December 22, 2010

December 22, 2010
Florida Health Chief Dismissed

Welcome to another day in my life. Today is Wednesday and we have almost made it through the middle of another work week. I hope you are having a safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

I received some disturbing new today about the dismissal of our state health chief and the privatization of our public health clinics in the state by our incoming governor.

Surgeon General Ana Viamonte Ros faced strong criticism from Gov.-elect Rick Scott's transition team. State Surgeon General Ana Viamonte Ros, head of the Florida Department of Health, is resigning following a withering attack on her management by Gov.-elect Rick Scott's transition team.

An agency spokesman said Tuesday that Viamonte Ros had offered to resign several weeks ago, like other Crist appointees. But while most agency heads are staying for another 60 to 90 days, Viamonte Ros was told Monday that her job would end Jan. 3, Health Department spokesman Rob Hayes said.

The Health and Human Services Transition Team is headed by Alan Levine, who had been secretary of the Florida Agency for Health Care Administration under former Gov. Jeb Bush.

In a 68-page report, Levine's team lambasted the state Health Department for a show up for work culture of mediocrity, and recommended consolidating the 20,000 employee agency with AHCA, which regulates hospitals and outpatient clinics and runs the state Medicaid program.

The transition team also recommended freezing job openings within the Health Department and privatizing some government run primary care clinics and hospitals. And it suggested that A.G. Holley Hospital in Lantana, the nation's only tuberculosis hospital, be closed and the property sold.

The Palm Beach County Health Department runs seven public clinics and employs about 1,000 people. Many of the local clinics were launched to ease pressure on local emergency rooms. It may be possible and even logical to convert them to nonprofit, private clinics, said John Couris, CEO of Jupiter Medical Center, praising Scott's transition team.

"I think what they are doing is bold, it is aggressive, it is innovative, but now it is going to have to be measured against the set of realities the governor has in front of him," Couris said. "Scott is beginning to fulfill a campaign promise."

Scott's team stressed that the report is just an advisory document and he will not necessarily adopt the findings as his own.

A former Obama transition team member who now runs a Lake Worth based health policy institute cautioned that privatizing and consolidating services could have unintended consequences.

The county's health clinics bring in federal Medicaid and other dollars, said Dr. Claude Earl Fox, director of the Florida Public Health Institute. Privatizing them would mean losing the people who step in during public health emergencies such as school-based tuberculosis infections, the H1N1 influenza vaccine campaign, hurricanes and rabies outbreaks.

County health department clinics serve nearly 60,000 people a year. Another 11,000 dental patients are seen.

"I would hate to see them dismantle the public health infrastructure in this county, because I think it is going to be very hard to rebuild it," Fox said. "You may end up with a whole bunch of people who have an insurance card and nowhere to go."

In addition to Levine, Scott's transition team included Gainesville plastic surgeon Jason Rosenberg. Rosenberg slammed what he said he saw during visits to the state Health Department: health officers operating in silos, a perverse incentive structure which rewards those who can defend and spend their budgets, and staff who evaluate employees as satisfactory to avoid having to document anything.

One Tallahassee receptionist refused to give a transition team member directions to Viamonte Ros' office, pointing to a clock to show she still had two more minutes before her shift began, the report stated.

"One of the largest challenges that the incoming administration will face, in both the short and long term, is how to redefine the culture of the department to promote excellence," the transition team wrote.

The team depicted the Medicaid program as a ticking time bomb, set to explode as the Obama administration's health reform rules push millions of people onto already swollen Medicaid rolls.

They urged Scott to endorse moving all state Medicaid enrollees into managed care, and said Medicaid's woes should be a centerpiece of his first State of the State address.

"The public does not yet truly understand the financial storm ahead," the transition team wrote, adding that next year, Medicaid will cost the state $3.6 billion. It consumes a quarter of the state's entire budget. Health reform will add another estimated $1.4 billion a year after 2014.

The group recommended continuing the fight against the Affordable Care Act.

The current structure of the state's health agency dates to Gov. Lawton Chiles, who wanted to break up a single Florida Department of Health and Rehabilitative Services in the name of improving responsiveness and efficiency.

Fox cautioned that privatization does not always save money. During the Clinton administration, Fox oversaw the Health Resources and Services Administration.

"We found the functions we privatized cost two to two and a half times more than if we did them in house," Fox said. "Those are some of the assumptions that really need to be approached very carefully."

I just hope this does not mean that Floridian will not get the services they need because an out of touch with reality politician with deep personal pockets does not understand the consequences.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab