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OCMS, SCMS have concerns about legislation regarding scope of practice issues and telemedicine

Fraser Cobbe, Executive Director of the Orange County Medical Society and Seminole County Medical Society, expects to see scope of practice matters, telemedicine and a proposal by pharmacists to diagnose and treat flu and strep throat to be issues likely to come up during the current session of the Florida Legislature.

"We do know that the Speaker of the House has some ideas about expanded roles for non-physician practitioners which have us a little bit concerned," Cobbe said. "Definitely there are some scope of practice bills that have been filed that we're going to be expressing our concerns about over patient safety."

Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs) are likely to go after independent practice again. Cobbe said the medical societies want to make sure there are patient safeguards included in that.

"In general, we oppose them working totally independent and without adequate physician oversight to make sure the medical diagnosis, treatments and follow through are applied appropriately," Cobbe said. "We know the pharmacists are coming after the ability to diagnose and treat strep and flu. We do have some concerns about their inability to do a history and a physical on a patient. And they're utilizing new tests that aren't 100 percent foolproof, so we have some concerns with misdiagnosis of flu and strep if patients start to use the pharmacists as their only caregiver."

It is also likely that the governor will support passage of a telemedicine bill. While the medical societies are supportive of telemedicine, it needs to be done in an appropriate way where the State of Florida still has the ability to regulate the quality of medicine delivered through telemedicine including that potentially provided by out-of-state providers.

"We feel strongly there needs to be some way to hold those medical professionals accountable for their recommendations and care that they give through that telemedicine portal," Cobbe said. "The state should not abdicate their responsibility for quality of care in those instances. On a positive note on telemedicine, I think we're ready for Florida to receive parity, like a number of the other states have, where if you're a physician in Florida providing telemedicine services, then those services would be reimbursed similar to what an in-person visit would be."

The Orange County Medical Society and Seminole County Medical Society are supportive of the expansion of needle exchange programs. There has been a successful pilot program at the University of Miami with a needle exchange program that proved to help reduce rates for HIV, hepatitis and other blood-borne diseases.

"We're going to be active in trying to get that pilot program expanded to other communities," Cobbe said.

Insurance reform is another hot button issue.

"Organized medicine has been going after insurance reform for the past several years in ways which are pro-patient and pro-physician, as well," Cobbe said. "We're hoping at some point to continue to push those forward. The fail first protocols require patients to try certain medications first and fail on those medications before they get to the medication that the physician wanted to prescribe in the first place. We want to make sure there's a way for a physician and patient to opt out of those fail first protocols if they know those medications are going to be ineffective."

Another issue is retroactive denials where physicians verify the eligibility of the patient. The care authorized by the insurance carrier is given only to find out later that the patient had fallen delinquent on paying their premiums. In cases like that, insurance carriers have historically denied reimbursement. Cobbe said physicians shouldn't be saddled with that debt for a service being provided in good faith.

There's also a bill that's going to be filed that prevents insurance carriers from changing formularies in the middle of a contract year for a patient.

"Many patients will shop for their insurance coverage based on what drugs are in their formulary, and what tiers all those drugs are on," Cobbe said. "We've got concerns with insurance carriers that sell a product to a patient and then a month later they change the drug formularies, or change the tiers, and all of a sudden the patient is stuck for that full year with a policy or benefit that they did not anticipate when they purchased that product. I'd like to see some patient protections in there that they shouldn't be able to switch that formulary until the end of the contract year."

The medical societies also favor a state system that mediates disputes between insurance carriers and physicians. Currently, the state requires physicians and insurance companies go through Maximus, which is the third-party dispute resolution contractor used by the state. Cobbe said since it is not mandatory for either party to go through that process, the vast majority of the time insurance carriers have opted not to participate.

"We think we need to come up with a better regulatory scheme to hold insurance carriers accountable," Cobbe said.

Another consideration is surgery center legislation. What surgeons would like to see is that the length of stay in the surgery center be 23 hours from the start of the procedure. Current Florida law says that the patient has to be discharged by midnight.

"Most states in the country allow 23 hours from the start of the procedure," Cobbe said. "Florida is somewhat handcuffed in our ability to use surgery centers because you've got to discharge the patient by midnight. We think that arbitrary midnight deadline is something that jeopardizes quality of care, and potentially increases cost if the patient has no other option but to then get admitted at midnight."

Workers comp is another issue under consideration. Cobbe said the workers comp system is full of delays and is often not meeting it core objective of returning an injured worker back to work as soon as possible. He said currently business owners have no idea what quality of care they are purchasing through workers comp.

"We think it would be a good idea just to have some transparency by having the state publish a list of each carrier, and how they perform against each other on similar types of injuries," Cobbe said. "With that transparency, then those who are doing a good job obviously will shine on those reports. Those who are not doing a good job will be more incentivized to work with the treating physicians to get better results."

Physicians are encouraged to get involved with the legislative proposals.

"The state makes decisions on appropriate coverage, quality of care and access to care for patients," Cobbe said. "It's really important that physicians are involved in that process to have a positive impact on the system."

Cobbe expects this to be a year of transition because of a new governor, as well as new leadership in both the Florida House and Senate.

"It's a little different in the fact that everybody is still kind of feeling out the process with the new leadership," he said. "But we are already laying the groundwork for the issues that are important to us."