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Florida hospital leaders are frustrated that the Florida Legislature did not reach an agreement on the continuation of Personal Injury Protection (PIP) insurance during its regular session.

The hospital community is asking the legislative leadership and Gov. Charlie Crist to add PIP to the June special session — a tall order since the session is dedicated to property tax insurance, the legislature's dominant issue this year.

"On Oct. 1, when PIP is scheduled to sunset, the 20 percent of Floridians under the age of 65 who do not have health insurance will be left with no coverage when they get behind the wheel of their car," said Wayne NeSmith, president of the Florida Hospital Association (FHA).

A membership survey conducted by FHA found that hospitals and health insurers could potentially foot a bill of $350 million in lost revenues, since 40 percent of motor vehicle crash victims had no other form of health insurance coverage.

"The result of this legislative inaction will shift uncompensated costs to Florida's hospitals and directly impact health insurance premiums by tens of millions of dollars," NeSmith stressed. "The seriousness of this issue cannot be ignored. Some hospitals may have to reconsider whether they can continue to operate their trauma centers."

A countdown to the sunset of PIP began during the final week of the regular session with "ample time" to address the issue, according to hospital leaders. Hospital employees sent more than 100,000 emails asking lawmakers to support the continuation of PIP or replace it with alternative coverage.

Hospital leaders will be convening via conference call to discuss the expected impact the loss of PIP will have on hospital services and what future actions can be taken to mitigate the grave impact on communities across Florida, added Rich Rassmusen, FHA's vice president of strategic communications.

"FHA has consistently advocated for the continuation of PIP or an acceptable (substitute)," Rasmussen noted. "Last year alone, Florida's hospitals provided more than $2 billion in free care to Florida's uninsured and treated more than 115,000 patients injured in motor vehicle crashes."

No hit to LIP
In the nick of time, however, the Senate and House were able to iron out their differences regarding continued state investment in the state's Low Income Pool (LIP), which provides special Medicaid payments to hospitals.

Congress agreed to fund LIP with an appropriation of $81 million. This state investment will be added to the more than $723 million in local tax support that is used to draw down more than $1.1 billion in federal funds. LIP is funded by a combination of local, state, and federal funds, providing more than $1.8 billion to provide services to the uninsured and underinsured.

"LIP is a critical component that assists hospitals in funding the more than $2 billion for uninsured patients served annually," NeSmith said. "We believe Congress recognized the tremendous contribution hospitals make in providing care to (this) growing population."
LIP funds are used to provide additional Medicaid payments for hospitals that meet selected criteria developed by the statutorily created LIP Council, made up of representatives from counties, taxing authorities and hospitals. Loss of LIP funding would have cost Florida hospitals an estimated $4.6 billion throughout the next five years.

"With LIP fully funded, we can now focus on the continuation of PIP in an attempt to avoid a $350 million cost shift to hospitals and health insurers," NeSmith concluded.

Medicaid stays the same
Despite intense lobbying by the Florida Medical Association (FMA), county medical societies, specialty societies and key legislators, Congress denied an increase in Medicaid funding for physician reimbursements, due to what they say is an unprecedented budget shortfall.

Florida physicians are reimbursed at one of the lowest rates in the country. Currently, they receive less than five percent of the Medicaid budget and only 56 percent of the Medicare reimbursement rate.

"The legislature did acknowledge that this was a big concern for doctors. Senate president Ken Pruitt and his chief aid even went over the budget numbers personally with the FMA," said Orange County Medical Society president Dr. Connie Micklavzina. "Unfortunately, each year, there's some 'big issue' that takes precedence. This year it was property taxes that dwarfed the Medicaid issue. It's unfortunate, since healthcare is just as important."

It takes time to push a bill through the Legislature. Each bill must muscle its way through several committees and be heard on both the Senate and House floor. "If the Legislature's time is occupied by another issue, there's not much time left to address others," Micklavzina continued. "Obtaining Medicaid funding is complicated. I don't think the legislature has a bad heart. They just didn't have the time this year. However, that doesn't solve the problem."

Francie Plendl, vice president of government relations for the FMA, agreed that time was the ultimate factor, and expects the issue to be a top priority in 2008. "We did get our point across that an increase is long overdue," she said. "We expect both House and Senate leadership to work on this issue next year."

Scope of practice
The FMA did win a partial battle, helping to scale down a scope of practice bill that would have allowed pharmacists to provide all immunizations. The bill was reduced from administration of all vaccines/immunizations to only influenza vaccines, or "flu shots."
Micklavzina — who worked as a full-time, registered pharmacist before becoming an ob-gyn, and whose husband currently is a full-time pharmacist — has strong, personal opinions on the subject.

"The training pharmacists receive in school is not adequate to give shots. They have no nursing skills; no skills in resuscitation or emergency medicine," she stressed. "Pharmacists in busy outlets such as Wal-Mart and CVS are filling prescriptions every three minutes. They have no time to stop and assess a patient or perform and evaluation. What if someone has an allergic reaction and goes into anaphylactic shock?"

"Like my husband says," she added, "'I never touched a patient in pharmacy school, and I don't want to start touching them now.'"
Micklavzina believes the issue is simply a "marketing plan" by the slower, smaller pharmacies (such as those in Publix) to increase business and draw potential shoppers into the store.

Other issues
Legislation was passed requiring the collection of physician workforce data by the Department of Health in order to assess the negative impact on Florida's physician workforce due to the medical liability crisis and inadequate reimbursement levels. The data will also be used for medical education planning.

Also passed was a bill that waives the licensure renewal fee (a savings of about $400) to up to 10,000 MDs and DOs who exclusively use electronic prescribing systems.

And in the last bill taken up by the legislature, the medical community successfully thwarted a new assessment on Florida physicians by extending an exemption in current law set to expire in May. If passed, all physicians in Florida who carry medical liability insurance would have been susceptible to assessments as high as 7 percent to bolster the state's hurricane catastrophe fund.


June 2007

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