May 4.
In retrospect, the 2007 Legislative Session will best be remembered for what did NOT happen. No cosmetic tax was passed despite the revenue shortfall, insurance companies did not eliminate a physician’s right to seek damages under the Prompt Pay law, and the Fabre doctrine allowing defendants to apportion damages to non-parties was not overturned. Even more importantly, efforts to gut the TIME Bill and last year's recognition of board certified plastic surgeons were quashed. The defeat of each of these proposals was critical to the FSPS' members, and our legislative staff worked hard to preserve the status quo on these issues. On a negative note, legislators did not increase Medicaid physician reimbursement, nor did they renew PIP, and an effort to secure facility fees for certified office surgery units was unsuccessful. We look forward to advocating these issues again next year.
Notwithstanding the paucity of bills actually passed, a few notable pieces of legislation are now awaiting Governor Crist’s signature. For instance, fiscal intermediaries will now be subject to Florida’s Prompt Pay law.
The combination of a new Governor, new legislators, and an unanticipated revenue shortfall made 2007 a challenging year, but some promising signs have emerged. Relationships were forged with several legislators who are committed to our cause, Armed with those relationships and the renewed commitment of its membership, the FSPS is poised to do great things in 2008.
April 27.
SB 920 (Cosmetology) just passed out of the Senate without language that would have authorized cosmetologists to expand their scope of practice to include lasers.
Score one for the good guys.
April 20.
This week saw action on some of our most significant bills, leaving much work to be done in the remaining few weeks.
On Monday the Senate Judiciary Committee passed both the Pharmacist Immunization and Fabre bills by identical 6-5 votes, with Chairman Villalobos casting the deciding vote on each issue. The first bill was amended to provide for extra physician supervision, which evidently was just enough to make it palatable to the six members who voted for it, allowing the bill to proceed to the Senate floor. On the Fabre bill, the Committee decided that it was more important to ensure that a plaintiff received his or her full damages than it was to ensure that a defendant's liability only matched their culpability. Despite the setbacks, we will continue our efforts to defeat these bad bills.
Fortunately, other news was very good. A bill aimed at making cranio-facial repairs a mandatory insurance benefit unexpectedly passed the Senate Health and Human Services Appropriations Committee and is now headed to the Senate floor. The Florida Health Information Network bill that we expected not to pass until next year cleared the House floor unanimously on Wednesday, while its Senate companion passed the Government Operations Committee and now heads to its last committee stop, the Health and Human Services Appropriations Committee. Likewise, a bill designed to allow physicians and patients to review a patient's prescription history passed the House Health Council, while its Senate companion also passed the Government Operations Committee and now awaits action in the Health and Human Services Appropriations Committee.
With all House committees having ended meetings, we may rest assured that the most significant threats to plastic surgery (i.e., further office surgery regulation and a cosmetic surgery tax) no longer pose a realistic threat of passing this Session.
Only two weeks remain in the Session, so stay tuned for more frequent updates in the final, frantic days that are to follow.
April 13.
Despite movement on several significant bills supported by Chapter, this week in the Legislature will be remembered more for what did not happen.
The Senate Judiciary Committee on Tuesday promised to be a donnybrook, as the Trial Bar and Medicine prepared to square off on the bill to eliminate the Fabre Doctrine and Medicine was attempting to beat back an attempt by pharmacists to gain the right to provide immunizations. However, both issues were tabled when the debate on whether to allow employees to bring guns to work exhausted all available time. The issues are now scheduled for a hearing next Tuesday in the same committee.
Several positive bills did advance. HB 1121, which would establish a Florida Health Information Network, advanced to Third Reading in the House, while a Senate compromise on SB 2348 passed the Health Regulation Committee and brought the Senate version closer to that of the House. Meanwhile, SB 518, which would establish a prescription database, passed the Senate Criminal Justice Committee and now heads to the Health Appropriations Committee; the House companion should be considered Tuesday in the House Health Council.
