Under fire from lawmakers, the Florida Department of Health has proposed a sweeping plan to reorganize — and shrink — its operations. Among other things, it would move the state out of the primary-care business.
The recommendations, released in a 154-page report late Tuesday afternoon, call for cutting 1,608 department jobs and consolidating dozens of divisions and bureaus. One of the proposals would buck the powerful doctors’ lobby by lifting a requirement that the department secretary be a physician.
“The department requires an agency head with strong leadership and operational management skills to plan, direct, coordinate, and execute the powers, duties, and functions vested in the department,” the report said.
The reorganization would lead to many department duties being shifted to other state agencies, privatized or eliminated altogether.
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In one major change, the report calls for the state to stop paying for primary-care services at county health departments. The proposal would save about $22.3 million and comes as some state officials want to rely more on federally qualified health centers to provide primary care.
In another big change, the report calls for contracting with a private company to run at least part of the Children’s Medical Services program. CMS serves children who have a variety of serious medical conditions.
[Patrick Johnson, administrator of the Flagler County Health Department, had not yet fully digested the report Wednesday morning, but said its impact may be limited for two reasons: Medicaid reimbursement rates have not yet been set, and won’t be set until the Legislature meets later this month. Those rates enable the department to provide most of its services, including primary care. And two local job reductions that may be required according to the state plan may be taken care of by attrition. “One position we have vacant, and has been vacant–that’s easy to eliminate,” Johnson said. “Another, we had another person resign and move on to another employment last week.” The local health department had 66 positions. From his reading of the report so far, Johnson said, “quite a bit of it doesn’t impact us.” He’ll be meeting Thursday with state officials to further gauge the report’s impact.]
State lawmakers last year required the department to conduct a review of its operations and come up with recommendations for possible changes. House leaders, in particular, have been highly critical of the department, contending that it is unfocused and has taken on too many roles over the years.
While the department worked on the recommendations, new Gov. Rick Scott’s transition team also issued a blistering appraisal of the agency. Some of the transition team’s recommendations — such as moving away from primary care and allowing a non-physician to serve as department secretary — are evident in the report.
But many public-health advocates have worried that changes in the department would go too far. As an example, they expressed repeated concerns last year that changes would gut prevention and education programs.
The report calls for making major changes in the department’s organizational chart, going from 11 divisions to six and 50 bureaus to 18. Programs would be moved around to fit under the new framework.
Also, many programs would be moved to other state agencies, including the Department of Children and Families, the Department of Environmental Protection and the Agency for Health Care Administration.
Other programs would be farmed out to private contractors or see their funding disappear. Many of the programs targeted for elimination serve only specific geographic areas of the state.
But some cuts would have broader reach, such as the proposed elimination of $4.8 million for the Area Health Education Centers Network, which is involved in anti-smoking programs. The report says the so-called AHECs could pursue other sources of money.
In all, the report calls for eliminating 1,608 department jobs, though at least 180 would shift to other state agencies. It was not immediately clear Tuesday how many of the targeted jobs might be vacant.
Lawmakers required the department to submit the report by Tuesday, a week before the start of the 2011 legislative session. That would provide time for the Legislature to consider changes this year.
Scott’s transition team went further than the report’s recommendations and called for a merger of the department with the Agency for Health Care Administration. Scott administration officials have said the idea is still being considered, though lawmakers have not publicly taken it up.
–Jim Saunders, Health News Florida