Hospital reforms to benefit patients among the priorities to pass in House votes

Hospitals would have to provide infection rate information to patients and be required to inform them if they’ve been placed on observation status rather than admitted outright, under a handful of bills that cleared the Florida House Wednesday.

The proposals, some of Speaker José Oliva’s healthcare priorities, are among those that are starting to clear the chamber as lawmakers prepare to shift from policy-making into negotiating over the state’s mammoth budget for the next fiscal year.

Lawmakers voted 101-10 for HB 319, which would require hospitals to provide quality measures like hospital-acquired infection rates or rates of readmission within 15 days to patients upon request. The bill would also require facilities to collect data on patient safety measures and submit it to the state Agency for Health Care Administration.

They also voted, unanimously, for HB 813, which would require hospitals to notify patients if they are placed on observation status rather than admitted outright, and to record that notification in a patient’s medical records.

A third Oliva priority to expand direct healthcare agreements beyond primary care services also cleared the House Wednesday — though some Democrats, including Rep. Evan Jenne, D-Dania Beach, unsuccessfully sought to amend the legislation to prohibit employers from being able to sign up on behalf of an employee or set restrictions on when a provider can terminate such agreements. HB 7, which passed 90-24, would expand such patient-provider contracts, in which a patient directly pays a provider a fee for services, to providers like dentists, in addition to nurses, doctors, chiropractors or group practices.

The move to check some of the Miami Lakes Republican’s smaller legislative wish-list items comes as leaders approve each chamber’s proposed take on the state budget, which they first sketched out in subcommittees last week. The most significant healthcare budget disagreement between the House and the Senate so far lies in how the state reimburses hospitals for Medicaid care.

In question is about $318 million in additional payments that currently go to about two dozen hospitals that serve a patient population that is at least 25 percent covered by Medicaid.

House Republicans are proposing trimming hospital Medicaid reimbursement spending evenly by about $110 million, with a 3 percent cut to both inpatient and outpatient reimbursements regardless of the facility’s percentage of Medicaid patients. The Senate, as it did last year, is instead proposing changing the tiers of reimbursements that determine what is allocated to hospitals.

The Senate plan would move additional Medicaid payments in what safety-net hospitals are calling a “critical care fund” into the base rates paid to all hospitals. The state gives each hospital a base rate but adds additional Medicaid payments, or automatic rate enhancements, to a class of about two dozen hospitals that see the highest percentage of Medicaid patients in the state.

That means that the reshuffling would largely affect those hospitals that currently access higher reimbursement rates, disproportionately safety-net facilities that are among the largest in the state.

According to an analysis from the Safety Net Hospital Alliance of Florida discussed among Senate Democrats Wednesday, Jackson Memorial, Miami-Dade’s signature public hospital, could lose more than $58.7 million in Medicaid reimbursements under the Florida Senate’s proposed budget for next year. It would lose about $7.3 million under the House’s cuts. Nicklaus Children’s Hospital would lose almost $3.1 million under the Senate plan, though it would lose nearly $5.2 million more in the House.

Tampa General under the Senate plan would lose $13.7 million in reimbursements, though it would only lose $3.7 million should the House plan prevail.

Broward General would lose $15.2 million under the Senate plan, versus $2.4 million with the House, and Memorial Regional would face an $11.1 million cut with the Senate compared to nearly $3.8 million under the House plan.

Improvements under the Senate plan, according to the analysis, would largely be borne by smaller hospitals with a smaller fraction of Medicaid patients, including for-profit hospitals that stood to gain when the Senate unsuccessfully proposed a similar change last year.

Sen. Aaron Bean, R-Fernandina Beach, who chairs the Senate’s healthcare budget committee, had said when the proposal was rolled out last week that reshuffling the reimbursement rates would ensure “money follows the patient” and more evenly compensate facilities for Medicaid care.

But in a statement, Justin Senior, the alliance’s CEO, cast the change as a blow to the facilities that disproportionately provide the most complex care to vulnerable patients, and said they were working to convince the House to reconsider the $111 million cut and sway the Senate to not change the existing reimbursement structure.

“This funding is vital to treat Medicaid’s most critical patients and ensures world-class care for the sickest and most vulnerable newborns, children, parents, and disabled adults in the state,” Senior said, citing critical care that he said is disproportionately done by such facilities. “Medicaid dollars should follow those patients who need the most complex care, like neonatal intensive care, pediatric cancer treatments, pediatric transplants and pediatric burn care.”

This story was originally published March 27, 2019 at 7:11 PM.