Originally published at Naples Daily News.
Alexandra Glorioso , alexandra.glorioso@naplesnews.com; 239-435-3442 Published 1:36 p.m. ET Jan. 27, 2017 | Updated 9:08 p.m. ET Jan. 27, 2017
Gov. Rick Scott, once again promising to make health care a priority, wants to make it easier to open new hospitals and trauma centers, and wants more transparency in medical costs.
But for all of his expertise on the issues as a former hospital executive, Scott faces an uphill battle in the Legislature in the upcoming session.
“I don’t think the Senate is on this wave length,” said Senate budget committee Chairman Jack Latvala.
Scott announced some of his health care agenda this week.
“This session, I want to fight to make the health care system fair for families and ensure health care works for patients and not for hospitals’ bottom lines,” he said.
Latvala said the governor and House Republicans have been trying to do some of these reforms for years.
Last year, the Senate opposed similar proposals. However, last year’s Senate president was a hospital executive who led the opposition.
House Republicans argue these measures would help alleviate some of the financial burden health care places on the state by making Florida’s health care industry more competitive.
“Although health care, given the federal regulation, will never truly be a free market, there are things we can do to bring the consumer closer to the decision-making process, which will increase access and lower cost,” said Rep. Jason Brodeur, R-Sanford, chairman of the House’s health budget subcommittee.
The two mechanisms the state uses to regulate growth in health care facilities are certificates of need and trauma center caps. The certificates are used to identify demand for more hospitals, hospices, nursing homes, psychiatric facilities, rehabilitation centers and trauma centers.
Rep. Jose Oliva, chairman of the House Rules and Policies committee, said although these restrictions were intended for good, they have had negative financial effects on costs. The main agency that oversees hospitals and most state Medicaid money is 32 percent of the state’s budget.
“Today, the hospital industrial complex is larger than the military industrial complex. Hospitals swallow up competition around them,” said Oliva, R-Hialeah.
Oliva said that in addition to the lack of competition the regulations create, applying for permits is an expensive process.
The Senate never has passed a bill to repeal certificates of need.
However, Sen. Denise Grimsley last year filed a bill that would have eliminated the certificates in rural areas, where hospitals generally are poorer and cannot afford to apply for the certificate.
“I think I would agree with Sen. Latvala that there’s probably not a lot of appetite in the Senate for a total repeal of CON, but I think senators are open to looking at streamlining the process,” said Grimsley, R-Sebring.
Grimsley, a hospital administrator, said other than relieving hospitals that can't afford applying for certificates, she doesn't think repealing them would have a major effect on cost.
The reason, Grimsley said, is full-time health care providers such as doctors and nurses are so limited in Florida that more competition would require hospitals to contract out for more expensive providers, which goes to the bottom line.
The divide between advocates for regulation and for free-market principles comes down to how they understand the drivers of cost, hospital lobbyist Keith Arnold said.
Advocates for the certificate of need process argue it ensures an adequate number of patients to cover the cost of operation.
“If you think the cost of health care is driven by utilization rates, it’s easy for us in the industry to make the leap that lack of CON drives up health care costs,” Arnold said.
"If you buy a piece of equipment and it’s used intensively, over and over again, by patients and providers, the cost of each encounter necessarily goes down per procedure and the quality of health care necessarily goes up."
He said even though there was disagreement in other areas, he and his clients largely supported Scott's efforts on price transparency.
Through a law passed last year, a database of hospital prices and procedures should go live this summer.
However, more needs to be done, Arnold said.
“Even if you make a database, still, the way it’s reported is convoluted," he said. "You have charges and write-offs and contractual amounts and co-pays. It’s crazy.”