Scott Transition Gets Health Care Recommendations



By David Royse
The News Service of Florida

Some of the work of the state’s health care agencies should be consolidated, the state should push for repeal of the federal health care law, and shifting of Medicaid patients to managed care should continue, Gov.-elect Rick Scott’s health care transition team recommended.

The recommendations of Alan Levine, who was secretary of the Agency for Health Care Administration under Gov. Jeb Bush, and his team, were made public by the Scott transition office on Monday evening.

Alan Levine
Alan Levine

The first issue Levine dealt with in a long recommendation was redundancies in the several state agencies that deal in some way with health care.

Levine, who after leaving the Bush administration went to work for Gov. Bobby Jindal in Louisiana, said there was a consensus in the transition team that several Florida health and human services agencies overlapped in their roles, and that some consolidations would make sense.

The team recommended merging the Department of Health and the Agency for Health Care Administration, while considering adding other agencies with overlap as well. “In the team’s review, the merger could provide substantial efficiencies, including the reduction of duplicate processes and services, an enhanced customer experience, and the ability to more effectively identify system-wide support,” the transition team report said.

Joining those two agencies in a larger health and human services agency might be the Agency for Persons With Disabilities and the Department of Elder Affairs, the team said. The state used to have a health and human services agency, but it was split into more mission-specific agencies about two decades ago.

“We believe that a large number of process efficiencies could be achieved if those who coordinate and deliver services are collocated with those who pay for and monitor those services,” the transition memo continued.

The memo also was highly critical of the Department of Health and its leadership, reporting that the agency appeared to have a “cultural barrier to excellence.” The memo was released after hours Monday and Department of Health officials weren’t available to comment on the description.

But it came on the same day a DOH spokesman confirmed that while Scott was asking some agency heads to remain on after Gov. Charlie Crist leaves office to help with the transition, one who wasn’t being asked to stay was the head of the Health Department, Dr. Ana Viamonte-Ros.

The transition report said the Health Department was “fragmented” and that officials there don’t communicate across divisions or with other agencies, leading to inefficiencies.

Other consolidation possibilities raised by the transition report included eliminating perceived duplication of services in the providing of primary health care by county health departments and other service providers, such as academic health centers.

The incoming administration should look at whether the state could “consolidate or eliminate clinical sites that are currently being operated by the (county health departments),” particularly if there are nearby academic health providers or federally qualified health centers, the transition team said. “A good number of these sites are less than ten miles from each other, and thus it would be important to understand the justification for the location to ensure that the site is a good use of state resources.”

The transition team threw out a few other detailed specifics as possibilities, among them raising again the oft-proposed idea of closing A.G. Holley Hospital in Palm Beach County, which the Department of Health runs as the state’s hospital for tuberculosis patients.

“These TB patients will need to be moved to other facilities and a cost will be associated with their care, but significant savings can be realized by reduction in facility-related overhead and sale of the hospital and its large campus,” the team’s report said.

The transition team also recommended a hiring freeze at the Department of Health. About 10 percent of the allocated 22,000 positions at the agency are currently vacant.

The state should continue its push to move Medicaid patients into managed care, taking a pilot project in some counties statewide, the report said. That move was begun under Bush and Levine, but has stalled in recent years.

Another major recommendation is that Scott continue his opposition to the federal health care law, with its mandate for health insurance that starts in 2014. The federal health care mandate needs to be repealed, the transition memo argued, because it is likely to increase the cost of Medicaid. “We cannot even afford to operate the Medicaid program in its current form,” the memo said.

Scott takes office Jan. 4.


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