If proposed fee caps on some procedures at freestanding medical clinics in Florida withstand further legal challenges, the reduced charges could save patients and insurers $200 million annually, according to a state report.
Last month, a three-judge panel of the 11th U.S. Circuit Court of Appeals in Atlanta upheld Florida's fee caps as constitutional (March 7, p. 65).
But because medical provider groups have appealed the decision to the full appellate court, an injunction that's banned enforcement of the law for almost two years remains in effect.
Last week, a legislative effort by the Florida Medical Association to repeal the 1992 fee cap law failed because state legislators couldn't reach a consensus on a healthcare reform bill proposed by Gov. Lawton Chiles (See related story, p. 44).
Mr. Chiles, who now is expected to call a special session on healthcare reform in June, wants legislators to approve his bill, which would provide subsidized insurance to 1.1 million of Florida's 2.5 million uninsured residents.
The fee cap repeal was one of several provision inserted by Republican senators that led to the legislative stalemate. Another provision, which also was opposed by Mr. Chiles, would have allowed "any willing provider" to treat patients enrolled by health maintenance organizations if the provider accepts the HMOs' prices (March 21, p. 18).
An FMA spokesman said the association will continue to fight for patient choice of physicians if a special session is conducted. "We view fee caps as a form of price fixing that has no place in the healthcare reform debate," said Gerry Soud, an FMA spokesman.
Meanwhile, a spokeswoman for the Agency of Health Care Administration said the state will move ahead with its plans to inform physicians of the fee caps as soon as the injunction is lifted. A final decision by the appellate court in Atlanta is expected in the next two weeks, a spokeswoman said.
The fee caps were approved by the state Legislature to limit charges for certain procedures at freestanding clinics in five designated health service categories to 115% of the rate allowed by Medicare. Hospitals and group practices were exempted from the law. The services are diagnostic imaging, clinical laboratories, radiation therapy, rehabilitative services and physical therapy.
Douglas Cook, AHCA's director, said imposing the fee caps could save patients and insurers $26.5 million each year just for the top 10 diagnostic imaging procedures covered under the fee caps.
Mr. Cook said lawyers for the state haven't made a decision whether to retroactively seek repayment for overcharges back to July 1, 1992, when the law would have gone into effect. He estimated the overcharges total $500 million.
Mr. Cook said average charges for the services range from 83% to 300% more than the maximum charges allowed under the fee caps.
If the fee caps are left intact, an AHCA spokesman said, insurers would quickly act to deny payments exceeding allowable limits for specified services, and companies and physicians wouldn't be allowed to bill patients to make up the difference.