Amid a new wave of legal battles about hospital projects, Gov. Rick Scott on Tuesday called for eliminating key regulations about building health-care facilities and opening trauma centers.
Scott said he wants to eliminate what is known as the "certificate of need" process for building hospitals, nursing homes and hospice facilities and also get rid of a limit on the number of trauma centers scattered across the state. Both proposals deal with issues that have sparked years of political and legal battles in the health-care industry, often pitting competing hospitals against each other.
The governor, a former health-care executive, has taken a free-market approach in recent years to regulatory issues in the industry. But the announcement Tuesday appeared to go further by seeking to eliminate certificates of need for nursing homes and hospice facilities --- along with hospitals --- and by calling for the end of the longstanding limit on trauma centers.
State Rep. Alex Miller, R-Sarasota, filed a bill (HB 7) on Monday that largely mirrors Scott's position on the certificate-of-need process. The bill will be considered during the legislative session that starts March 7.
"This session, I want to fight to make the health-care system fair for families and ensure health care works for patients and not for hospitals' bottom lines," Scott said in a prepared statement. "I will champion legislation that will repeal the outdated certificate of need program, repeal the cap on trauma centers and ensure transparent and upfront pricing for patients."
House Republican leaders have sought in the past to repeal the certificate-of-need process but have not been able to get the Senate to go along. Miller's bill and any attempt to eliminate the statewide cap of 44 trauma centers likely will touch off lobbying and political fights, with the potential changes affecting major players in the health-care industry.
Under the certificate-of-need process, the state Agency for Health Care Administration reviews proposed health-care projects and determines whether they should be allowed to move forward.
Some parts of the hospital industry have favored eliminating the process, saying such a move could help expand access to health care and create more competition. But other parts of the industry, including many public and safety-net hospitals, have opposed the idea. Opponents argue, in part that eliminating certificates of need would lead to hospitals being built in affluent areas, while older safety-net hospitals would be left to treat low-income and uninsured patients.
The regulatory process often leads to legal battles, as evidenced by a flood of filings in recent days in the state Division of Administrative Hearings. At least nine cases have been filed, including five that involve challenges to the Agency for Health Care Administration's preliminary approvals of certificates of need in southern Sarasota County for projects planned by Sarasota Memorial Hospital and Venice Regional Bayfront Health.
Two of the other cases involve hospitals that received preliminary approval for Orange County, including one hospital that is planned to be affiliated with the University of Central Florida. Another challenge involves a planned hospital in Marion County, while another involves a challenge to the Agency for Health Care Administration's denial of a certificate of need for a small hospital in Gilchrist County.
Disputes about opening new trauma centers also have led to repeated legal battles in recent years. State law has limited the overall number of trauma centers statewide, along with placing restrictions on how many of the facilities can be opened in different regions of the state.
Supporters of building more trauma centers contend, in part, that they can help make emergency care more accessible for people with severe injuries. But critics of easing the limits on trauma centers say the facilities are costly to operate and require highly trained medical staffs. They contend that adding new facilities can siphon patients and staff from existing trauma centers.
