The Legislature is about to enter the fourth week of the Legislative Session and the Florida House has continued its assault on the House of medicine and the hospital industry.
Rep. Dr. Pigman has filed his scope of practice expansion bill which would allow independent practice for PA’s and APRN’s. This bill is moving through the House. There is no companion measure to this bill in the Senate but it is widely speculated that it will be one of the trade issues this Session. Under Senate Rules since the issue has not been filed in the Senate it can be amended onto a germane bill which there are several moving. Also moving is a bill that would allow pharmacists to test and treat for flu and strep. There is a balanced billing bill addressing air ambulance services. Rep Renner has the bill that deregulates many things including physicians, rad assistant, rad techs to list a few. The plan would be to legislatively review these chapters and if not re-enacted by the Legislature the act’s sunset. This bill has a companion measure in the Senate filed by Senator Diaz but it has not moved. The House bill is anticipated to move as Rep Renner is in line to be Speaker after Speaker designee Sprowls.
The budgets of both houses have been rolled out and in the upcoming week they will vote on their budgets and agree to disagree. At the moment they are $1.4 billion apart.
The budget negotiations are part of the legislative trades. It is an election year so folks will not want to go into overtime and at the moment that is not anticipated.
Session ends March 13th so there still is a lot of time on the clock for things to happen.
Alison Dudley, FRS Lobbyist
More Legislative Update
As you have most likely seen and hopefully not ignored, there are major legislative efforts underway in both Washington and Tallahassee that could have serious effects on our practices. Please make every effort when are you are sent an email with the option to send a message to a legislator via an embedded link, to do so. The number of responses that the legislative offices receive is tallied and can make a difference.
Surprise medical bills:
While legislatively dealt with in Florida in 2016, the battle lines have moved to Washington where the insurance lobby is working with extreme diligence to create legislation that would seriously undermine all network contracts. There is every reason to believe that the suboptimal bill passed in Florida in 2016 could be overridden by a worse bill in Washington. As described in a previous E-Brief, this legislation is not just about a small number of patients getting large out of network bills. It is all about physicians being strangled by the insurance companies while trying to negotiate a reasonable in-network contracted rate. Due to effective PR, the insurance lobby has gained the upper hand but we are making progress through the aggressive response of medical societies, physician service company representation, and individual physicians contacting their legislators. Do not assume that someone else is taking care of this for you.
Medicare fee schedule:
There have been severe cuts proposed in the 2021 Medicare physician fee schedule that would result in a decrease in radiology services reimbursement of approximately 8 percent (Do the math). The rationalization is based on an increase in the payment for E/M (evaluation and management) codes that requires an offset by other codes to remain budget neutral, with a very disproportionate negative effect on radiology reimbursements. This devaluation will certainly trickle from Medicare to most private contracts, since most are based on a percent of Medicare. So unless you think you are overpaid, look for opportunities to send your comments on this issue to your federal office holders as well.
Of somewhat less direct relevance to radiology, there is active pressure from Florida House leadership to pass a bill granting significant expansion in the unsupervised practice of mid-level providers. It is early in the session, details are not yet available, and it is hoped that this is not likely to result in an expansion of mid-level providers into the diagnostic imaging realm. Due to work we had performed a number of years ago, the FRS crafted legislation that restricted Radiology Assistants to non-image interpretation work. However, that does not guarantee encroachment by mid-level practitioners not licensed as Radiology Assistants. Further, it would be very shortsighted not to support those specialties more likely to see encroachment now. As with the proverbial camels nose under the tent, this effort to cheapen medical care at the expense of quality is likely to eventually find us.
Within the next few weeks, you will likely be seeing “Calls to Action” from the ACR, FMA, FRS, or other subspecialty organizations. Please take note of them, and respond when asked. Again, please feel free to disregard all of this if you think you are overpaid.
David H. Epstein, MD FACR