CON Reforms, Direct Primary Care Head To House Floor

Jan 22, 2018

The Florida House is ready to take up two familiar healthcare reform measures Wednesday. Supporters say both bills will make care more accessible and more affordable. The plans face uphill battles in the Senate.

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For years, House lawmakers have been trying to codify direct primary care agreements. It’s sort of like a healthcare membership. Subscribers pay a set monthly fee directly to a primary care doc in exchange for a slate of basic services. It cuts out the insurance companies and the middle men, and puts doctors closer to their patients. That’s according to bill sponsor Danny Burgess, a Zephyrhills Republican Representative.

“This is just highlighting it as a choice in healthcare for patients and providers. Something that Dr. Kumar told me once is that this also puts the joy back into the practice of medicine. I thought that was pretty interesting and insightful. And I hope we can help do this for practitioners, allow them to spend more time with their patients,” Burgess said.

Dozens of states across the country have recognized these agreements. House Bill 37 would help define what these plans are and what they’re not. Chris Nuland is with the Florida Chapter of the American College of Physicians.

“The reason this bill is necessary is that under current law, the way OIR interprets the current law, you cannot have a monthly payment to your primary care physician to take care of you. It’s considered insurance and you have be licensed by the insurance code. As far as what this bill does, it actually provides a series of protections for the patient who goes into this arrangement so they know what they’re getting and they know what they’re not getting,” Nuland said.

Direct primary care is not insurance, and supporters say it’s not supposed to be. But for some patients it could be a more affordable way to get regular checkups and basic testing and screenings. The plan got overwhelming support at its one committee stop, a signal it’s on a fast track for passage. Still, the bill has fallen through the cracks in past years, Burgess admits.

“Hopefully this year we’ll get it across the finish line,” Burgess said.

The other healthcare change lawmakers are slated to take up on Wednesday has to do with certificates of need. Right now, certain providers have to have state approval before they build a new hospital, expand a rehab program or perform open heart surgery or organ transplants. Application fees for this process can cost up to $50,000. 

Supporters say available services should track a community’s needs, in order to keep costs down. But Fort Myers Republican Representative Heather Fitzenhagen wants to change that.

HB 27 simply eliminates the need for a certificate of need for hospitals. Removing the CON requirement will remove barriers to entry and increase competition resulting in more accessible care and reduced prices,” Fitzenhagen said.

For years, lawmakers have tried to tweak one aspect of the CON process or another, largely unsuccessfully.

Under Fitzenhagen’s bill, hospitals would still have to work with state regulators on licensing; they just wouldn’t have to prove a need for their services before building.

“What we’re doing is we’re eliminating the restrictions where we say can you open a new hospital or not. It’s not for us to say. It’s for the community demand to say, and it’s for the company that is the hospital business to say whether or not they find it feasible to serve the community need,” Fitzenhagen said.

But those in favor of regulation say free market forces don’t really work in healthcare. A car crash victim isn’t in the position to shop around for the best deal. And Fort Lauderdale Democrat Bobby Dubose is worried the change could pull staff, resources and paying patients away from hospitals that depend on them.

“There are times when competition isn’t always great in certain communities, and there have been I guess cherry picking that may result. Especially in these areas where you may have safety net hospitals, there’s potential for that,” Dubose said.

But Fitzenhagen says state regulators would ensure care is available for low income patients.

While the House has overwhelmingly passed versions of both bills in past years, neither got traction in the Senate. It remains to be seen if 2018 will be any different.