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April 28, 2008

Good Morning,

This is the last week of the 2008 Legislative Session. While it has been a long and exhausting seven weeks thus far, I am pleased to report that the FMA's top legislative priority is poised to pass. On Friday, our Managed Care bill SB1012, sponsored by Senator Don Gaetz and Representative Bill Galvano, and co-sponsored by several more, passed the Florida Senate with an unanimous vote of 38-0. The House went on to adopt the Senate's version and today, SB 1012 is scheduled for it's final reading in the House. This hard-fought legislation will significantly improve your ability to practice medicine and level the playing field between physicians and insurers.

Not surprisingly, such common sense efforts to help physicians have been vigorously opposed by the insurance industry and its lobbyists. Thankfully, the FMA has a seasoned and talented cadre of lobbyists of it's own to fight on your behalf. It remains my mission to seek ways to continue to help you deliver the best and most cost efficient care to our patients. If you have any suggestions in this regard, please contact me or Dr. Miguel Machado, the Chair of the FMA's Council on Legislation.

From the beginning, the state's budgetary news has been grim. The economic slowdown has reduced state revenues and as a result, very difficult choices are being made. Unfortunately, many of these choices are affecting healthcare, which consumes a large portion of the State's budget. Late yesterday afternoon, the Senate and House negotiators reached an agreement on the new budget. The spending plan for the fiscal year beginning July 1, 2008, is a staggering five billion dollars less than last year's budget. The full Legislature is expected to adopt the budget, which includes significant health care cuts, before adjourning on Friday.

Disappointingly, an attempt to improve access to care by increasing physician reimbursement rates under Medicaid was not part of the final budget agreement. The House had a 21 million dollar increase in their budget, but the Senate, considering the severe cuts taking place in other areas, would not agree. These cuts included a 6.5% cut (167 million dollars) in the Medicaid reimbursement rate for nursing homes and a 7.3% cut (255 million dollars) in the Medicaid reimbursement rates for hospitals. State spending on Medicaid HMOs was also cut by 55 million dollars.

For the time being, Medicaid revenues will continue to be spent in inefficient and wasteful ways, while better and more efficient care in the offices of primary care physicians will be denied to this population. Approximately three hundred million dollars of Federal matching funds will remain in Washington, DC, instead of being used in Florida to enhance the care of those in need. While elected officials struggle to address the economic downturn, our health care system hangs precariously by a thread. It is certainly a matter of priorities. Those with more money and lobbyists – and that includes the major power players in Tallahassee – will have their issues addressed preferentially. Whatever your specialty, work environment or locale, we will either find ways to work together or our priorities will be marginalized. This is detrimental to our profession and, most importantly, to our patients.

We will have an end of session review for all in a week or so. In the meantime, it is most important that you schedule meetings with your elected representatives this summer and reinforce the message that Florida's largest and most important industry--Health Care--must be protected. Your colleagues and the staff at the Florida Medical Association are committed to staying the course. These are problems that will not and cannot be ignored and we will continue to fight on your behalf as long as it takes.