Checking the pulse of Florida health care news and policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

— FAU study —

A research paper by Florida Atlantic University professors adds a wrinkle to the annual scope-of-practice battle between certified registered nurse anesthetists and physician anesthesiologists.

CRNAs are highly trained nurses who administer anesthesia care. Florida law requires CRNAs to practice under a supervising physician, making autonomous practice unattainable to some practitioners with advanced nursing degrees.

The trade group representing CRNAs, the Florida Association of Nurse Anesthetists (FANA), makes a scope-of-practice play nearly every Legislative Session. Thus far, they haven’t been successful.

Still, FANA’s top argument in favor centers on health care access. CRNAs claim that some Floridians can’t get quality anesthesia care under the current paradigm, but the FAU paper says that’s an inaccurate narrative.

The paper focuses on “opt-out” provisions, which allow patients — typically those in rural states — who may not be able to get speedy care from a physician anesthesiologist to be treated by a CRNA who a physician doesn’t supervise after they learn of the potential risks.

Lead author Scott Feyereisen, Ph.D., examined hospital data from 2010 through 2021 and found no meaningful increase in access to anesthesia care in states with “opt-out” provisions.

“We discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals,” the paper reads, with a subsequent section noting, “Notably, opt-out provisions do not improve access in rural counties.” The study did find that “surgical access limitations still exist” in rural states but that “opt-out” provisions have done little to ameliorate the shortage.

The Florida Society of Anesthesiologists (FSA), a trade group representing physician anesthesiologists (and FANA’s foil), funded Feyereisen’s research. The latest report follows up on prior research that also found opt-out provisions had no impact. The FSA hailed the findings, asserting they proved what medical doctors have been saying.

“We have long suspected — based on our direct field experiences — that when states dangerously expand the scope-of-practice for CRNAs, allowing them to perform anesthesia services without the supervision of a physician, areas with nurse shortages do not benefit. This detailed analysis by three respected FAU professors clearly bears this out,” said FSA President Asha Padmanabhan.

“Not only is the practice of allowing nurses to independently practice anesthesia medicine without physician supervision costly and potentially dangerous, but this paper also demonstrates that it does not yield more nurses working in underserved areas.”

Padmanabhan concluded, “In the end, the data unequivocally showed that taking the costly and potentially dangerous steps of expanding scope in anesthesia medicine does not improve access to care — especially in rural communities.”

— Belt-tightening —

GuideWell, the parent company of Jacksonville-based Florida Blue, is implementing a 3% reduction in its workforce nationwide.

The layoffs, first reported by the Jacksonville Business Journal, are expected to affect employees in 29 states. Florida Blue did not disclose how many Jacksonville-based employees would be affected.

“The health care industry is facing complex challenges, including competitive market conditions, regulatory changes and rising medical costs. We are driving necessary innovation and transformation to keep health care costs under control, advance operational excellence, and improve care for our members,” a Florida Blue spokesperson said. The spokesperson added that the company is committed to supporting affected employees during this transition.

Florida Blue is the largest health insurer in Florida, with over 5 million members and 8,900 employees statewide.

— Win-win —

HCA Florida Ocala Hospital and HCA Florida West Marion Hospital recently announced a $10,000 donation to Interfaith Emergency Services to help combat hunger in Marion County.

As part of the 2024 Healthy Food for Healthier Tomorrows Food and Nutrition Drive, HCA Healthcare hospitals nationwide were encouraged to showcase their creativity by constructing sculptures from cans and boxes of food donated by staff. The winning hospital in each division received a $10,000 grant from the HCA Healthcare Foundation to support a local food bank.

HCA Florida Ocala Hospital emerged as the winner for HCA Healthcare’s North Florida Division and donated the grant to the food bank operated by Interfaith Emergency Services.

The nursing managers at HCA Florida Ocala Hospital created a food sculpture of a smiling turkey to emphasize the importance of supporting neighbors during the holiday season.

“HCA Florida Ocala Hospital is proud to assist Interfaith Emergency Services in the fight against food insecurity and to help our less fortunate neighbors achieve a healthier tomorrow,” said HCA Florida Ocala Hospital CEO Alan Keesee. “I am incredibly proud of our hospital team whose creativity and commitment made this donation possible.”

Interfaith Emergency Services CEO Karla Greenway added, “This $10,000 will sustain our truck and driver for five months, enabling us to collect approximately 365,000 pounds of food, including fresh produce, dairy, meats, and nonperishable items, which will be delivered to households within 48 hours.”

— Welcome aboard —

A new head and neck specialist joins HCA Florida Memorial Hospital in Jacksonville.

Russell B. Smith is the latest addition to the hospital’s dedicated care team. He specializes in advanced surgical care for conditions in the head and neck regions. His treatment area is relatively broad, including cancers of the head and neck and associated areas such as the mouth, throat, voice box, sinonasal cavities and skin.

“We understand that being diagnosed with cancer is life changing. We are committed to taking a personalized approach to provide multidisciplinary care for each of our patients, making sure they understand all options to therapy,” said Smith. “At all times, our patient’s care and comfort is our highest priority, and our entire team works diligently to ensure that each patient and their entire family are supported throughout the process.”