With next week being the final week for committees and councils to meet, the Legislative session truly has entered into its final, frenzied push. Stay tuned for frequent updates on our most important issues.
In other news, the amended Office Surgery Rule that would require all office surgeons to document training comparable to residency or board certification for every procedure they perform, will become effective April 18. This is a major win for the FSPS, as it again raises the required level of competence for office surgeons.
With the Session’s halfway point looming, the Florida House and Senate this week picked up the legislative pace by addressing a myriad of bills impacting the Society and its members.
In Tuesday’s action, the House Health Innovation Committee indefinitely tabled a bill (HB 1513) that would require all health care providers to give uninsured patients the benefit of their negotiated insurance discounts (a similar proposal met the same fate last week in the Senate). Likewise, the Senate Judiciary Committee, faced with vehement opposition from Medicine and its business allies, declined to consider a repeal of the Fabre doctrine (SB 1958). Unless that committee takes the highly unusual step of reconsidering the bill, physician defendants will continue to be liable only to the extent of their culpability.
Meeting later in the day, the House Health Care Council passed bills establishing a Florida Health Information Network (HB 1121) and creating a State Surgeon General whose duties will now include promotion of public health initiatives. Although the Council did not take up the controversial Pharmacist Immunization Bill (HB 543), our sources have indicated that the Council likely will hear that bill the week of April 9th.
The highly anticipated war on PIP saw its first battle this week, as the Senate Banking and Insurance Committee passed an amended SB 1880 that would renew the mandate of PIP coverage but limit physician reimbursement to 200% of the Medicare fee schedule.
March 30 -- Update / Joint & Several Liability.
The Fabre Bill (SB 1558) was temporarily postponed when sponsors realized they did not have the votes to pass it out of the senate Judiciary Committee. We publicly opposed it, and special thanks to Mutaz Habal, M.D., for appearing to testify against this bad bill.
This bill was only postponed and may well come up again. Keep an eye out for more opportunities to voice our opposition.
March 16.
This week in Tallahassee saw two serious setbacks, as the two House Committees passed out bills opposed by Organized Medicine. In the first, the House Constitution and Civil Law Committee passed HB 733, which would again make named defendants solely liable for 100% of all damages suffered by the plaintiff, regardless of the defendant's true liability. This would restore the essential unfairness of joint and several liability, and we will continue to fight it in future committees and in the Senate. Special thanks to Representatives Flores, Hukill and Mealor for voting against this bad bill. In the second, the House Health Innovation Committee passed HB 543, which would allow pharmacists to administer the full range of vaccinations. Special thanks to Representatives Frische, Homan and Porth, all of whom saw the inherent danger of this legislation. The week was not a total loss, as HB 1121, which will establish a statewide EMR platform, passed the Health Quality Committee. In the Senate, Senator Atwater amended SB 770 to include a study of the Physician Workforce, which has long been needed to combat Trial Bar claims that no physician access crisis is brewing.
In addition, Senator Bullard's SB 16,which would lead to the mandatory coverage of cranio-facial abnormalities, has advanced to the Health and Human Services Appropriations Committee.
The 2007 Legislative Session has begun....
March 8.
The first week of Session was highlighted by two pitched battles, both of which ended in draws that will require rematches in the coming weeks. On Tuesday, pharmacists and physicians crowded the House Health Innovation Committee to debate whether pharmacists should be allowed to administer the full range of vaccinations. Sensing the volatility of the issue, the chairman opted to temporarily pass the bill for at least a week. The next day physicians and trial lawyers took part in a two hour debate on whether to repeal the Fabre doctrine. Under current law, which we are attempting to retain, a defendant can ask that a portion of the damages be attributed to an unnamed defendant. The Trial Bar, on the other hand, would like only named parties to be responsible for the full amount of damages, even if the culpability of the named parties is minimal; this would restore the inequity of joint and several liability in which a defendant's liability does not necessarily match their culpability. The debate ran into overtime, meaning that the Committee's final vote will be postponed until next week.
