HCA Healthcare
April 25, 2019

SOURCE: Naples Daily News
AUTHOR: Liz Freeman

Lee Health is joining the Florida Hospital Association in a push against two bills they say would be harmful to patient safety and to the bottom lines of hospitals that treat the needy.

Florida lawmakers may eliminate the certificate-of-need requirement for new hospitals. A change last week to the Senate version would make it easier for specialty hospitals to gain entry in Florida. The specialty hospitals, also known as boutique hospitals, are now prohibited in the state.

Requirements that would make Florida unattractive to owners of boutique hospitals were stripped from Senate Bill 1712, said Dr. Larry Antonucci, president and chief executive officer of the publicly operated Lee Health.

Safeguards that specialty hospitals have emergency rooms, accept Medicaid and charity patients, and have a minimum number of beds were taken out of the Senate bill. The measure heads to the full Senate, likely this week.

“I don’t know what happened behind the scenes,” Antonucci said.

The other Senate bill would allow patients to stay overnight in ambulatory surgery centers. The surgery centers are not subject to stringent safety and quality standards as hospitals that are better equipped to care for patients with more complicated conditions.

Antonucci said the concern is that surgery centers would start taking more complex cases without added safeguards like a physician on duty 24/7.

The FHA is urging Florida residents to contact their state senators to say the current prohibition against specialty hospitals needs to stay, along with requiring new hospitals to operate 24-hour emergency departments.

Lee Health - Coconut Point medical campus is pictured on Thursday, Nov. 15, 2018, in Estero. The facility opened Dec. 3, 2018. (Photo: Jon Austria/Naples Daily News)

Senate Majority Leader Kathleen Passidomo, R-Naples, could not be reached for comment Monday.

Opponents to the certificate-of-need requirements say the rules are onerous and stifle competition and access to care.

House Speaker Jose Oliva, R-Miami Lakes, has championed eliminating it entirely for hospitals, nursing homes and hospices with an effective date of July 1.

The Senate version would repeal the certificate-of-need requirement beginning in July 2021.

Lee Health and competitor HCA Healthcare are waiting for an administrative law judge to issue a finding on their dueling certificate-of -need approvals to build hospitals in fast-growing Estero.

The state Agency for Healthcare Administration last year approved Lee Health’s 82-bed hospital plan for its outpatient complex at Coconut Point. At the same time, the state approved HCA’s application for an 80-bed hospital less than 5 miles away.

The approved applications and appeal predate current efforts to repeal the certificate-of-need requirements.

There is nothing in the bill, as it is written now, that would impact the current case, Lee Health spokeswoman Mary Briggs said.

The NCH Healthcare System and Physicians Regional Healthcare System, both in Collier County, are opposing the new hospitals in south Lee.

Florida prohibits specialty hospitals that in other states provide limited services, such as orthopedic surgery with more personalized attention.

"Boutique/specialty hospitals typically provide high volume services to commercially insured patients at low risk for complications," the FHA said on its website. "These hospitals do not serve the uninsured or Medicaid patients."

Antonucci said allowing specialty hospitals to operate unfettered in Florida would be detrimental to Lee Health's financials and other hospitals that must serve all patients and rely on the insured market to balance care costs of charity patients.

“We would like an even playing field,” he said.

Lee Health does not get direct taxpayer support and its 3 percent operating margin would be at risk if there are no controls on specialty hospitals, he said. Lee Health’s general revenue is about $1.8 billion a year.

Lee Health for years opposed efforts to get rid of the certificate-of-need rules but is taking a modified stance now, Antonucci said.

If new hospitals are allowed to be built without the state approval process, they should be required to have emergency rooms and take charity patients, he said.