Make us your home page

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Hospitals that serve Florida's neediest patients decry proposed change to Medicaid payments

TALLAHASSEE — Hospitals that serve Florida's neediest patients stand to lose the most under a new system for how the state doles out Medicaid dollars.

The DRG payment model — or "diagnosis-related group" — would categorize Medicaid patients based on the type and severity of illness and pay hospitals accordingly. Currently, hospitals are paid various daily rates based on actual costs.

Dozens of hospitals stand to receive more Medicaid dollars under DRG, but representatives of the state's 15 "safety net" hospitals say their facilities are among the biggest losers. That includes Tampa General Hospital and Miami's Jackson Memorial Hospital.

Advocates say the model should be tweaked so that these hospitals, which serve the state's poorest and most severely injured patients and are often the training ground for future doctors, are held harmless.

The state Agency for Health Care Administration has run the numbers showing what each hospital could receive under DRG compared with the status quo in the 2013-2014 fiscal year.

Jackson Memorial would drop from $345.6 million to $301.2 million. Tampa General Hospital's payment would decrease from $139.5 million to $128.2 million.

Even though the model was tweaked in a way that benefits the state's two freestanding children's hospitals, All Children's in St. Petersburg and Miami Children's would lose $9 million and $1.4 million respectively.

None of the 13 hospitals that draw from Medicaid the most — those in line for more than $50 million annually — stand to see increases under DRG. Ten of these are "safety nets" and all but one is not-for-profit.

On the other hand, most of the hospitals that see the biggest increases under DRG are operated by for-profit companies.

Last month, AHCA sent the plan for moving to the DRG system to Gov. Rick Scott, House Speaker Will Weatherford and Senate President Don Gaetz. That means any changes would have to happen during the legislative session starting March 5 because the state hopes to launch in July.

Jim Zingale, who works for the Safety Net Hospital Alliance of Florida, said hospitals won't just be lobbying lawmakers.

"You have to sit there and get the message out to the public, 'Do you want services to children to be cut in five months?' " he said Tuesday after AHCA held a final public meeting on the recommendations. "This isn't down the road, six years. This is in five months."

The DRG model is similar to how the federal government reimburses health care providers under the Medicare program for the elderly. Converting Medicaid to DRG and standardizing how hospitals are paid will make them more efficient and improve quality while protecting tax dollars, AHCA said.

Eight hospitals owned by HCA, the hospital chain co-founded by Scott, could see their Medicaid payments increase by 32 percent or more and by at least $1 million. Aventura Hospital could rise from $4.6 million to $7.1 million. Hudson's Bayonet Point Hospital, another HCA affiliate, could increase from $3 million to $4.1 million.

In a statement released through AHCA on Tuesday, HCA East Florida Division president Michael Joseph lent his support to the DRG model.

"We believe that the movement away from a per diem system and to the DRG system is a progressive step for Florida," Joseph said. "It assures a consistent and predictable payment system for all providers in the Medicaid program and will result in a more equitable and cost-effective approach to reimbursing hospitals for inpatient care."

But the "safety nets" disagree. Zingale believes the state should have a test period where it uses actual 2013-2014 data, and not simulation models, to compare what hospitals would receive under the new system compared with the old. Then, the state can determine whether it needs to alter the DRG base rate to accommodate different types of hospitals.

Medicaid is a health care program for the poor that is administered by the state but funded mostly by the federal government. Florida has 3.3 million people currently on Medicaid, but that number could increase greatly in 2014 if the state allows 1.6 million more people to enroll as part of the federal health care law.

Contact Tia Mitchell at or (850) 224-7263.

Hospitals that serve Florida's neediest patients decry proposed change to Medicaid payments 01/09/13 [Last modified: Wednesday, January 9, 2013 10:36pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times


Join the discussion: Click to view comments, add yours

  1. Search for missing Army helicopter crew suspended in Hawaii


    HONOLULU — Officials have suspended the search for five Army soldiers who were aboard a helicopter that crashed during offshore training in Hawaii last week.

    Water safety officials hand over possible debris from an Army UH-60 Black Hawk helicopter crash to military personnel stationed at a command center in a harbor, Wednesday in Haleiwa, Hawaii, a day after. an Army helicopter with five on board crashed several miles off Oahu's North Shore. Officials  suspended the search for five Army soldiers in a helicopter crash during offshore training in Hawaii on Monday. [Associated Press]
  2. Rubio praises Trump for 'excellent' speech on Afghanistan


    Sen. Marco Rubio praised President Donald Trump's "excellent" speech on Afghanistan. Sen. Bill Nelson was less effusive but agreed with the goal.

  3. Gov. Rick Scott blasts report of shifting words on Charlottesville


    Gov. Rick Scott, one of the most scripted politicians in modern Florida history, said Monday that "both sides” bear blame for Charlottesville.

  4. Record $417 million awarded in lawsuit linking baby powder to cancer


    LOS ANGELES — A Los Angeles jury on Monday ordered Johnson & Johnson to pay a record $417 million to a hospitalized woman who claimed in a lawsuit that the talc in the company's iconic baby powder causes ovarian cancer when applied regularly for feminine hygiene.

    A bottle of Johnson's baby powder is displayed. On Monday, Aug. 21, 2017, a Los Angeles County Superior Court spokeswoman confirmed that a jury has ordered Johnson & Johnson to pay $417 million in a case to a woman who claimed in a lawsuit that the talc in the company's iconic baby powder causes ovarian cancer when applied regularly for feminine hygiene. [Associated Press]
  5. Search under way for missing sailors; Navy chief orders inquiry


    SINGAPORE — The U.S. Navy ordered a broad investigation Monday into the performance and readiness of the Pacific-based 7th Fleet after the USS John S. McCain collided with an oil tanker in Southeast Asian waters, leaving 10 U.S. sailors missing and others injured.

    Damage is visible as the USS John S. McCain steers toward Singapore’s naval base on Monday.