[Nfbf-l] Scot's plan for merging departmentts

[Kirk]

Scott team: Merge agencies

 By Jim Saunders and Carol Gentry
12/21/2010 © Health News Florida

Gov.-elect Rick Scott's transition team is calling for a dramatic change in 
Florida's health-care governance, merging the Department of Health and the 
Agency for Health Care Administration into a mammoth new agency.

The Department of Elder Affairs and the Agency for Persons with Disabilities 
would be folded in, as well. So would the mental-health and substance-abuse 
programs of the Department of Children and Families.

It would return Florida to the centralized service model that was broken up 
during the 1990s, with the demise of the old Department of Health and 
Rehabilitative Services. But Alan Levine, who headed Scott's health and 
human services transition team, said there's no intention of recreating HRS.

Child welfare got lost in the old HRS, he said. Department of Children and 
Families will retain its independence in the suggested reorganization.

Levine said the merger of DOH, AHCA and the others aims to align 
"functions" -- putting people together who do similar jobs. That's the way 
to create more efficient government and reduce duplication, he said.

The report predicted "large savings" if the plan is enacted, a necessity in 
hard economic times, with the state facing a deficit of around $3.8 billion. 
Lawmakers have already done some cost-cutting and tapped state trust funds.

A proposed organizational chart calls the new agency, the "Department of 
Health and Human Services,'' an echo of the federal health agency.

Levine said he knows there will be opposition from "stakeholders" who have 
strong ties to agencies they are accustomed to dealing with. "I said, 'Let's 
not worry about the politics of it. Let's tee it up for the Legislature and 
governor to debate.'"

Such a major change would require legislative approval and would take at 
least a year to plan and put in place, the document says. House 
Appropriations Chairwoman Denise Grimsley, a Sebring Republican who is a key 
player on health issues, said in an e-mail this morning that she backs the 
concept.

"I do favor consolidation if we can show cost savings, and I believe we 
can,'' Grimsley said.

But Doug Martin, the Tallahassee-based legislative director of the American 
Federation of State, County and Municipal Employees, said he thinks such a 
merger would take several years if the Scott administration wants it to 
work.

"If they just want to jam stuff together like a potato salad, they could do 
it in a year,'' he said.

Martin also raised the specter of creating something like HRS, which he 
called "just an impenetrable bureaucratic maze.''

The 68-page plan, released late Monday, also calls for a statewide expansion 
of managed care in the Medicaid program. Levine, who served as AHCA 
secretary and as a top aide to former Gov. Jeb Bush, was an architect of a 
pilot managed-care program for Medicaid.

The team also recommended that Scott appoint someone in the governor's 
office who could "quarterback" three issues: the merger of the agencies, 
reforming the Medicaid system and carrying out the new federal health 
overhaul. However, the report also urged Scott to play a leadership role to 
repeal that federal law, the Patient Protection and Affordable Care Act, 
saying its massive expansion of Medicaid will bankrupt the state and 
undermine the private market.

Scott made a fortune in the health-care industry, building the Columbia/HCA 
hospital chain before stepping down amid allegations that the company 
defrauded Medicare. But his health-care positions during this year's 
gubernatorial campaign were mostly broad statements of support for more 
privatization and expansion of managed care in Medicaid.

The transition-team recommendations call for far more sweeping changes in 
how government interacts with the health-care system.

They call for more privatization of government services, taking county 
health departments out of the business of primary care, privatizing three 
state mental hospitals and closing the A.G. Holley state tuberculosis 
hospital.

Also, the recommendations strongly call for a statewide expansion of the 
Medicaid pilot program, which currently requires most beneficiaries in five 
counties to enroll in managed-care plans. Along with the expansion, the 
recommendations call for using managed care in the state's long-term care 
programs.

The report also expands on criticism that some lawmakers have heaped on the 
Department of Health. Members of the transition team said the department 
lacks a clear mission and headlined one section of the report as, 
"Challenge: Cultural Barrier to Excellence.''

"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,'' part of the report said. "It is obvious 
that the current state of affairs is a product of a multitude of issues, 
including but not limited to, a lack of understanding with respect to the 
department's mission, an absence of defined and measurable outcomes and 
ineffective department leadership.''

The report includes examples of dysfunction at the department. In one of the 
examples, a transition-team member asked an employee for directions to the 
surgeon general's office.

"The employee pointed to the clock and noted that it was 6:58 a.m. and they 
did not begin work until 7 a.m., so they were unable to be of any 
assistance,'' the report says.

Levine said the problems at DOH are "cultural." When the team asked which 
employees were best, the answer was that all were "satisfactory."  When the 
team asked DOH to create a priority list of its functions, it couldn't, 
viewing all of its tasks as equally important.

"Left to its own devices," Levine said, "the agency will not recognize that 
it has problems."



Kirk Harmon
President & CEO
Florida Disabled Citizens
for Progress
P.O.Box 61794
Jacksonville, FL 32236
PH(904) 783-9896
Cell: (407) 473-2176
DAV/BVA
Life Member

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