As he looks ahead to 2016, Ken Peach, executive director of the Health Council of East Central Florida (HCECF), is concerned about increasing access to primary care.
"If there's not a way to increase access, we're going to be in trouble," he said.
The private, non-profit healthcare planning agency serves the four-county region of Brevard, Orange, Osceola and Seminole.
Three key legislative issues the organization would like to see progress on are all models that can increase access to primary care. That's where its focus has been, according to Peach.
"Because of the last short legislative session, we're focused on the same issues this year as last year," said Peach.
First, the Florida House is hearing a bill, which will significantly expand nurses' scope of practice. This bill does the following:
- Allows ARNPs to administer, dispense and prescribe controlled substances and narcotics.
- Allows nurse practitioners to practice independently without any physician supervision.
"The expanded scope of practice is so clinicians can practice at the so-called 'top of their license,' as our state faces a shortage of physicians by 2020," said Peach.
Florida will also attempt to move forward again with telehealth parity legislation. This would prohibit private insurance plans, Medicaid fee-for-service and managed care plan from denying services provided via telehealth.
"With telehealth payment parity, physicians may be reimbursed for the time they spend with a patient either in-person or face-to-face using telehealth," Peach explained.
Chris Chowquan, founder of Miami-based Healthchat, a mobile app that allows patients and their doctors to communicate with each other using short, 30-second video messages, believes that telehealth parity legislation should be a priority for the legislature in 2016.
"From Healthchat's perspective, the healthcare issue the state legislature should prioritize next is reimbursement for telemedicine," said Chowquan.
Chowan said to address shortages of nurses and physicians, and to reduce overall care delivery costs, the healthcare industry needs to more readily embrace telemedicine options.
"And physicians must be reimbursed for these patient encounters to accelerate widespread adoption," he added.
Finally, HCECF is watching legislation regarding direct primary care (DPC). The legislation specifies that DPC agreements permit physician offices to offer their health services without falling under state insurance regulations. Rep. Fred Costello (R-Ormond Beach) renewed efforts in August to help clear the way for doctors and patients to enter into DPC arrangements. Costello pre-filed a bill (HB 37) that will be considered during the 2016 legislative session.
This would free doctors and patients from the onerous requirements and regulations under the state insurance code. The bill would make clear that the agreements aren't regulated by state insurance laws. In this fee-for-service model, patients would pay the physician office a fixed monthly fee for all care received, which means that insurance is typically not part of the mix.
Earlier in the year, Garrison Bliss, MD, co-founder of a successful direct primary care practice called Qliance and chairman of the Direct Primary Care Coalition, was part of a panel that provided members of the House Subcommittee on Health Innovation a primer on DPC.
Bliss told the subcommittee that although primary care doctors are usually the lowest paid providers, they can play a critical role in transforming the healthcare delivery system and to help expand access to care under the Affordable Care Act. Not only could DPC achieve superior health outcomes, but Bliss mentioned that it can also lower costs and enhance the patient experience.
Peach said that HCECF sees DPC agreements as a real solution and a different approach to healthcare.
"From our standpoint, direct primary care really changes the parameters," said Peach. "This would lower the cost of healthcare by allowing patients to purchase primary care directly from the medical office with a catastrophic health insurance policy in place for major expenses."