Jan 23, 2012

Senator Joe Negron won't take "the easy way out" to balance budget

Sen. Joe Negron speaks at a press conference at the Capitol.

Gov. Rick Scott's proposed budget trimmed reimbursements to hospitals by $1.8 billion but there are growing signs that the Legislature is loathe to cut institutional providers that hard.

Sen. Joe Negron, chairman of the Senate Budget Subcommittee on Health and Human Services Appropriations, said on Thursday he's tired of "taking the easy way out" and doesn't plan on making flat across-the-board percentage cuts to facilities.

Though the Senate has not distributed any budget allocations Negron told his committee he is expecting to have to trim about $850 million from general revenue in the Health and Human Services budget that his committee will be working on next week.

The Palm City Republican said that traditionally there have been cuts to hospitals and nursing homes and hospice, all of which trickle down to reductions in managed care plans. He plans to avoid that at all costs this year.

"I'm going to be very resistant to just taking the easy way out," said Negron who continued,"There's a saying in the Bible, a laborer is worthy of his hire. And I really believe that."

Negron said the Legislature has "unilaterally" made cuts to hospitals, which have federal requirements to take care of the uninsured who show up at emergency rooms.

"At some point, it really gets to where we are almost demanding servitude for people who have contracts with the state. And all that does is shift cost to other people and I don't think that's responsible budgeting."

Sen. Don Gaetz, R-Destin, agreed with Negron saying "I don't have the stomach for assuming everything and everybody is providing equal value."

To avoid making reductions in reimbursement rates Negron compiled a nine-page list of programs that Florida Medicaid offers but isn't mandated to do so. The list also includes what he said are prevention and education program in the Agency for Health Care Administrations, the Department of Elder Affairs, the Department of Children and Families, Health and the Agency for Persons with Disabilities.

He distributed the list -- as well as accompanying budget language that explained the programs. For his part, Negron identified four programs on the list he would like to see eliminated, including privatizing AG Holley Tuberculosis Hospital, which Negron says is so old it looks like something out of a black-and-white movie.

Also included on the list were prevention programs at DOEA designed to keep people out of nursing homes, and mental health and substance abuse prevention programs.

"This isn't an academic exercise," Negron said, stressing that he doesn't want to reduce all the programs on the list, he just wants the committee to consider them all. " I want to force us to consider for today not having to cut reimbursement rates."

Scott's budget turns upside down hospital reimbursements by initiating rating bands for facilities, which would be a net reduction to hospitals of $1.8 billion. Scott defended the approach by saying that current reimbursements vary greatly even among hospitals that are located in the same area.

Negron said he's concerned that the general revenue savings -- or state share -- of the savings is just $388 million.

As an alternative to that approach Negron had Gaetz -- a former hospital administrator explain the concept of DRGs, diagnostic related groups.

DRGs are used in Medicare and pay based on the patient's diagnosis. Medicaid in Florida pays hospitals for its costs.

Gaetz said Florida could transition to a DRG system, but that Medicaid officials say it could take from three months to two years to initiate and as much as $3 million to actually implement.

Gaetz said a DRG system "begins to get at the inequities" in Medicaid reimbursements.

"It's simply is a way of identifying patients based on reason and paying hospital based on the complexity of what they do.,'' he said. "That, then, provides the hospitals with some norms."

Meanwhile in a memo to his members House Speaker Dean Cannon, R-Winter Park, said the House budget will continue to work toward a simplified hospital funding model, consistent with the Florida Medicaid reform enacted into law last year, recognizing that this effort will require more time-consuming, meticulous work and the investment of stakeholders. A state study of DRGs was included in last year’s sweeping Medicaid rewrite, that placed most Medicaid patients in Florida—from the cradle to the grave—into managed care.

Senate Minority Leader Nan Rich, D-Sunrise, expressed concerns with the cuts saying the committee is asked annually to make reduction. “I wish one year that we could look at some loopholes in our tax structure.”
Story by: thefloridacurrent.com - Reporter Christine Jordan Sexton can be reached at csexton@thefloridacurrent.com.