Don’t Legislate Through the Constitution

As you may know from my blog posts last spring, I spent significant time and energy during the first half of 2017 working with other health care professionals and legislators across the state to ensure that the Certificate of Need (CON) program was not repealed here in Florida.

Certificate of Need is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services here in Florida. In my opinion, repealing CON remains bad news for the consumer because it has the potential to not only increase costs, but could also lead to a decrease in the accessibility and quality of health care in our state. Thankfully, last spring the Florida Legislature failed to pass a bill that would have eliminated CON. This means hospitals like Tampa General Hospital can continue to offer the highest quality and most accessible care at an affordable price.

As I predicted last June, the debate on CON is far from over. This time, however, those that are set on repealing CON and have been previously unsuccessful have decided to take a new approach. They are now looking to revise the state constitution in order to eliminate CON and in order to do so, have filed a constitutional amendment with the Constitution RevisionCommission that would repeal CON. This would prohibit the State of Florida from limiting the number of hospitals, nursing homes, hospitals or care facilities for individuals.

The Commission’s General Provisions Committee voted inDecember to approve the proposed constitutional amendment, sending it to the full Commission for a vote. If the Commission gives the amendment the thumbs up, the fate of CON will be in the hands of Florida voters come election time in November.

And so, while I am passionate about maintaining CON here in Florida, I am equally passionate about keeping it off the ballot. And here’s why:

1. CON is a legislative issue and not a constitutional one. Lawmakers need to do their jobs. Regulation should be administered via the legislature.
2. A ballot initiative campaign will be incredibly expensive as millions of dollars will be spent on television ads trying to persuade voters to one side of the issue or the other. This is money that could be better spent on helping to provide accessible and affordable health care to millions of Floridians.
3. And most importantly, CON is a highly complex and nuanced issue that would be difficult to explain and be understood by voters in a thirty second sound bite. For a complicated issue that really affects people’s everyday lives, it would be irresponsible of the lawmakers to casually bury this into the ballot.

Everyone in our community deserves access to the best, most affordable health care. The repeal of CON has the potential to dramatically increase health care costs, as well as lead to a significant decrease in quality of health care across Florida. It also has the potential to dramatically decrease access to quality health care that members of my community currently enjoy.

I will continue to do all I can do to make sure that CON remains in place, including working to keep it off the ballot in November. I ask you to join me by making your voice heard.

Specifically, I encourage you attend one of the Constitution Revision Commission’s public hearings being held across Florida during February and March. There, you can let members of the Commission know your desire to have access to high quality and affordable health care and keep CON off the November ballot. 

For a full schedule of the Commission’s statewide tour, visit here.

The Future is Bright

On June 5th, I accepted the position of President and CEO of Tampa General Hospital (TGH), a role I will assume on September 1st. Over the last seven years, the team at Jupiter Medical Center has been able to transform a great hospital into a world-class system of care. We have done this through innovation, collaboration, the proliferation of technologies and programs, and the embracing of common goals and organizational culture. And so I leave not only proud of the work that has been done by the entire team, but excited for the future of Jupiter Medical Center going forward. There is great momentum at Jupiter and I look forward to witnessing all the amazing things to come.

While leaving Jupiter will be bittersweet, I am honored and truly humbled to accept this new role at TGH. Moving to TGH represents a return to what I love most—academic medicine. I got my start in academic medicine with Massachusetts General Hospital and working within that model is where my passion lies and what gets me the most excited and motivated.

TGH is an incredible institution run by an amazing team with an illustrious history and deep, deep roots in the community. I feel privileged that I am able to work with this group of people. Everyone from those in senior leadership to the trustees, to the team members and physicians.

For those of you not familiar with the hospital, it is truly world-class and one of the leading medical institutions in Florida and the southeastt. It is home of one of the leading organ transplant centers in the United States. It contains one of only four burn units in Florida and is the only level one trauma center on the West Coast of Florida—transporting patients from all over the region via medical helicopter to receive life-saving care. Finally, it is the primary teaching affiliate of the University of South Florida’s Health Morsani college (USF).

My first task after joining the organization will be to listen—to team members, to physicians, to patients and community members and to learn from them. I plan to immerse myself in all levels of the organization and in its culture in order to truly understand all aspects of the hospital from its successes to its challenges. I also want to understand both quality and patient satisfaction metrics. I believe wholeheartedly that in order to lead effectively you must learn and listen first.

There are also countless people in Tampa who rely on the hospital for their care and well-being. In order to best serve the community, I will spend time getting to know everyone involved—reaching out to its business leaders, its civic leaders, its government officials and its citizens.

In addition, one of the hallmarks of TGH is its relationship and collaboration with USF. This relationship is critical to the current and future success of the hospital and I plan on spending significant time working with our USF partners and physicians to not only understand the great things that they are doing, but also to understand where they want to go in the years to come. We can’t lose sight of the rich history TGH has with its local community physicians so we need to continue engaging and supporting them as well.

Once I have spent time learning and listening, I will begin to work with the trustees and the entire team to develop a strategic plan for the future. Together we will map out the vision and objectives for the next three, five and ten years of TGH. At the end of the day, my goal is to help TGH deliver the highest possible quality care that is met with the highest satisfaction ratings from its patients.

Since I first stepped into TGH, I was blown away by the quality and level of care they provide as well as the world-class programs it offers. I cannot wait to get started and to help drive that tradition of excellence further. I know the best days of the hospital are ahead of us as we lead not only the region but the state of Florida in medical excellence.

