Last week the Palm Coast City Council voted 4-1 to send a letter voicing strong opposition to a bill Rep. Paul Renner is co-sponsoring. House Bill 145 would expand the use of surgical recovery centers and create a new category of recovery care centers. Hospitals, including Florida Hospital Flagler, oppose the measure, seeing it as enabling competition through lesser standards of care. The city chose to side with its hospital.
“Do we have any feedback on whether this bill is going to die on the floor or not?” Palm Coast City Council member Nick Klufas asked just before the vote. “Because it may be a poor utilization of our strategery.” (It’s not clear if he meant the word derisively, as is usually the case when using a word first used by Will Ferrell in a Saturday Night Live skit ridiculing George W. Bush).
“On this one the feedback is that it’s going nowhere,” City Manager Jim Landon predicted.
Today, however, the bill started going somewhere, but in vastly different form: an amended version of its companion bill easily cleared its first Senate committee. The four previous years’ version of that bill had made it through the House, but had never managed to get support in the Senate. This time, support is there, starting with the Senate Health Policy Committee, on which Flagler’s legislator, Sen. Travis Hutson, serves.
The committee supported an expansion of the amount of time a patient may stay in a so-called ambulatory care center. Those centers are not part of a hospital. They provide elective surgical care such as cataract surgery and colonoscopies, two of the most common procedures performed at those centers. In 12 months ending in June 2015, there were 3 million visits to Florida’s 432 licensed ambulatory care centers.
Currently patients are forbidden from staying overnight, so if they show up in the evening, they must be gone within a few hours. The bill that passed the committee today allows them to stay in a recovery center for up to 24 hours, regardless of when they show up.
But the Senate Health Policy Committee lobotomized the rest of the bill. It had called for the creation of so-called Recovery Care Centers, a new class of post-surgical health care facilities that hospitals strongly oppose. Such recovery centers would have allowed patients to spend up to 72 hours in post-surgical recovery facilities outside of hospitals, at presumably lesser cost. Hospitals (and Palm Coast) are opposed because, they say, the standard of care would be lower, and such recovery centers would be under no obligation to accept patients without insurance or Medicaid patients, thus ultimately costing hospitals much more by having to provide care to those patients.
The recovery care center provision is still in the House version of the bill. But the amended bill introduced by Sen. Dana Young, who chairs the Health Policy Committee, eliminates all references to recovery care centers. That amendment was adopted without objection. It essentially means that the recovery care center proposal is dead this year, even if, once again, it makes it through the house—assuming a last-minute revival of the proposal doesn’t get slipped into the reconciled version of the bill, should two separate versions pass the two chambers and end up in conference.
“I’ve spoken to Travis Hutson about his level of support is for this, his is not as much as Representative Renner’s,” Mayor Milissa Holland said last week.
That may be so. But Hutson this morning found a way not to vote: before the committee took its 4-1 vote on the bill, Hutson had slipped out. (It’s not clear if he was still in the committee room when the amendment was adopted; there was no recorded vote on the amendment.) When his name was called out for the vote, there was silence. (The bill passed with the bi-partisan support of two Democrats and two Republicans, and two Republicans absent.
David Ashburn, general counsel for the Florida Hospital Association, still spoke in opposition of the amended bill. “We are grateful for the amendment to the bill,” Ashburn said. “We think it’s an improvement. However we still have concerns about the 24-hour stay for patients in an amb-surg center, and we oppose that provision.”
Paul Bruning, a physician and the chief operating officer for the Tallahassee Orthopedic Clinic, said “this is not trying to make ASCs hospitals,” referring to ambulatory surgical centers. “This is about patient care. It’s about the cost of care. In the staff report, you’ll see that ASCs can provide the same level of care as hospitals for many surgical procedures at a significantly lower cost of care. This isn’t trying to keep patients for 24 hours. It’s about being able to extend pour operating day later in the day. Right now our last surgery can be scheduled around 3, 4 o’clock p.m., because it takes different people different periods of time to recover from anesthesia. Right now, the arbitrary midnight rule means that if we have a patient there at the stroke of midnight, we have to transport them by ambulance to a hospital for no other reason than it’s midnight and they might turn into a pumpkin.”
The Palm Coast City Council letter opposing the bill addressed the House version’s recovery care centers specifically, leaving silent the proposal to expand ambulatory care centers. The 4-1 vote reflected opposition by councilman Steve Nobile.
“As far as strategy goes,” Mayor Milissa Holland said, “we’re not losing anything by doing this, it’s actually supporting our local hospital, but it’s not going to hurt us politically.” The House version passed two committees.