The Rules are Different Here!

Somewhere in the back of my mind I recall a Florida Governor who used that statement as a marketing slogan. Come to Florida. We will make it easier for you to do business. Come live and work where fun and sun are part of the both physical and social climate with which to work.

The rules are different here!

Now that mantra haunts me like an “ear bug.” It seems to be used as the excuse, rationale, defense for all the myriad of differences in data that represent Southeast Florida’s distinctions in health status, insurance penetration, poverty levels, health services supply and utilization, more pain clinics than hospitals, higher healthcare costs per capita or per any other measure. It’s the excuse, rationale and defense for Miami-Dade County’s health system fraud and abuse, excessive testing, physicians without malpractice insurance (i.e. self-insured), more MRI machines than the country of Canada, more Medicare Advantage programs than entire states, and literally hundreds of “home care” agencies billing half of all claims in the nation.

The rules are different here!

Those of you who work hard every day in every way to do the right things for patients, payers, tax payers, personnel and fellow professionals know that you don’t have to serve on the MEDPAC board or be a professor at Dartmouth to know the rules are different here. From municipal elected officials to county commissioners to state legislators to Congressional Representatives to Statewide office holders, the way to get and stay in office is to promise and promote lower taxes. Never mind that the quality of our educational institutions and the funding of health and human services are dependent on tax dollars to survive. Even in the area of citizenship and philanthropy Florida ranks 46th and 44th respectively. “In fact the Miami-Ft. Lauderdale MSA ranked 50th among the nation’s 50 largest metropolitan areas on 3 key civic indicators: volunteering, public meeting attendance and collaboration with others on local issues,” according to the Florida Joint Center for Citizenship’s most recent study. Of course it’s not easy or popular to find revenue during a recession, but I haven’t heard many legislators say they are going to Tallahassee looking for creative ways to secure resources instead of ways to “cut funding.”

The rules are different here!

Now we actually have elected officials that think we should apply for a Medicaid waiver that allows the state to receive its share of Federal funds, but not actually run a Medicaid program. There are also folks who think the state should pass legislations that would create a ballot measure to amend Florida’s constitution in a way that would exempt us from implementing national healthcare reform once Congress and the President finish with the process. This article is supposed to be a prediction of the year ahead. Well my prediction is that the rules here aren’t that different. And if we, the hospital and healthcare system, don’t embrace and creatively implement healthcare reform, it will be done to us. If our managed care companies can’t find a way to serve our seniors at a per member per month amount closer to the cost of other communities, they won’t have Medicare contracts. If our physicians can’t figure out a way to diagnose and treat our patients without using every machine in their arsenal, then some of those services will stop being paid for. If hospitals and doctors can’t do a better job with the first admission, lowering the readmission rates, then reimbursement rates for an entire range of DRGs will be less. And finally, if we don’t as succeed in marketing whatever new health insurance options are available through the new exchange, the numbers of uninsured won’t get lower.

The rules are different here!

So this is the moment in time when we should use this to our advantage. We should fix our system as rapidly as we can. Hospitals ought to sign up with PSOFlorida to provide safer more consistent care. Doctors, hospitals and legitimate home care agencies ought to align their incentives and prepare for bundled payments. The uninsured ought to start taking responsibility for their health by participating in Cover Florida, Miami-Dade Blue, or the other lower premium, reasonable benefit health plans and/or by using the constellation of available federally qualified community health centers instead of hospital emergency rooms for non-emergent needs. If the rules are different here then we need to create a set of rules that work a lot better. It will be nice to be distinctive for being the best, for leading the way at reform, and for a reputation of lower cost, higher quality, accessible care.