Trauma center, certificate of need bills die in Legislature again

This was the year that Gov. Rick Scott and Republicans in the Florida Legislature delivered on all their talk about opening up competition in health care. Like with medical marijuana legislation, it was a big failure.

One only needs to see every other billboard on Interstate 95 to realize the hospitals are in an all out war for patients in areas of heart surgery and maternity care. But Scott and House Republicans wanted to open up it even more in some very troublesome areas, critics said.

They wanted to add trauma centers across the state and to eliminate the requirement that hospitals prove community need before expanding into an area of practice.

Both bills (HB 7 and HB1077) died on Friday when the Senate refused to take them up. This is not the first time that Scott, a former health-care executive, has tried to get rid of these regulations.

This blog explored both issues during the session that also saw lawmakers fail to implement voter-mandated medical marijuana laws. 

When comes to specialized hospitals programs and trauma, hospitals need as many patients as they can get so they can perfect the practice. You know, brain injury and pediatric heart surgery are not exactly easy.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott wants to eliminate the need for hospitals to prove a community needs them to expand.

Trauma centers are no different.

Scott called for getting rid of a limit of 44 trauma centers statewide. Right now, Palm Beach County has two level-one trauma centers: St. Mary’s Medical Center and Delray Beach Medical Center.

Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, told The Post earlier this year that it is important to limit the number of trauma centers.

“Can you imagine coming to a center and you have traumatic brain injury and the neurosurgeons only do about 10 operations a year? Are you going to comfortable there or do you want somebody who does 1,000 operations a year?”

Advocates: Disabled take huge hit under GOP health reform

Advocates for the disabled say the House Republican plan to replace the Affordable Care Act seriously threatens some of the most vulnerable Americans.

The website DisabilityScoop reports that advocates say the bill threatens home- and community-based services and other supports that people with developmental disabilities rely upon.

Photo: Joshua Zader/Creative Commons

“The American Health Care Act shows callous and dangerous disregard for the well-being of people with disabilities and their families and erases decades of progress,” said Peter Berns, CEO of The Arc, an organization that service people with intellectual and physical disabilities.

The House passed the bill 217 to 213, allowing President Donald Trump and Republicans to do a victory lap that they had finally succeeded in destroying Obamacare. The measure though was roundly criticized by doctors, hospital and senior groups. It must still pass the U.S. Senate, which gave it a lukewarm response and promised to address its more draconian measures.

While the disabled take a hit, the most wealthiest Americans are big winners with the new legislation as it delivers a big tax cut the would redistribute billions of dollars to the upper tier.

 

How does it hurt the disabled? The many groups who represent them say the bill would institute a per capita cap for Medicaid. This means the federal government would offer a fixed amount of money for each beneficiary.

“These huge cuts and caps will likely put pressure on states to cut home- and community-based waiver services, especially those that are ‘optional,’ like personal care services and therapies,” said Kim Musheno, chair of the Consortium for Citizens with Disabilities, a coalition of disability advocacy groups.

Schools also would be affected by the Medicaid shift because they are currently able to seek reimbursement for a variety of services provided to disabled children to a tune of $4 billion annually. That means money to reimburse schools for speech and occupational therapy, specialized playground equipment, and even wheelchairs is now in jeopardy.

Advocates for the disabled say House Republicans would allow states to no longer consider schools as eligible Medicaid providers.

To read all of the story by DisabilityScoop click here.

 

Moving on up: Palm Beach County now the 8th healthiest in the state

Palm Beach County got it’s annual physical and the news was good.

Diverse and with a population of 1.4 million, Palm Beach County moved up to No. 8. It has moved up one slot each of the last two years and health officials say it shows that wellness programs by the Department of Health are working.

All the other counties ahead of them have far less population.

The  2017 County Health Rankings and Roadmaps is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute to give a snapshot of health across the country.

The researchers look at physical environments, social and economic factors, health behaviors and clinical care.

