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Health Care 'Train' Coming?

Leaders of the Florida House, hoping to protect their pet health issues from being picked apart in the Senate,  have bundled them into a package to be introduced Thursday morning. In legislative parlance, they're creating a "train."

The idea of a train is that it's a bunch of railcars that are connected and it would be hard to remove one of them without causing them all to derail. As a practical matter, it means some lawmakers might have to accept a bill they don't like in order to get one that's a must-pass.

The House Health & Human Services Committee is expected to take up two bundles of bills at its meeting at 9 a.m.  They are substitutes for HB 7113 and HB 573.

According to the proposed bill language posted on the committee site  Wednesday afternoon, the new HB 7113 would include three major parts:

Trauma centers. The original bill (HB 7113) offers protection for three suburban HCA Healthcare-owned trauma centers that have been challenged in court by large urban non-profit trauma centers. The urban centers say the suburban facilities will divert too many patients and undercut their financial base and caseload, which could affect their medical readiness skills.

The HCA facilities that would gain protection are Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County.

In a nod to the Tampa Bay Times’ series on high “trauma access fees” being tacked onto hospital bills, the proposed bill would limit them to $15,000 until July 1, 2015. By then, a study of the issue should have been completed and any adjustments to the access-fee limit could have been made.

Independent nurse practitioners. Unlike the Senate, the House wants nurses with at least two years' post-graduate training and three years' experience to be able to practice on their own, not under the supervision of a physician. The proposed bill creates the new license category and makes these independent nurses a primary care provider authorized to do most of is only now is allowed only for primary care physicians, including admitting patients to the hospital and prescribing controlled drugs.

Telehealth. The bill sets up the legal structure for medical consultations and provision of other health-care services from a distance, using  communications technology. The House has all along said it wants to keep the restrictions on telehealth as  light as possible so that the new field can grow and provide greater access to care.

However, the Senate has accepted the Florida Medical Association’s position, that out-of-state providers performing telehealth services for Florida patients should have a Florida medical license. The House has said that would make it difficult for telehealth to develop.

The proposed House bill says telehealth providers working with Floridians must be licensed in good standing in their own state and that they must register with the Florida Department of Health, a registration that could be withdrawn if warranted.

As for the new HB 573, it starts with the old one -- ramping up oversight of assisted-living centers -- and adds two unrelated matters, the Times/Herald Tallahassee Bureau reports. One provides for grandparent visitation, the other would allow day-surgery centers to add "recovery care," enabling them to keep patients up to 72 hours. 

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.