CON Quality

As you read in my most recent blog post, Florida State Senator Rob Bradley recently introduced legislation (SB 676) which seeks to repeal the Certificate of Need program. This is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services here in Florida. In my opinion, it’s not good news for the consumer because deregulation of CON has the potential to not only increase cost but lead to a decrease in the accessibility and quality of health care in our state.

The reality is that there are significant benefits to the consumer to keeping CON, the most notable one being elevating the quality of patient care. While there is no direct correlation to the presence of CON and high quality of care, the fact remains that with CON in place, hospitals are more likely to perform a greater number of a specific procedure due to increased volume among fewer hospitals. And it is well-documented through extensive research that the more times a hospital performs a certain procedure, the better the outcomes. 

For example, when choosing a hospital for neuro surgery, wouldn’t you want to select the hospital with the most experience — the one that does the procedure multiple times a day as opposed to once a week or once month? CON helps ensure that hospitals with a depth and breadth of experience in various procedures are available in your community.

CON also limits the creation of unnecessary service offerings — as hospitals do not have free reign to offer services whose need cannot be demonstrated — and helps ensure that the services are targeted and focused on what the community actually needs. Again, this means that CON elevates the quality of care the consumer experiences in their own backyard.

But it is not just Florida where CON helps drive the quality of patient care. As Steve Baumert and Marie Knedler, both CEOs of nonprofit hospitals in Iowa—a state with one of the highest-quality, lowest-cost health care systems in the country—explain in a recent op ed advocating for CON to remain in effect in their state, CON also contributes to the quality of patient care by “support(ing) the collaborative spirit that fosters communication and cooperation among Iowa health care providers, which, again, leads to better health care for everyone.

And because I believe we must do what is best for the consumer, I am continuing to advocate for our legislators to put together a statewide “blue ribbon” working group comprised of legislators, health care leaders, physicians, medical professionals and patient advocates. The mission of this group will be simple: to come together, roll up its collective sleeves and work toward providing the highest quality and most affordable health care for this State’s most precious resource — Floridians.

Finally, if you are concerned about how the deregulation of CON and specifically, Senate Bill (SB 676) will affect your access to high quality and affordable health care and if you want to see a panel put together to work on this problem, I encourage to reach out to legislators and make your voice heard.

Like what you read? Want to keep in touch? Please connectwith me on LinkedIn. 

No Place for Health Care in a Free Market Economy

Last week, Florida State Senator Rob Bradley, State Senator Rob Bradley  introduced legislation (SB 676) which seeks to repeal the Certificate of Need program here in Florida. Despite the potential for an increase in cost and decrease in quality, that would come with deregulation, Governor Rick Scott has expressed his support of the legislation.

As I have explained in my previous posts, the Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

As you also know, I oppose the deregulation of CON, in particular as it relates to the creation and expansion of inpatient care. I have outlined in significant detail the negative effects deregulation of CON would have in previous posts but in short, I believe it will have a negative impact on cost, quality and access to health care in our state. However, Senator Bradley, Governor Scott, and those who support the elimination of CON believe that free market forces will improve quality while lowering costs.

And while I staunchly believe in free market economics, the reality is that health care does not operate in a free market space. In a free market economy, prices, quality and quantity of goods and services are determined by the open market and consumers.  In addition, the government imposes very little - if any - restrictions and regulations on the forces of supply and demand that drive the costs of goods and services.

Hospital pricing cannot be determined by a free market system because a hospital cannot set their own pricing for services. Hospitals are reimbursed for services based on rates established by the Centers for Medicare and Medicaid and thus, must work with insurance providers and government agencies to negotiate wholesale pricing. In addition, hospitals cannot provide or deny services based on a patient’s ability to pay, making the system of supply and demand irrelevant. For example, if a patient comes to the ER requiring stiches, federal law requires that they be treated even if they do not have insurance or the money to cover the cost of the treatment they received.

Additionally, hospital and health care pricing is also incredibly complicated and there is a scarcity of price information out there for consumers. This makes shopping for certain types of health care services incredibly difficult and many times, consumers won’t know exactly what they owe for a procedure until they get the bill. There also tends to be significant variety in pricing from provider to provider and cost does not always directly correlate to quality. This is yet another complication when it comes to health care in a free market space.

When new hospitals come into the region due to deregulation, they will look to compete for patients with insurance coverage or the financial means to pay for their own care. And so, while I am a big believer in free market economics and know the positive effects it has on many sectors of our economy, free market economics and deregulation simply don’t work when it comes to health care. Despite the belief of those who support the legislation, it will drive up costs and decrease quality. Take it from someone who has been working to provide quality health care to the consumer for the past 20 years.

And so what, now? As I have said before, I think here in Florida we can buck the trend, put party politics and ideology aside and come together in the spirit of doing the right thing for our State when it comes to access to high quality and affordable health care. I don’t think we need to rush bills into the legislature but instead, we can sit down at the same table and thoughtfully and engage with each other to work towards a positive outcome that puts consumers and our neighbors first.

It is in this spirit that I want to challenge our legislators to put together a statewide “blue ribbon” working group comprised of legislators, health care leaders, physicians, medical professionals and patient advocates. This mission of this group will be simple: to come together, roll up its collective sleeves and work toward providing the highest quality and most affordable health care for this State’s most precious resource—Floridians.

Finally, if you are concerned about how the deregulation of CON and specifically, Senate Bill (SB 676) will affect your access to high quality and affordable health care, I encourage to reach out to your legislators and make your voice heard.

Like what you read? Want to keep in touch? Please connect with me on LinkedIn.