In an effort to continue our advocacy efforts throughout the summer, FHA hosted a “State of Hospitals” Roundtable with special guests Representative Kristen Arrington (D – Osceola) and Representative Chase Tramont (R – Daytona). We were pleased to be joined by government relations executives from member health systems AdventHealth, Nemours Children’s Hospital, and Orlando Health.
Representative Chase Tramont, Jacob Horner Director, External Affairs, Nemours Children’s Health, Jamilah Felix Manager, Government Advocacy for AdventHealth Central Florida Division, Mary C. Mayhew, President and CEO, Florida Hospital Association, Michelle Strenth Senior Director, Government Affairs & Public Policy, Orlando Health, David Mica, Jr. EVP, Public Affairs, Florida Hospital Association, Representative Kristen Arrington, Zach Hoover, Government Affairs & Public Policy Manager, Orlando Health, Michael Williams SVP of Federal Affairs and General Counsel, Florida Hospital Association
FHA representatives shared an overview of the current state of hospitals and health systems in Florida and provided perspectives on some of the state’s most pressing legislative issues. Workforce shortages continue to be important to our lawmakers as FHA distributed recent data on nursing turnover and vacancy rates, discussed the ongoing cultural and environmental challenges hospitals are facing to staff their facilities, and reviewed the historic labor cost increases that remain a major concern. We sincerely appreciate the thoughtful engagement from Representatives Arrington and Tramont, as well as the input of our member experts, and look forward to continuing our work on these critical issues.
AHCA Ends Contract for Maximus for Dispute Resolution
As of June 30, 2023, the Agency for Health Care Administration ended its contract with MAXIMUS, an independent dispute resolution organization, to assist hospitals and other health care providers in resolving claims disputes with health plans. This IDR process was created when Florida updated the prompt pay laws as an avenue to resolve issues. Maximus has been under contract by the state since May 1, 2001, to provide this service. In 2021, 111 claim disputes were filed by providers with 73 accepted as eligible claims for review. Under the federal No Surprises Act, Florida providers can use the state IDR system instead of the federal one if the claims meet the state criteria. For more information click here.
FHA will be following this closely so watch for further updates.
HHS Issues Proposed Remedy for Unlawful 340B Payment Cuts
Following last year’s unanimous Supreme Court decision in favor of 340B providers (with the American Hospital Association as the lead plaintiff), the Department of Health and Human Services yesterday issued its proposed remedy for the unlawful payment cuts to certain hospitals that participate in the 340B Drug Pricing Program.
HHS’ proposed rule contains two central components: 1) HHS would repay 340B hospitals that were unlawfully underpaid from 2018 to 2022 in a single-lump sum payment. The proposed rule contains the calculations of the amounts owed to the approximately 1,600 affected 340B covered entity hospitals, and 2) HHS proposes to recoup funds from those hospitals that received increased rates for non-drug services from 2018 to 2022. CMS proposes to recoup these funds by adjusting the outpatient prospective payment system conversion factor by minus 0.5% starting in the calendar year 2025, making this adjustment until the full amount is offset, which CMS estimates to be 16 years.
FHA supports the proposal by the Agency to repay these critical providers promptly and with a single lump sum. However, we oppose the clawback proposal, which ultimately penalizes hospitals because HHS acted illegally when finalizing the 2018 rule.
FHA will review the proposal and expects to submit comments before the September 5 deadline.
FHA Statewide Call - Update on New Laws Including Masking, Immigration, and More
This week, FHA hosted a statewide call with member Chief Executive Officers, Chief Medical Officers, Nursing Officers, General Counsels, Infection Prevention staff and Government Relations Executives to discuss newly enacted laws on hospital immigration reporting, facial coverings in hospitals, storage of personal health information, and more. More than 300 member hospital staff joined to provide helpful questions and feedback. FHA continues to coordinate with government stakeholders to understand these requirements and communicate next steps to our membership.
Below please find follow up materials from the call:
CMS Announces CY 2024 Proposed Outpatient Payment Rule
Yesterday afternoon the Centers for Medicare and Medicaid Services issued the CY 2024 Outpatient Prospective Payment System proposed rule. The rule includes a net 2.8% increase in payments, changes to the transparency rule, and multiple provisions that would improve access to behavioral health services. CMS will be seeking comments on the proposed rule through September 11. FHA will provide further analysis of the rule and work with our members to develop a response.
Important Drug Shortage Situation Reports
The U.S. is continuing to face an all-time high of drug shortages. Recently added to that list has been penicillin – more specifically Pfizer’s long-acting, injectable form of penicillin called Bicillin. On June 12, 2023, Pfizer released a letter to clinicians stating that there is a “limited supply and impending stock out situation for select Bicillin L-A (penicillin G benzathine injectable suspension) and Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) Prefilled Syringes.” The shortage is attributed to the rise in syphilis infection rates as well as a general increase in demand.
