three properties elsewhere in Spring Hill and expanded there. That allowed the center to admit more patients. Narconon charges up to $30,000 for a three-month stay.

One site was in a commercial center. Narconon shuttled patients there for what director Tammy Strickling described as "daily therapeutic classes.'' The other two sites were houses. One slept eight, the other six. Narconon staffers, trainees and overflow patients bunked there.

"I don't like turning anyone away,'' Strickling said in court last year.

But all three rented locations may have violated state law.

Substance abuse treatment centers in Florida are required to deliver services only at licensed facilities. Since Narconon opened in 2008, it had been licensed by the state Department of Children and Families to provide services at one place, 8213 Cessna Drive.

"My mouth is hanging open,'' said Department of Children and Families licensure specialist Troy McDermott, when told of the rented sites. In his 21 years at DCF, he never has encountered a center providing services at unlicensed facilities, he said.

Penalties can range from a moratorium on patient admissions to loss of license.

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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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