“These rankings are a testament to the hard work and commitment our community partners have toward assuring a healthy community,” said Dr. Alina Alonso, Director, Florida Department of Health in Palm Beach County.

Dr. Alina Alonso, director of Department of Health in Palm Beach County, has gotten healthier as well in the last few years.

Patrick McNamara, president and CEO of Palm Healthcare Foundation, said programs such as Let’s Move, Diabetes Month and Healthier Together have paid off with healthier citizens.

He pointed to Joshua Timmer, a 14-year-old from St. Ann’s Catholic School in downtown West Palm Beach who took it upon himself to bring the Let’s Move program — a Palm Healthcare initiative – to his classmates. The program encourages 30 minutes of vigorous exercise a day to combat obesity.

Joshua told The Palm Beach Post’s for a story earlier this month that he wanted to get kids moving who play a lot of video games.

On Wednesday, Joshua said between classes he was thrilled with the county’s ranking but wants to get people moving around the world.

He said it wasn’t easy putting down the video games at first.

“It was a hard change,” he said. “At the beginning, I wanted to play more video games, but then I realized I got stuff to do and I need to do more stuff outside.”

These days he plays basketball with his sibling and golf. “I do at least 30 minutes outside every day,” he said.

McNamara said it was Timmer and residents like him that moved the needle for Palm Beach County in the right direction.

“He was just an example of a resident taking it upon himself to be part of the solution,” he said. “One of the affirming things for us is that we are seeing growing numbers like him.”

Timmons is not alone. Andrea Bruton, the owner of SkyeHigh Fitness, leads an exercise program for older women in the black community in Delray Beach.

“Let’s Move has already made such a positive difference, such as bringing people and communities together–groups that would never otherwise mingle and building great rapport between the community and law enforcement,” she said.

The program gets companies, schools, colleges, non-profits, local community groups, families, to organize a team whose members log the minutes they have “moved” and compete against each.

Let’s Move is held each March for the entire month.

So let’s look at the numbers of the county’s annual checkup.

We got good numbers in the category of “health behavior” be it smoking tobacco or drinking excessively, ranking third among all Florida’s 67 counties. We landed in the top 10 in Life Expectancy (9) and Clinical Care (9).

Palm Beach County did get seem dings. It ranked 19th in Social and Economic Factors, such as income inequality and violent crime. It also ranked 32nd in “Physical Environment” that measures everything from pollution to driving alone to work.

We are lonely commuters, it appears.

Dr. Anthony N. Dardano, the vice president for Medical and Academic Affairs at Delray Medical Center.

The hospitals see it from a different perspective. They see a community benefiting greatly from the Charles E Schmidt College of Medicine at Florida Atlantic University which spins out doctors in training to five hospitals.

“It is kind of known fact whenever you have academic institution affiliated with a hospital provider that elevates the level care,” said Dr. Anthony N. Dardano, the vice president for Medical and Academic Affairs at Delray Medical Center.

He also said that increase the quality of care and cutting-edge medical care are due to the elderly population.

So next time you shake your fist at a senior maybe driving too slow think that he or she is to thank for heart surgery techniques not available in other counties and a host of other specialties that are available when it comes to treating cancer and brain disorders.

“The average age of a patient at Delray Medical Center is in the 80s,” Dardano said. “They are sicker people and in order to keep up we have developed state of the art techniques and have recruited physicians who can do all these specialties.”

 

Florida bill eliminates considering community need for hospital expansion

 

When it comes to highly specialized hospital programs, practice makes perfect.

The intricate ballet of say operating on an infant’s heart means hospitals with such programs need the patient pool limited so they can be proficient.  As a result, few have such a program.

This is why when competitors say they want to establish a specialized unit they must obtain a certificate of need. It may sound bureaucratic but the certificate of need tests whether a community actually needs a hospital to expand.

