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Lawmakers Offer Ideas to Meet Health Demands

December 4, 2013 - 6:00pm

Pointing to concerns about meeting the state's growing health-care demands, key House Republicans said Thursday they will pursue expanding the use of telemedicine and possibly giving more authority to nurse practitioners.

Rep. Travis Cummings, R-Orange Park, said during a Florida Chamber of Commerce health-care webinar that he is working on a bill that could bolster telemedicine, which uses online technology to link patients with physicians and other health-care providers for treatment.

Also, Rep. Jose Oliva, a Miami Lakes Republican who is chairman of the House Select Committee on Health Care Work Force Innovation, said lawmakers will look at giving advanced registered nurse practitioners more autonomy in providing primary-care without the supervision of physicians -- long a controversial issue.

House leaders say they are concerned about a combination of factors that could make it harder to meet increased demands for care. That includes a growing state population, aging baby boomers and primary-care doctors and nurses who, overall, are getting older.

"We have a demographic change which is giving us an aging population and a shrinking workforce,'' said Rep. Cary Pigman, an Avon Park Republican and physician who also took part in the chamber webinar.

The telemedicine and nurse-practitioner ideas, however, likely will draw heavy debate and lobbying during the 2014 legislative session. The powerful Florida Medical Association, for example, has fought previous proposals to allow advanced registered nurse practitioners to provide primary-care services without physician supervision.

Erin VanSickle, the FMA's vice president of communications, said in an email Thursday that "expanded collaboration" is part of an FMA plan to expand patients' access to care.

"We can all agree that turning nurses into de facto doctors overnight is not going solve the primary care access issue, especially since there is also a shortage of nurses in Florida,'' VanSickle said. "We need more nurses, and we need them collaborating very closely with physicians."

But Oliva said nurse practitioners already are providing primary-care services in many places, particularly in rural areas. While state law requires nurse practitioners to be under the supervision of doctors, sometimes they work out of separate offices.

Oliva said giving nurse practitioners more autonomy could allow them to practice to the full extent of their training. But he acknowledged the difficulties in dealing with such issues, saying there is a "tremendous political challenge to this."

Cummings, meanwhile, indicated he will sidestep what could be the most politically volatile issue in discussions about expanding telemedicine. Unlike two other telemedicine bills that have already been filed in the House and Senate, Cummings said his proposal will not require insurers to pay the same amounts for services that are provided through telemedicine or in doctors' offices -- a payment concept known as "parity."

A member of Oliva's select committee, Cummings said he thinks reimbursement rates should be negotiated between providers and insurers. He said he doesnt think the Legislature will require a "mandate" on reimbursements.

With the House select committee already meeting, it appears that lawmakers will focus during the upcoming session on issues about preparing for Florida's future health-care needs.

The Florida Chamber of Commerce, an influential lobby, has not released its agenda for the session but is looking at issues such as telemedicine and expanding the authority of nurse practitioners to help meet health-care needs.

Dave Christian, the chamber's vice president of governmental affairs, said the business group is focused on three health-care priorities: controlling health-care costs, improving access to care and making care more affordable.

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