During the week we also spent a considerable amount of time lobbying our major issues, such as increased Medicaid reimbursement, prompt payment of insurance claims, reimbursement for office surgeries, and the value of ACGME training.
February 22, 2007
Legislative Report
Late developments in the final week of pre-session meetings should cause concern for physicians. For instance, the House Republican Property Tax Relief plan is based in part upon a proposed change that would cap the growth of Medicaid revenue, which necessarily will limit physician reimbursement. Moreover, Senator Jones has filed SB 1838, which not only would reconstitute the Board of Medicine to include more consumer members, but also would require more information on professional liability actions to be posted on a physician's profile. However, progress was made on several fronts. Senate Majority Leader Daniel Webster voiced his firm opposition to last year's legislative victories. Moreover, Senator Burt Saunders continues to support the need to require ACGME residency as a prerequisite to board certification and is working with the Society staff to draft appropriate language.
Next week is an "off" week for the Legislature before the official season begins on March 6.
Legislative Update
Week Ending February 9, 2007
Christopher L. Nuland, Esq.
The past week was highlighted by some promising news on the Medicaid Reimbursement front, while storm clouds formed on several other fronts.
With regard to Medicaid, House Health Council Chair Aaron Bean intimated to us that his initial budget request would be for an additional $139 million for physician reimbursement. While not the $249 million needed to bring Medicaid reimbursement to Medicare levels, the increase would be substantial. We plan on testifying at next Tuesday’s Budget meeting on the need for increased physician reimbursement. The FSPS also secured a commitment from the Senate sponsor to "fix" a Cosmetology bill to ensure that cosmetologists would not be allowed to use lasers.
In less exciting news, the Pharmacist Immunization Bill (HB 543) will require a massive effort to defeat, despite the bill’s lack of essential patient protections such as adequate emergency equipment and training, mandatory histories and physicals, and interaction with the patient’s primary care physician. On the tort front, a bill to eliminate the Fabre Doctrine (which apportions damages to all those at fault, not just those named in the suit) has been filed by Representative Needelman (HB 733). If this bill were to pass, damages would be attributed only to named parties, allowing plaintiffs to not include more culpable (but less wealthy) co-defendants who enter into side agreements; the result would be a return to the days in which scores of doctors would be named in malpractice suits in the hope of finding one with “deep pockets” and the dismissing cases against more culpable but less wealthy defendants.
Committee weeks are scheduled until the last week of February, after which the official Session will begin after a one week hiatus.
The Week That Was…
Tallahassee Update
January 26, 2007
Christopher L. Nuland
While property insurance understandably took the headlines during the past week, the House and Senate Health Committees took the opportunity to lay the groundwork for some dramatic legislative proposals.
Society representatives met with the leaders of both the House and Senate Health Committees and discussed ways in which to facilitate the creation of a Florida Health Information Network that could serve as a platform for a statewide system of e-prescribing. Also discussed was the need for a Medicaid physician pay raise, as we noted that Medicaid pays only 57% of already-decreasing Medicare, while physician services now account for less than 5% of the overall Medicaid budget. Each committee discussed each of these issues, and it is evident that some sort of legislative proposal will be forthcoming.
Other issues, while not discussed in the committees themselves, were the subject of much lobbying and coalition building. For instance, the Trial Bar appears poised to join Medicine in opposing any attempts by the insurance industry to legislatively overturn the Westside EKG case, which gave physicians the right to sue HMOs directly for violations of the Prompt Pay law.
Over 300 bills were filed last week, many of which seek to expand the scope of practice of nurses, cosmetologists, and pharmacists. We will continue to oppose such efforts.
