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Health Bill 'Train' on Its Way

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The Florida House Health & Human Services Committee passed a megabill Thursday  morning that combines three prickly issues, in the hope that packaging them will make it harder for the Senate to kill or maim any of them.

HB 7113 would protect private for-profit trauma centers, allow for independent practice for nurse practitioners and allow out-of-state doctors to participate in telehealth without a Florida license. The Florida Medical Association opposes the latter two.

Such a package is sometimes called a "train" in legislative parlance. The idea of a train is that it's a bunch of connected railcars, and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers have to accept a proposal they don't like in order to get one they really want. One of the creators of the telehealth legislation acknowledged as much.

"It was not my choice for all these things to be in the same bill," said Rep. Mia Jones, D-Jacksonville. "We're going to take some good and some bad and move forward."

A few minutes later, the process was replayed as another combo bill rolled out of the committee. HB 573 heightens oversight of assisted-living centers, allows visitation for grandparents, and enables outpatient surgery centers to expand their services as "recovery care" centers.

The first two parts of that combo brought no opposition to speak of. Disagreement was saved for the third, as both hospitals and nursing homes foresee the loss of some paying patients.

But their lobbyists didn't get to say much. HHS Committee Chairman Richard Corcoran, R-Land O'Lakes, limited public testimony to one minute per speaker, saying the committee had a lot to cover during this, its last meeting.

On HB 7113, some of the strongest objections came from Reps. Ronald "Doc" Renuart, R-Ponte Vedra Beach, and Gayle Harrell, R-Port St. Lucie. (Renuart is an osteopathic physician; Harrell is a former winner of the FMA's award for "legislator of the year.")

Renuart said physicians study many more years than nurse practitioners, grilling bill proponent Rep. Cary Pigman, R-Sebring, who is also a physician. "What useless knowledge were we given in those eight years (of college and medical school)?" Renuart asked.

Pigman said it is misleading to compare the undergraduate training of physicians and nurses. Would-be doctors can enter medical school with a degree unrelated to medicine, he said, noting that he majored in chemistry. By contrast, he said, nurses have to major in nursing.

Renuart also objected that independent-practice nurses might not work in a "collegial manner" with physicians. Pigman said that's not something a law could or should determine. Current law requires that nurse practitioners contract with doctors to devise their practice protocol -- and pay them for the privilege.

Data from other states show there is no significant difference in outcomes between physicians and independent nurse practitioners in primary care, Pigman said.  Florida has access-to-care issues, he said, and it's time for "innovation."

In discussing out-of-state practitioners engaging in telehealth with Floridians, Harrell objected to the bill's lack of a requirement that they have a Florida medical license. Without that, Harrell said,  state authorities could do no background check or fingerprinting.

"We must be sure that our patients are getting -- whether in person or through telemedicine --the standard of care," Harrell said.

Bill backers said the doctors would have to have a license in good standing in their own state to register with Florida health officials as telehealth providers.  Few would go through the time-consuming and onerous process of applying for licensure in every state for which they serve as telehealth consultants, they said.

Rep. Mia Jones asked fellow committee members not to put up "roadblocks" to the use of technology for patients' benefit. Other states are far ahead of Florida on this, she said.

"We need to recognize times are changing," Jones said. "We don't want Florida to be left behind."

(More information on HB 573 is at this earlier article by Times/Herald Tallahassee Bureau.)