A Look Ahead at 2012’s Major Challenges and Initiatives Impacting Florida Hospitals
Concerns Over the Florida State Budget
The way Florida Hospital Association (FHA) President Bruce Rueben sees it, without a doubt the primary challenge for Florida hospitals in 2012 is Governor Rick Scott’s proposal to balance the state budget with a $2.1 billion cut from hospitals’ Medicaid rates. Many local hospitals could lose a substantial portion of what they currently receive to treat 408,000 Medicaid patients across Florida. While this proposal occurs early in the long legislative process, slashing Medicaid payment rates for Florida hospitals would have dire consequences for the state’s health care system.
Says Rueben, “This issue dwarfs everything else. The cuts are too big to be reasonable and the assault on hospitals is unprecedented. I’ve never seen a proposal like this in any other state. It’s not sustainable. I believe that once the legislators really understand the repercussions of what Governor Scott is proposing they’ll have to come up with a different approach.”
According to the Agency for Health Care Administration’s numbers from July, Florida general acute care hospitals receive $450 to $3,040 per Medicaid patient's daily stay, and $15 to $203 for outpatient care per diem. Governor Scott’s plan would reduce the rates for general acute care hospitals to $660 per inpatient night, and $73 per outpatient appointment.
“The plan would balance the budget on the backs of hospital patients, and the unmet costs would be shifted to those who can pay for their care. At worst, some hospitals could be forced to shut down, at best, hospital jobs would have to be cut,” Rueben says.
Rueben believes that since it’s still early in the legislative process, one can’t be precise about the timeline of when budget issues will be decided. “This year the legislative session started early because of redistricting. There is a chance that the Florida legislature may not deal with this until the Spring.”
Florida’s Applications for Waivers from the Centers for Medicare and Medicaid Services
FHA president also reports that Florida has applied for important waivers through the Centers for Medicare and Medicaid Services (CMS) that impact managed care and Florida hospitals. The first waiver was approved on December 15 by CMS, and it extends Florida’s existing Medicaid managed care waiver through June 30, 2014. Currently, the waiver is operational in Broward, Duval, Baker, Clay and Nassau counties. FHA believes this waiver extension will require a medical loss ratio for managed care plans of 85 percent, effective in 2013. The extension also authorizes full funding of the Low Income Program through June 30, 2014 at the current level of $1 billion. A second CMS waiver, still pending, is related to expanding mandatory Medicaid managed care to 67 counties in Florida. FHA staff believes that approval of the first waiver opens the door for future discussions on other Medicaid waivers.
Three Statewide Collaboratives Improve Care and Reduce Florida’s Healthcare Costs
“On another note, we have good news to report about positive actions hospitals are taking to improve care and reduce costs,” Rueben reports. He’s referring to three statewide collaboratives that grew from FHA sponsored patient safety and quality improvement initiatives.
The first collaborative is called the Florida Surgical Care Initiative (FSCI). FHA is partnering with the American College of Surgeons to bring hospitals and surgeons together in a statewide effort to prevent surgical complications, reduce costs and improve the quality of care for Florida’s patients. This initiative focuses on four high-impact areas, including surgical site infection, urinary tract infection, elderly outcomes and colorectal outcomes. Obvious benefits to surgical patients are fewer complications, faster recovery times and a shorter average hospital stay. Initial estimates predict this initiative could save $10 to $20 million a year in health care costs.
A second initiative is the Collaborative on Reducing Avoidable Readmissions. For more than two years, participating hospitals have been working to reduce the likelihood of patients being re-hospitalized. Hospitals have adopted new practices toward this goal, including: redesigning the discharge process to include more patient education, better transitions to home or another care setting, visiting the patient in the home soon after discharge, and scheduling follow up appointments with physicians. Since the project started, readmissions for the five conditions have dropped 11 percent statewide.
Eliminating Hospital Acquired Infections is the final FHA initiative, begun in September 2009, to address the preventable central line-associated bloodstream infections (CLABSIs) that kill 31,000 patients yearly. The 72 participating units promote teamwork, and establish a culture-of-patient safety and implementing strategies to improve care, with the goal of reducing the incidence of central line infections to zero. Rates of CLABSI have dropped 30 percent statewide since 2009. FHA expanded this initiative in March 2011 to focus on reducing Catheter Associated Urinary Tract Infections (CAUTI).
For more information about the Florida Hospital Association and the Florida statewide collaboratives, contact Sarah McBrearty, Director of Communications at firstname.lastname@example.org, or visit the FHA website at www.fha.org.