Next week is an off-week for the Legislature, allowing the Society’s attention to turn to the Board of Medicine, where the Surgical Care Committee will be considering amendments to the Office Surgery Rule that would tighten the training requirements of those performing Level II and III Office Surgery. Of course, we will be there again to protect the interests of our members.
Tallahassee Update
Christopher L. Nuland, Esq.
January 18, 2007
While this week may be devoted to issues pertaining to property insurance and taxes, health issues still were in play. Not only would the Senate property insurance proposal place a surcharge on all insurance policies, including medical malpractice, but all of the members of the various health care committees were in Tallahassee with plenty of time to talk about upcoming issues.
While most agree that health care issues are not likely to dominate this year, several proposals are likely. Already the nurses have re-filed their controlled substance prescribing bill, and naturopathic licensing again will be an issue of concern. Action on tort reform appears to be limited, although “loser pays” legislation may be considered, and we still will introduce a "clear and convincing" proposal. In other positive notes, it truly appears that increased physician reimbursement for Medicaid is an issue on which the legislators agree in principle and the health care leadership will consider language tying scope of practice to a physician's residency training.
As on the federal level, EMR issues will emerge, with legislators asking for ways in which physicians may be “incentivized” to invest in EMR. In a related issue, the electronic prescription database and Florida Health Information Network bills will both resurface.
Finally, it has often been said that politics make for strange bedfellows and that today’s opponent is tomorrow’s ally. In the wake of the Westside EKG case, which gives physicians an independent cause of action to enforce the Prompt Pay Statutes, the health insurance industry is likely to seek legislation nullifying that victory. We have already been lobbying against any such legislation, as has the Trial Bar, which relishes a new cause of action against managed care.
2007 promises to be another exciting legislative session
The FMA waiver form allows physicians who are members of the FMA and their county medical society to enter into an agreement with patients that caps non-economic damages at $250,000. FMA Waiver Seminars help explain legal issues and implementation processes necessary for physicians to participate.
FMA Waiver Seminars were held on: November 27 in Sarasota for the Charlotte County Medical Society, Sarasota County Medical Society, and Manatee County Medical Society; November 28 in Fort Myers for the Lee County Medical Society, Collier County Medical Society, and Hillsborough County Medical Association; and December 1 in Jacksonville for the Duval County Medical Society; and December 11 for the Seminole County Medical Society, Orange County Medical Society, and Lake-Sumter County Medical Society.
Future Waiver Seminars have been scheduled for: January 16 in Ocala for the Marion County Medical Society; January 18 in Lakeland for the Polk County Medical Association; January 30 in Volusia and Brevard County; January 31 for Indian River County Medical Society; February 1 for Palm Beach County Medical Society; February 6 in Panama City for the Bays County Medical Society; and February 15 in Miami for the Dade County Medical Association. Several other counties are currently in the process of scheduling Waiver Seminars with the FMA.
For a current listing of Waiver Seminars Click Here.
Legislative Update
This week saw the new Florida Legislature begin its 2007 season in earnest. It may only be January, but it is readily evident that the legislators and special interests already are in full gear. Each of the four health care committees held hearings, scores of bills were filed, and several trends emerged.
Overall, it appears that the 2007 Session will target property taxes and insurance as its signature projects. However, this certainly does not mean that health care issues will be ignored. Already much discussion has centered on Medicaid reform, Kidcare, and the crisis in ER staffing. With regard to the latter, legislators and the Florida Hospital Association agree that reimbursement, liability, and lifestyle concerns all must be addressed if physicians are to return voluntarily to emergency room duty. With regard to Medicaid, there was a consensus that physician reimbursement needs to be increased, as it is illogical that physicians are the most vital part of any health care delivery system, yet account for less that five percent of the current Medicaid budget.
Challenges also have arisen. Senator Dennis Jones today made it apparent that he once again will target physician financial responsibility, and Senator Saunders has once again filed his ARNP prescribing bill.
2007 promises to be another exciting year full of challenges and opportunities that we are well prepared to face.