Telemedicine Veto Symbolic

Posted on June 19, 2014


Earlier this month, Florida Governor Rick Scott vetoed three telemedicine funding initiatives.  Becker’s and other media reports did not seem to delve into the back story on the action.  In this case, a little speculation might be predictive and helpful to provide broader understanding.

Governor Scott has taken considerable criticism from the state’s healthcare industry for not extending the Medicare / Medicaid coverage.  A handful of states are adamant about not extending coverage, and Florida has been consistently in that camp.  On the surface, the lack of additional coverage is a blow to healthcare systems in Florida who must provide care and ‘get creative’ (the way it is described to me by system administrators) about continued care reimbursement pinches.  Unfortunately, this is fiscal planning status quo for healthcare provider systems right now, but far from a unique challenge.

Without knowing all the facts, I liken his decision to not expand a payment infrastructure similar to his refusal to take federal money for another infrastructure project:  high-speed rail.  Scott could have taken a teaser amount to get the project off the ground, but the long-term fiscal downside exposure was far, far greater than any short-term good to be gained.  The idea was not bad, but the financial terms were not good for Florida taxpayers.

That said, Governor Scott does not appear to have an ax to grind with healthcare providers in Florida.  Scott made his career in healthcare, with much financial success.  He may even have a soft spot for the industry for all we know, though it appears he is dishing out some tough love.

I have been trying to understand Scott’s legislative actions as a way to perhaps understand a larger business-savvy approach he has for the State to negotiate the massive change in healthcare.  I trust he has an ethos running through his gubernatorial healthcare record.  If anyone can take advantage of his advanced knowledge of the healthcare industry, and use that insight to make smarter legislative decisions for Florida, it is Scott.

So, when Governor Scott line-item vetoed telemedicine recently, it appeared maybe Scott does want healthcare providers to suffer.  Not so fast.

First, knowing how laws are constructed, and how pork can fatten (or poison) even the most beneficent bill, line-item vetoes can be good for leaning an otherwise well-guided legislative effort.  Maybe these three telemedicine efforts were unwanted add-ons.

Second, these three items do appear to be narrowly focused projects for three specific healthcare systems in the state.  Through his veto, Scott is not necessarily denying the benefit of telemedicine; he could simply be voting against three pet projects. There are ways to spend money in telemedicine, especially to benefit large populations of Floridians, and maybe this just is not one of them.

I could see some broader ideas being embraced; for instance, anything that would standardize or help network state hospitals for telemedicine might gain some traction.  I would say that given Scott’s background in for-profit healthcare, and his entrepreneurial interests as a venture capitalist, he probably knows quite a bit about the potential benefits of telemedicine technology.

A third fact that makes this veto look suspect as a long-term stance against telemedicine or healthcare:  the bottom line.  The three initiatives totalled $1.775 million.  To quote the Black Knight from Monty Python and the Holy Grail, “Tis but a scratch”.   In other words, the dollar value is a tiny fraction of a single percent of the state’s annual budget, and approving $1.775 million would have likely garnered less attention than rejecting the spend; therefore, this was a statement by Scott, and not part of a universal blockade.

Fourth, looking at the three telemedicine offerings excised from the law, two are for telemedicine ICU initiatives.  Most of my experience in seeing telemedicine in action is in infrastructure-challenged areas where simple needs, like access to important specialists, are not being met.  For instance, telemedicine can allow a psychiatrist hundreds of miles away to remotely evaluate a patient in a rural area that has no psychiatrist.  Maybe the ICU is not the best place to explore telemedicine.

These telemedicine petitions are closer to three healthcare systems seeking grant money from the state.  Even Moody Chisholm, CEO of St. Vincent’s Healthcare in Jacksonville, one of the three snubbed, said the veto would not stop his system’s investment in telemedicine.  His reply even sounds like a grant petitioner when a grant has been refused.

In the end, I do not see the veto from Governor Scott as a big deal.  It is likely not a vote against telemedicine, or against healthcare, but the latest reply in a conversation about the state’s strategic use of tax funds:  to land dollars for healthcare, try a little harder.