BY DEBORAH BALSHEM

One day after the start of the 2007 Florida Legislative Session, U.S. Senator Mel Martinez (R-FL) introduced a bill to protect $4.6 billion in Medicaid funds for Florida hospitals. The legislation seeks a two-year moratorium on the implementation of a proposed Centers for Medicare & Medicaid Services (CMS) rule that, if approved, would cut hospital payments by more than $932 million a year.

"CMS is trying to enact a rule that will financially crush our hospitals. The impact will be severe and devastating," Martinez said. "This proposal will ensure Florida's hospitals can continue providing services to the most vulnerable families seeking care."

The proposed rule would limit which state entities can contribute to the nonfederal share of payments for Florida's Low Income Pool (LIP), which provides special Medicaid payments to Florida hospitals and nursing homes serving as "safety-net" providers for the uninsured and underinsured.

The restrictions would dramatically reduce the "pool" of eligible entities that draw federal match dollars, and require funding be derived directly from tax revenues. It also would put constraints on which private hospitals can dip into the well.

Martinez's bill seeks to place the moratorium on CMS's implementation of this proposed rule so that further study can take place to determine the extent of any negative impact on states–particularly those with Medicaid or State Children's Health Insurance Programs.

"This legislation is welcome news to Florida's hospital community," said Wayne NeSmith, president of the Florida Hospital Association. "Senator Martinez's bill prevents a financial tidal wave from overcoming our state's hospitals. The CMS proposal would devastate our healthcare system if allowed to become law and we are grateful for his commitment to protect our patients and the communities we serve."

At the time of this article, the bill, SB787, was referred to the Finance Committee for review.

A sticky situation
Also advancing is HB543/SB2022, which allows pharmacists to administer a variety of immunizations in addition to the "flu shot." These include diphtheria, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, pneumococcal, meningococcal and others.

At its heart, the bill would allow Florida pharmacists to immunize patients under a voluntarily-entered, written protocol with a physician outlining the scope, terms and conditions pursuant to which the pharmacist can offer immunization services.

In order to provide these additional vaccinations, the bill requires pharmacists to:
· maintain at least $200,000 of professional liability insurance;
· enter into a supervisory protocol with a physician or public health department;
· have written approval to administer flu vaccines from the pharmacy center;
· have received training and immunization certification approved by the Board of Pharmacy (BOP) in consultation with the Board of Medicine; and
· have 20 hours of continuing education classes approved by the BOP, instruction in safe and effective administration of immunizations, and instruction in potential allergic reactions to immunizations.
"The proposed requirements … do not provide the protections needed for Florida patients. The practice setting of pharmacists is not adequately set up to allow them to administer immunizations safely," said Francie Plendl, director of governmental affairs for the Florida Medical Association (FMA). "Pharmacists are trained and licensed to compound and dispense drugs. They are not trained to diagnose conditions and initiate appropriate treatment."

But according to Michael Jackson, RPh, executive vice president and CEO of the Florida Pharmacy Association (FPA), the purpose of this legislation is to increase patient access to preventive healthcare and, thereby, reduce patient illness in Florida.

"It is not designed to allow pharmacists to treat patients for any illness. It is designed to prevent unnecessary death, hospitalization or expensive treatment for completely unnecessary and avoidable illness," he stated. "This is accomplished by increasing patient access to preventative care at the healthcare delivery outlet they visit most–their community pharmacy."

The FMA claims there is no indication that patients in Florida are under-vaccinated or are having trouble finding a practitioner from whom to receive a vaccine. "This is not an access issue," Plendl maintained, adding that the immunizations a pharmacist would be allowed to administer can result in serious complications that a pharmacist is not prepared to identify or address.

"There is some concern that pharmacists are not qualified and trained for this, when in fact, they are uniquely qualified," Jackson countered. "Pharmacists go to school a minimum of six years and have extensive training in life sciences. Many go on to do residencies and fellowships as well. Plus, with the additional requirements under the legislation, they are clearly capable."

Majority rules
Currently, 44 states allow pharmacists to immunize patients, including all states in the southeast (see map). More than 2,500 pharmacists in the United States have been certified to immunize patients, and more than five million immunizations have been administered by pharmacists across the country without even one adverse incident reported, according to statistics provided by the FPA.

Still, FMA believes the less cooks in the kitchen, the better. "Currently, nurses can provide vaccinations in pharmacies as well. So there's no shortage of providers who can administer vaccinations," Plendl noted. "There's no reason to add another group that has no hands-on treatment experience with patients."

The reality, though, according to Jackson, is that–particularly in rural areas–"physician offices just do not offer immunizations anymore and patient access to immunization would be dramatically increased if immunizations were offered in pharmacies all the time, not just for a two-hour period once a season when a visiting nurse is in the pharmacy."

At press time, the bill had advanced to committee in both the House and Senate.