|2018 Position Statement Overview|
Appropriate Utilization of Opioids - SB 8 (Benacquisto) HB 21 (Boyd) - SB 458 (Bean)
One of the greatest challenges facing communities across the country is the crisis with opioid use and treating dependency. The OCMS supports restrictions in the supply of opioids. The OCMS has been working with the Orange County Task Force to educate physicians on appropriate prescribing of these highly addictive medications as well as supporting treatment professionals and law enforcement in educating and protecting the public. The OCMS does have concerns with the potential ramifications to the health of some patients that may need opioids to recover from major trauma or for end-of-life care and is working to institute appropriate safeguards to balance the needs of appropriate pain relief while limiting the supply on the streets.
Direct Primary Care – Less Paperwork, More Care – SB 80 (Lee) and HB 37 (Burgess & Miller)
One of the most promising developments in health care delivery in recent years has been the Direct Primary Care (DPC) movement. DPC is an alternative to the traditional fee-for-service model in which patients are charged a simple, affordable flat monthly fee for comprehensive coverage of all primary care services. DPC physicians have been able to control costs by preventing chronic illnesses and reducing administrative expenses. The OCMS strongly supports legislation which would allow DPC to grow by defining direct primary care agreements as a medical service outside the scope of insurance regulation.
Right Medicine, Right Time – SB 98 (Steube) HB 199 (Harrison)
The OCMS supports efforts by patient advocates to ensure that appropriate prescriptive treatments are based on a physician’s recommendation. Each year, thousands of Floridians are subjected to “fail first” protocols, whereby insurance companies impose their own treatment decisions ahead of treating physicians’ medical judgment. This causes delays in care that can lead to unnecessary hospitalizations and sometimes devastating consequences for patients. Florida needs legislation that allows physicians and patients to override step therapy protocols when deemed medically necessary and in patients’ best interests. In addition, if a patient is currently stable on a drug, step therapy should not be required to continue usage of that drug because of changes in a health care benefit or plan. Finally, the FMA supports shortening the amount of time for a step therapy override to be granted. It is time to stop insurance companies from practicing medicine and getting in the middle of the patient-physician relationship.
Retroactive Denials – SB 162 (Steube) HB 217 (Hager)
The OCMS supports legislation that eliminates the ability of insurance carriers to retroactively deny claims
when they have provided a physician with authorization and the physician renders that service in good faith.
Maintenance of Certification – SB 628 (Grimsley) and HB 81(Gonzalez)
The OCMS supports legislation that prohibits the Board of Medicine, Department of Health, a health care facility, or an insurer from requiring maintenance of certification or recertification as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a subspecialty as recognized in the Florida Statutes.
Ambulatory Surgery Centers and Recovery Care Centers – SB 250 (Steube) HB 23 (Renner and Fitzenhagen) - Expands ASC Services providing that patients must be discharged within 24 hours (eliminates no overnight stay language). This is similar to the definition used by the Federal Government (CMS) as well as a majority of the states across the US. Creates Recovery Care Centers and provides statutory framework for Recovery Care Centers with a limited stay of up to 72 hours. Requires all RCC’s to include patient education, nutrition, pharmacy, and additional required services to comply with state law.
Scope of Practice Expansions
The OCMS is concerned with proposals that either have already been filed, or likely will be filed for debate in the upcoming legislative session that would expand the scope of practice for non-physicians. SB 524 (Brandes) and HB 431 (Plasencia) have already been filed which will enable pharmacists to diagnose and treat the flu and strep under protocols developed by a physician. We also anticipate legislation that will enable optometrists to perform laser surgery.
PIP Repeal – SB 150 (Brandes) and HB 19 (Grall)
The OCMS supports maintaining the current automobile no-fault system due to the potential harm that can be caused to our emergency and trauma system in return for minimal financial relief for consumers. The Pinnacle study released in 2016 notes that drivers in Florida would save $82 a year with the repeal of PIP. However, without PIP or some other form of mandated emergency med pay coverage, more injured drivers and passengers would rely on commercial insurance to cover the cost of their medical care while they litigate fault in the accident. Most patients carry commercial coverage with far higher deductibles and co-pays that would have to be utilized for care currently provided under their PIP benefit. Emergency Physicians and On-Call Specialists would likely face increased unfunded care and extended delays in reimbursement as fault is determined in each accident. While the current PIP system is far from ideal, it does provide a relatively in-expensive medical benefit that contributes significantly to our current trauma system.