St. Mary's Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)
St. Mary’s Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)

Gov. Rick Scott and some legislators once again want to blow up the law that would make it necessary for hospitals to prove there is a need in the community for a service or another hospital. The result could be a free-for-all in a hospital competition that is already cut-throat in Florida.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott wants to eliminate the need for hospitals to prove a community needs them to expand.

The News Service of Florida reports that lining up with the governor are House leaders, Sen. Rob Bradley, R-Fleming Island. They filed a proposal last week that would eliminate the state’s “certificate of need” regulatory process.

The News Service story reported that the certificate of need process determines whether hospitals, nursing homes and hospice facilities are built.

But SB 676 also says that the regulation the restriction be removed for hospitals looking to improve or expand a public facility.

Under the process, the state Agency for Health Administration reviews projects and determining whether they should be allowed to move forward.

Scott and House Republican leaders have failed to get this measure passed the Senate previously.

“By eliminating the state’s restrictive CON process we’ll increase competition and drive down the cost of health care for Floridians,” Bradley said in a prepared statement.

“For years, this cumbersome process has been used to block the expansion of facilities and restrict competition. So, in addition to driving costs, we should also see a significant economic impact in terms of the creation of new jobs by removing this barrier.”

 

FAU spearheads effort to help intubated patients communicate

Every year, almost 800,000 patients in the United States are intubated with a tube inserted in their body to help them to breathe during hospitalization.

More than 50 percent of these patients are awake and alert, but they are unable to communicate with nurses, physicians and their loved ones save for scribbling on a piece of paper — not exactly conducive to a patient in an emergency medical situation.

Enter the tablet-based communication application called “Speak for Myself,” developed at Florida Atlantic University’s Christine E. Lynn College of Nursing in Boca Raton.

 

 

“Speak for Myself” was developed by Rebecca Koszalinski  during her doctoral studies under the guidance of Ruth Tappen, an eminent scholar and professor at the Christine E. Lynn College of Nursing.

Results of a pilot study of Speak for Myself, conducted at three hospitals in South Florida, was recently published in the journal Computers, Informatics, Nursing. It found there is a  disconnect between what health care providers think patients want to communicate and what patients actually want to say.

“When patients are not able to clearly verbalize their needs, there is an elevated risk of misinterpretation and misunderstanding, which could lead to errors and unintentional poorer quality of care,” Tappen said.

“While writing boards and other traditional methods may be helpful, important information is often lost. Furthermore, allowing others to speak for the patient has its limitations.”

The app lets a patient communicate his or her level of pain using a scale from 1 to 10. It also helps them convey their physical needs such as suctioning, repositioning and requests to use the bathroom.

During the study, one patient using the device was able to help doctors learn that the nasogastric tube had become twisted and was causing severe pain. Another patient communicated her end-of-life decisions to stop treatment and disconnect the mechanical ventilation that was keeping her alive.

“It is accurate to assert that with enhanced communication, patients will have less frustration, their pain will be better controlled, and they will have a greater opportunity to participate in their own care, and this is all supported in our study,” Tappen said.

approximately 1,600 nursing students enrolled in programs at FAU’s College of Nursing.

 

Study: Medical mistakes third leading cause of death

When you think of leading causes of death, cancer, heart disease, maybe car accidents come to mind.

But a new study shows the cure may be more deadly than whatever ails you.

A new study finds – and not for the first time – that medical mistakes could be the third leasing cause of death, according to this CNN report on the findings in the latest edition of BMJ.

The study suggests that medical errors may kill more people than lower respiratory diseases like emphysema and bronchitis do. That would place medical errors right behind heart disease and cancer.

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A new study finds that medical mistakes are the third leading cause of death in the U.S.

The doctors estimate there are at least 251,454 deaths due to medical errors annually in the United States. And that’s not counting home and nursing home deaths.

The number is also greater than the one cited in a 1999 study from the Institute of Medicine that put the number in the 44,000 to 98,000 range.

“We have to make an improvement in patient safety a real priority,” said Dr. Martin Makary, a professor of surgery and health policy and management at Johns Hopkins.

To read the whole CNN story click here.