Legislative Wrap-Up

Legislative Wrap-Up


Medical Industry Experts Weigh-In on What Happened During this Year’s Florida Legislative Session


The Florida Medical Association (FMA) continued its fight during this year’s Legislative Session against efforts to expand practice rights for nurse practitioners, optometrists, pharmacists, and physician assistants in a session where, for the most part, health care took a back seat.

“The best part of this session is nothing good happened and nothing bad happened,” says Dr. Michael Patete, the Venice ear, nose, and throat physician who chairs the FMA PAC Executive Committee.

For the third year, “most of the substantive health care legislation got caught up in the political dynamics of the two legislative chambers,” the FMA’s 2017 Legislative Session Report says.

Chris Nuland, a lobbyist and Jacksonville attorney, agrees the reason it was difficult to pass laws in the last few weeks of the session was because of differing personalities and goals.  “Another reason has been an increasing pressure to create legislative trains,” he says.  “Bills aren’t designed anymore to go through the process and be passed . . . on their merits.”  Instead, he asserts that they are made to piggyback on other bills.  Nuland represents physician associations, including the American College of Physicians, the Florida Society of Plastic Surgeons, the Florida Public Health Association, the Florida Neurosurgical Society, the Florida Gastroenterologic Society, and the Florida Society of Thoracic and Cardiovascular Surgeons.

In its report, the FMA, which tracked 241 bills, highlights a 185-page bill designed give independent practice rights to Advanced Registered Nurse Practitioners (ARNPs).  It was sponsored by state Rep. Cary Pigman, R-Sebring and Okeechobee, an emergency medicine physician.  “A Senate companion was never filed, but the FMA continued to fight HB 7011 as it moved through the House committees,” the report notes.  The legislature agreed last year to allow ARNPs to prescribe controlled substances, with limitations and safeguards.

Dr. Sergio Seoane, president of the Polk County Medical Association, is glad the bill didn’t progress.  “A graduate degree, which takes 12 to 24 months to complete does not compare with four years of medical school and three to six years of postgraduate medical education,” he points out.  “We played very good defense,” adds Nuland, who has been battling to safeguard physician practice rights from encroachment for some 20 years.

An optometry bill would have allowed optometrists to perform laser and non-laser surgery on the eyes, as well as prescribe Schedule II controlled substances.  Nuland maintains that this bill presented more than a convolution between optometrists and ophthalmologists’ practice rights.  “It would have allowed optometrists to perform plastic surgery around the eyes,” he explains.

Another proposed bill “would have allowed pharmacists to order and evaluate laboratory and clinical tests; administer medications; initiate, modify or discontinue medications; and diagnose and treat influenza,” the FMA report notes.  “The pharmacist bill would have given the right to diagnose and to make differential diagnoses,” Nuland says.  “They said that’s not what they intended, but that’s what the bill said.”

Offering insight to the flip side of that coin is Michael Jackson, the executive vice president and chief executive officer of the Florida Pharmacy Association.  He conveys that in institutional settings, pharmacists already may be providing these services.  “What they’re doing now is not articulated in our practice act,” says the Tallahassee pharmacist.  “The intent here is to try to expedite patient care . . . There isn’t an adequate supply of healthcare providers.”

FMA also worked against bills to allow ARNPs and PAs to be medical directors and to “create a backdoor route for CRNAs [Certified Registered Nurse Anesthetists] to obtain an independent practice by allowing their protocols to be ‘in collaboration’ with a physician instead of under a physician’s supervision,” the report continues.

Florida will face a critical shortage of doctors through 2025 unless more residency training positions are created, according to a Teaching Hospital Council of Florida and the Safety Net Hospital Alliance of Florida study.  That 2015 study projected shortages could climb to 7,000 physician specialists in 19 areas, the bulk of them in psychiatry, general surgery, rheumatology, and thoracic surgery.

The legislature approved a permanent exemption from emergency assessments on medical malpractice premiums, effective June 23.  “That’s a huge help for even the employers of physicians.  They won’t ever see that increase,” Dr. Patete says.

Last year the legislature extended the expiration date for medical malpractice premium exemptions from emergency assessments for the Florida Hurricane Catastrophe Fund. “This year, SB 454 by Sen. Jeff Brandes and HB 359 by Rep. David Santiago repealed the sunset provision,” the report says.

“Having the catastrophic fund exemption for medical malpractice insurance will keep premiums from becoming more unstable,” Dr. Seoane says.  “If physicians are forced to pay an additional fee into the catastrophic fund, the result will be more physicians would choose to be self-insured.  And this would destabilize the medical liability insurance market.”

The tax, which could amount to $15,000 for some specialists, would be an “undue burden,” he adds.

The legislature unanimously passed a Board of Medicine rule proposed by FMA allowing physicians to administer controlled substances in a Level I Office Surgery setting.  When benzodiazepines or opiates are utilized, Flumazenil and Nalaxone must be in stock as antidotes.  “That’s going to allow a little bit more to be done in the office,” explains Nuland. “By having the several agents there, we actually improve safety.”  The treatment is for insomnia, anxiety or pain, according to the report.

FMA officials were hoping for insurance reform to protect patients and physicians from being denied insurance coverage or payment after services are provided.  “It hurts the physicians in the state a lot,” Dr. Patete says.  “We’re going to go back at it next year.”

The session “will be remembered as much for the legislation that didn’t pass as for the legislation that did,” according to the FMA.  “This was the least active session in terms of the number of bills passed since the Republicans gained control of the statehouse in the mid-1990s,” the report notes.  “While 3,131 bills were introduced this year, only a handful was approved by both the House and Senate.”



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