Legislative and News Updates

The Governor’s Executive Order applies to all physicians performing any procedure in a hospital, ambulatory surgical center, office surgery center, or in their office. The Executive Order prohibits physicians from “providing any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

According to the Department of Health, this order prohibits ANY medically unnecessary, non-urgent or non-emergency procedure performed in a physician’s office, not just those procedures that consume essential resources (such as personal protective equipment).

A “procedure” is any medical treatment or operation, including, but not limited to, injections, ablations, laser procedures, physical therapy, cosmetic procedures, allergy shots, etc.

The provision of in-person medical treatment of any nature is a “procedure” and thus must be postponed if doing so does not place the patient’s immediate health, safety or well-being at risk or will not contribute to the worsening of a serious or life-threatening medical condition.

Physicians can continue to see patients for purposes of evaluation and management, including the performance of a physical examination, in order to determine if they have a medical condition that needs immediate attention. Physicians, to the extent possible, should use telemedicine services to pre-screen patients so that those with clearly non-emergency conditions do not have to come to the office for evaluation. Telemedicine, as previously stated, can continue unabated.

Further clarification from the Department of Health does not appear to be forthcoming. The Department currently will only state that:

“While some specific examples of which procedures should be postponed are also contained within Executive Order 20-72, licensed health care practitioners are tasked with exercising reasonable and appropriate professional judgment in evaluating their patients’ specific circumstances, overall health, and the medical necessity of any procedures performed. Therefore, the Executive Order explicitly leaves discretion on proceeding with procedures to the medical professional, based on his or her expertise and the specific factual situation of each patient. Only the medical professional can make that determination.”

Based on this limited direction then, each physician will have to make a judgment call on whether a particular procedure is necessary to avoid putting the patient’s immediate health, safety or well-being at risk or whether delaying such procedure will contribute to the worsening of a serious or life-threatening medical condition. If the physician determines that an interventional pain procedure, ongoing course of treatment, diagnostic test, etc. is necessary under the parameters set forth above, then the physician can perform the procedure. If the physician determines that the procedure can be safely delayed, the procedure should not be done.

Guidelines for Cutaneous Oncology Cases

Led by House Speaker Jose Oliva, Scope of Practice bills dominated the 2020 Florida Legislative Session. Bills were filed that would have allowed Nurse Practitioners and Physician Assistants to practice independently, as well as allow pharmacists to practice primary care. Despite our fierce opposition, these proposals were passed in modified form, although our efforts did reduce the impact of this legislation.

For instance, while the initial legislation would have placed Nurse Practitioners and Physician Assistants on an equal footing with physicians, the final product only allows Nurse Practitioners to practice primary care without the supervision of a physician (any surgery would be limited to subcutaneous tissue), and then only if they meet additional training and experience requirements. The Pharmacy bills were modified to a lesser degree, and pharmacists will be allowed to test and treat for influenza, strep throat, and several other minor conditions so long as they have a physician protocol similar to that currently required of APRNs. While signed by the Governor, these initiatives both will require extensive rule making, so implementation will be delayed considerably.

Despite the Scope of Practice defeats, we were successful in many other areas. For instance, we defeated a proposal that would mandate e-prescribing (with no exceptions), as well a bill that would have required all practice mergers to be submitted to the Attorney General for approval. Likewise, we defeated a PIP proposal that would have eliminated the “physician set-aside” for such auto-accident cases.

As this year proves, advocacy cannot be measured simply in wins and losses, but must be measured by our ability to “move the needle.” While we certainly suffered legislative losses, thanks to the efforts of our staff and members, we were successful in averting the worst legislation, and we will come back next year with a renewed sense of purpose.

February 29, 2020

With only fourteen days left in the Legislative Session, 2020 is likely to be remembered as the year that the Florida Legislature declared war on Medicine. Just this week, the House of Representatives moved measures to the Floor that would grant independent practice to APRNs and PAs (actually, they passed it twice, in HB 607 and HB 7053) and allow pharmacists to test and treat for a variety of chronic health conditions (HB 389 and HB 599). These moves were in addition to passing legislation, which now moves to the Senate, that would mandate electronic prescribing of all prescriptions (even if the physician does not have an electronic medical record system), require Attorney General approval of most physician mergers, and shorten the time frames in which physicians must produce medical records.

For years, the Senate has been the firewall against such Anti-Physician legislation, but that wall has crumbled in recent weeks. Just this week, the Senate moved to the Floor legislation that would allow pharmacists to test and treat for the flu (SB 714), and an Independent Practice Bill (SB 1676) and expanded Pharmacist Scope (SB 1094) are only a single committee stop away from a full floor vote. While the current Senate versions of each of these bills is far superior than the House counterparts, the fact that each is likely to pass raises the likelihood that a deal will be worked out in all such issues, with the House taking the lead on the discussions.

The actions of the House are now a foregone conclusion, but we still have some support in the Senate. If you care about these issues, NOW is the time to contact your Senator by going to www.flsenate.gov to contact their Senator and ask them to vote NO on these Scope Expansion Bills.