Pfizer estimated that the supply for children may run out as early as the end of June 2023, while the supply for adults will be strained until 2024. Read the entire situation report for the Penicillin shortage from Healthcare Ready online.
Also, the American Society of Clinical Oncology (ASCO) continues to urge Congress to help prevent and mitigate cancer drug shortages by reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA) with provisions to improve the function and composition of the Strategic National Stockpile (SNS) to strengthen the drug and medical supply chain.
The ASCO is advising doctors with low amounts of medication in stock to reserve the drugs for patients with more of a “shot at a cure” and to not give the medicine to patients with recurrent or widely spread diseases. Cisplatin and carboplatin resupply dates are unknown, varied, back ordered, or anticipated in late 2023.
Also, on June 16, 2023, unionized drivers and workers for UPS are looking to authorize a strike if they don’t secure a new contract by the end of July. UPS Healthcare, the segment of the company focused on logistics for healthcare, is widely used by global healthcare companies. UPS’s specialized healthcare services include end-to-end distribution services, including for sensitive and high-value products.
Read the entire Oncology Shortage situation report from Healthcare Ready online.
Joint Commission Ends COVID-19 Vaccination Compliance Evaluation
The Joint Commission is no longer evaluating compliance with the COVID-19 vaccination requirement. While the standard will remain present in the current manual, surveyors have been advised not to evaluate for compliance. More information is available online.
FDOH and CDC Issue Malaria Advisory
The Florida Department of Health (FDOH) and the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to share information and notify clinicians and the public about the identification of locally acquired malaria cases, concern for a potential rise in imported malaria cases associated with increased international travel in summer 2023, and the need to plan for rapid access to IV artesunate, which is the first-line treatment for severe malaria in the United States.
CDC is collaborating with FDOH and Texas’ state health department with ongoing investigations of locally acquired mosquito-transmitted Plasmodium vivax malaria cases. There is no evidence to suggest the cases in Florida and Texas are related. In Florida, six cases within close geographic proximity have been identified, and active surveillance for additional cases is ongoing. Mosquito surveillance and control measures have been implemented in the affected area. All patients have received treatment and are improving. The risk of locally acquired malaria remains extremely low in the United States. However, Anopheles mosquito vectors, found throughout many regions of the country, are capable of transmitting malaria if they feed on a malaria-infected person.
Congress Negotiates Reauthorization of Pandemic All-Hazards Preparedness Act
The U.S. Congress is working to negotiate the reauthorization of the Pandemic All-Hazards Preparedness Act (PAHPA), set to expire on September 30. First signed into law in 2006, PAHPA is considered a "must pass" bill that bolsters the nation's medical and public health preparedness and response capabilities for nuclear and biological weapons, naturally occurring threats and natural disasters.
US House of Representative talks hit a snag last month when Democrats in the Energy and Commerce Committee demanded language to be included on fixing the nation's drug shortages. Republicans argue policies related to drug shortages fall outside the scope of PAHPA reauthorization. The Energy and Commerce Health Subcommittee is expected to mark up the legislation this week, according to Politico.
In the US Senate, comments were due today on a discussion draft released on July 3 by the Senate Health, Education, Labor & Pensions (HELP) Committee. That version, the core of which is bipartisan, would reauthorize programs until 2028, give the government more authority to respond to infectious threats with pandemic potential and provide grants for states to use in pandemic responses, such as for wastewater surveillance biocontainment labs. FHA will continue to provide updates as they become available.
Securing Florida’s Health Care Future Requires Investing In Graduate Medical Education Today | Column by Mary Mayhew
Most physician residency programs start this month. Medical and osteopathy school graduates who earned a residency spot start the next stage of their medical education. First-year interns become second-year residents. Second-years become third-years, and so on. Increasing the number of residency opportunities in Florida hospitals is essential for addressing the physician shortage, which is projected to reach 18,000 by 2035. Where a resident completes his or her training is highly predictive of where he or she will eventually practice medicine. Recognizing the need for solutions and funding, both the U.S. Congress and the Florida Legislature have made much-needed investments in GME. The Florida Legislature recently increased GME funding by 48 percent. At the federal level, Congress appropriated new funds in 2021 and 2023 to increase the number of Medicare-funded residency slots. Read more here.
FHA Workforce Partnerships and Collaboration
TBONL Board members pictured from left to right: Marta Mendoza MSN, BA, RN- President Elect, Gina A. McDaniel RN BSN, OCN, HN, GERO-TBONL President, Angel Smith MSN, RN, NE-BC-Secretary
On June 28, Cheryl Love, Chief Clinical and Patient Safety Officer represented on behalf of FHA at a recent meeting attended by 43 nurse leaders from the Tampa Bay Chapter of the Florida Organization for Nurse Leaders (TBONL). She presented and spoke on FHA’s role in advocating for the healthcare workforce, nursing workforce data, building the workforce pipeline, funding, and workforce housing.