Smith’s practice will be in the Head & Neck Specialists wing of HCA Memorial Hospital, located at University and Beach Boulevards in Jacksonville.

— Roster —

Amit Parmar has been hired as the Chief Operating Officer at HCA Florida Woodmont Hospital. Parmar has been working at HCA Healthcare for eight years, most recently at Tristar Skyline Medical Center, a Level I Trauma Center in Nashville, where he was vice president of Operations. In that role, he oversaw several key capital investment projects, including launching the HCA Healthcare TriStar Division’s first Helicopter Fuel Depot, planning and phasing an additional $128 million tower expansion, and an East Nashville FSER expansion.

 — ICYMI —

“Medicaid cuts could devastate rural Florida, affecting children” via Trimmel Gomes of Public News Service — A new report from the Georgetown University Center for Children and Families highlights the significant role Medicaid plays in ensuring health care access for rural communities in Florida. The report reveals that rural Floridians face unique challenges, including provider shortages, long commutes, and limited connectivity, all of which make accessing health care more difficult. Erica Li, a health policy analyst with the Florida Policy Institute, emphasizes the program’s importance for the state, noting that more than 52% of children in rural Florida rely on Medicaid or CHIP for their health insurance. “Medicaid is a critical lifeline for families who need it. And the longer that children go without coverage in health care, the more risk they are at for poor outcomes and other aspects of their life, such as educational obtainment and other quality of life measures,” she explained.

“Florida leads the nation (again) In Obamacare enrollment” via Craig Pittman and Christine Sexton of Florida Phoenix — Data released by the Centers for Medicare & Medicaid Services show that 4,633,650 residents signed up for insurance coverage through the Marketplace by the end of 2024. Nationally, CMS reports that 23.6 million people enrolled for 2025 coverage, including 3.2 million new consumers. Total enrollment is record-breaking, CMS said in a statement. Four insurance companies and 12 health maintenance organizations (HMOs) are participating in the Florida Marketplace, as shown on the Florida Office of Insurance Regulation website. HMO coverage is regional, and people must live where an HMO is authorized to operate to enroll in the managed care plan.

“State health care agency wants $6.7 million to hike staff pay, improve services” via Jeffrey Schweers of the Orlando Sentinel — The state agency that administers Florida’s Medicaid program for 5 million residents told lawmakers it needs a midyear budget boost of $6.7 million to address chronic staffing shortages that advocates say prevent needy families from getting medical care. The agency wants to raise the salaries of underpaid positions to hang on to those employees. Studies show that at current employee levels, some state residents wait hours on hold to talk to someone at Florida’s Medicaid call center. “Current salaries do not attract candidates with the desired skill sets, experience, and expertise,” Sonya Smith, Chief of Finance and accounting for the Division of Health Care Finance at the Agency for Health Care Administration, said in an email to legislators Dec. 27.

“Health services at historic Key West building will resume after lead concerns” via Julia Cooper of WLRN Public Media — A historic Key West building that houses critical public health services were closed down in November after trace amounts of lead were found in construction material. It will soon reopen to the public. The shutting down of the historic Gato building on Simonton Street displaced the administrative offices of several municipal agencies, including the Florida Department of Health in Monroe County. Testing determined that the lead came from a paint layer dating back to the 1970s or earlier. Now, the county says it’s safe for occupancy again. Officials expect the building to be fully operational in about six months.

— Rules —

The Florida Department of Health has issued a final rule for 65B1-4.001, which concerns acupuncture program requirements and will become effective Feb. 6, 2025. More here.

Rule 64B-4.022, related to standards of practice for Autonomous Certified Nurse Midwives, goes into effect Feb. 4, 2025. More here.

Rule 64B16-27.79, related to the standards of practice for compounding sterile products, goes into effect Feb. 2, 2025. More here.

— Pencil it in —

— Jan. 28 —

3:30 p.m. — The House Human Services Subcommittee meets. Room 314, House Office Building.

— Jan. 29 —

1 p.m. — The House Health Care Budget Subcommittee will meet. The agenda includes a mental health and substance abuse panel discussion with reports from the Department of Children and Families and the Agency for Health Care Administration. Room 314, House Office Building.

3:30 p.m. — The House Health Care Facilities & Systems Subcommittee meets. The agenda includes an implantation briefing on a 2023 bill (HB 121) related to Florida KidCare Eligibility. Room 404, House Office Building.

— Feb. 1 —

Happy birthday to Rep. Chuck Brannan!

— Feb. 4 —

1:45 p.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.

— Feb. 5 —

1:15 p.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.

— Feb. 6 —

Happy birthday to Sen. Clay Yarborough!

— Feb. 10 —

1:30 p.m. — Day One of the Florida Chamber of Commerce’s 2025 Legislative Fly-in. Donald L. Tucker Civic Center.

— Feb. 11 —

1:30 p.m. — Day Two of the Florida Chamber of Commerce’s 2025 Legislative Fly-in. Donald L. Tucker Civic Center.

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