Lawmakers refused Tuesday to lift a cap on the number of trauma centers in Florida, while also siding with hospitals in a dispute about contracting with managed-care plans.
The House eliminated parts of an omnibus health-care bill that dealt with both of the issues, which have been closely watched by hospital lobbyists. A Senate subcommittee also went along with hospitals on the contracting issue.
The bill (HB 1419) would have overhauled a process that the state Department of Health uses in approving trauma centers, including eliminating a cap of 44 trauma centers across Florida.
That process has been in the middle of a months-long legal fight that has pitted four Jacksonville and Tampa Bay-area hospitals against new trauma centers in Clay, Pasco and Manatee counties. If lawmakers had approved the proposal in HB 1419, it likely would have become easier to open trauma centers in the state.
Rep. Fred Costello, an Ormond Beach Republican who supported removing the trauma-center changes from the bill, said competition might normally be a good thing, but "trauma centers are different,'' because there aren't enough physician specialists to staff new facilities that might open.
"Quantity does not make quality," said Costello, a dentist. "We need to focus on what will give us the highest quality."
But Rep. Matt Gaetz, R-Fort Walton Beach, said private investors are willing to build new trauma centers, which are needed in some areas of the state.
"Is it really government's job, in a patronizing way, to say yes or no?" Gaetz asked. "Let's not let government get in the way of good health care."
State law includes a cap of 44 trauma centers and gives the Department of Health power to determine how many should be allowed in 19 different regions of the state. The bill would have eliminated the cap and other department rule-making powers involved in deciding whether trauma centers should open.
The hospital chain HCA is working with the University of South Florida to add trauma centers in various parts of the state, though an HCA attorney said last week that the company had not taken a position on HB 1419.
The long-running legal dispute involves HCA's decision to open trauma centers at Orange Park Medical Center in Clay County, Regional Medical Center Bayonet Point in Pasco County and Blake Medical Center in Manatee County. The Department of Health allowed the trauma centers to open despite opposition from Shands Jacksonville Medical Center, Tampa General Hospital, St. Joseph's Hospital in Tampa and Bayfront Medical Center in St. Petersburg --- all of which operate trauma centers.
The House voted 62-51 to eliminate the trauma center changes from HB 1419, which could come up for a final vote Wednesday.
Also, the House voted 65-44 to kill a proposed change that hospitals said would have forced them to contract with managed-care plans. The same change also was rejected Tuesday in the Senate Health and Human Services Appropriations Subcommittee.
Supporters said the change would help as the state gets ready to move to a statewide Medicaid managed-care system. That system will limit the number of Medicaid managed-care plans in various regions of the state, with the winning plans selected through what is known as an "invitation to negotiate" process.
Senate Health Regulation Chairman Rene Garcia, a supporter of the change, said requiring hospitals to contract with managed-care plans could help position more HMOs to compete for the limited number of spots in the Medicaid managed-care system. Ultimately, the managed-care plans in the new system will need to have contracts with hospitals.
"Why not allow it to happen beforehand to make sure we have more plans participating in the ITN (invitation to negotiate) process?" Garcia asked.
But critics said the state should not force contracting decisions and that the change would penalize HMOs that have already negotiated contracts with hospitals. Paul Belcher, a senior vice president with the Florida Hospital Association, told the Senate panel that hospitals already have more than 1,300 contracts with managed-care plans.
"We don't support mandated contracting,'' said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, which represents hospitals that serve large numbers of low-income patients. "We believe that it unlevels the playing field between hospitals and certain insurance companies."