Florida Infection Preventionists Participate in FHA Infection Prevention 3-Part Virtual Training Series: “Taking it to the Next Level”
This week, more than 100 infection prevention, quality, and clinical leaders from across the state registered to participate in FHA’s statewide infection prevention virtual training series, “Taking it to the Next Level”. The three-part series is an informative and interactive program designed to support the professional development of practicing infection preventionists in hospitals and communities. The objectives provide the next tier of knowledge and competencies for practicing infection preventionists who are the leaders we rely on for the implementation of effective infection prevention programs that drive a reduction in hospital-acquired infections and improved patient safety. The 3-Part Virtual Training Series agenda included:
FHA congratulates the program attendees for their successful completion of the program!
Biden Administration Takes Steps to Eliminate Hidden Junk Fees and Lower Prescription Drug Costs
Last week the Biden Administration announced several new actions under the Bidenomics agenda to lower health care costs and crack down on surprise junk fees for American families and consumers.
Crack Downs on Short-Term Insurance Plans
The administration will address what they are calling “junk insurance” or short-term plans by limiting their availability to three months, with a maximum of four months if extended, rather than the up to three-year short-term plans allowed by the Trump administration.
These short-term plans, which were initially conceived to cover a gap between comprehensive long-term coverage, are not required to have any of the protections established by the Affordable Care Act such as coverage for people with preexisting conditions, mental health services or treatment for substance use disorders, or the 10 essential health benefits – nor do they have annual out of pocket maximums.
Guidance on Rules Against Surprise Medical Billing
The administration also released guidance, via an FAQ, related to surprise medical bills. The FAQ addresses which out-of-network services should be counted against a patient’s maximum out-of-pocket limit under the Affordable Care Act and Public Health Services Act. They also clarify that if a provider, facility, or provider of air ambulance services has a direct or indirect contractual relationship with an insurance plan, then the providers are considered “participating” for purposes of the No Surprises Act and are considered in-network for the maximum out of pocket payment. The Consumer Financial Protection Bureau, HHS, and Treasury are collaborating to explore whether health care providers and third-party efforts to encourage consumers to sign up for these products are operating outside of existing consumer protections and breaking the law.
The FAQ also makes clear that for purposes of transparency in coverage requirements, good faith estimates for “items and services” must include “facility fees.
National Academy of Medicine (NAM) – Action Collaborative on Clinician Well-Being and Resilience
Health leaders have worked to operationalize the National Plan for Health Worker Well-Being. Leaders of the Clinician Well-Being Collaborative are committed to collective action to support health workers, and ultimately patient care. Using the National Plan for Health Workforce Well-Being, leaders across the health sector are cultivating a movement to optimize care providers’ well-being. The NAM is pleased to share these videos from the health leaders on the critical need to advance health workforce well-being. For more information on the National Plan for Health Workforce Well-Bing, please click here.
CDC COVID-19 Website is Relaunched
On July 13, 2023, a new, refreshed CDC COVID-19 website will be published. The new COVID-19 website is part of the CDC Clean Slate initiative – a large, organizational, agency-wide web update expected to relaunch in early 2024. The COVID-19 website has been restructured to improve the quality of information. As part of this transition to support sustainable public health practice, CDC has removed redundant content, consolidated information, and archived old content which is designed to be more user-friendly. Content that was relevant earlier in the pandemic but is no longer relevant is archived and can be found at archive.cdc.gov.
Florida Supreme Court Issues New Rule Regarding Medical Malpractice Experts
Last week the Florida Supreme Court issued a rule regarding the necessary qualifications of the expert witness a plaintiff uses to certify a medical malpractice suit prior to filing. The new rule allows an appeals court to review non-final orders that deny a motion to dismiss a medical malpractice claim based on the qualifications of corroborating witnesses.
The rule was issued after the court heard a case involving the University of Florida’s health system. Shands Teaching Hospital was sued by a plaintiff in a case that dealt with spine injury and used an expert witness certified in internal medicine to complete their pre-filing certification. The state Supreme Court ruled that current rules of procedure did not allow for the relief that the University of Florida sought, however, the court’s immediate move to change the rules of procedure is certainly a win for Florida’s hospitals.
Before filing a medical malpractice claim in Florida, a person who wants to sue must meet certain requirements, including having a medical expert file a written opinion corroborating the alleged malpractice. The law limits who can serve as a medical expert by requiring that they meet certain criteria, depending on the type of provider being sued. However, before the new rule, a provider could only challenge a lower court’s certification of the expert’s qualifications in incredibly limited circumstances. FHA filed an amicus brief with the Supreme Court, arguing the importance of qualified expert witnesses in the pre-trial process.