Florida’s emergency care environment is a dichotomy, blessed with considerable strengths but also beset with glaring weaknesses. Although the state performs admirably in the Quality and Patient Safety Environment and Disaster Preparedness categories, it is plagued by such major concerns as high numbers of uninsured residents, a poor record of vaccination for its substantial elderly population, a significant shortfall of primary care providers, and a medical liability system that threatens to further erode the physician supply.
Strengths. Florida’s numerous statewide systems positively affected the state’s grade with regard to the Quality and Patient Safety Environment. For example, the state has adverse event and hospital-based infections reporting requirements, and has a stroke system of care. Florida also maintains a statewide trauma registry and provides funding for quality improvement within the EMS system and an EMS medical director position.
Florida has made significant efforts to improve Disaster Preparedness in the state. It has the 11th highest rate of physicians registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals (39.8 physicians per 1 million people), has an all-hazards medical response plan, and receives emergency physician and public health input into the state planning process. Florida also has statewide “just-in-time” training systems and real-time syndromic surveillance systems.
Challenges. Access to Emergency Care is a serious problem for Florida patients. A large proportion of Florida’s population is uninsured with 21.9 and 18.9 percent of adults and children, respectively, lacking any health insurance coverage. The state also has relatively few psychiatric care beds (12.6 per 100,000 people), fewer than half the average across the states. Florida is also in need of 755.8 full-time equivalent primary care providers, compared with an average across the states of only 136.3 providers. The state also has a low number of physicians accepting Medicare (2.1 per 100 beneficiaries).
Florida fared poorly with regard to the Medical Liability Environment for a variety of reasons, including the state’s average medical liability insurance premiums ($41,946 for primary care physicians and $171,231 for specialists), which are more than twice the average across the states. In addition, there are an especially low number of insurers writing medical liability policies in Florida (2.1 per 1,000 physicians compared to an average of 9.2 per 1,000 across the states).
Florida’s poor performance in Public Health and Injury Prevention leaves significant room for improvement. The state’s total injury prevention funds ($58.36 per 1,000 people) fall well below the average among the states ($455.12 per 1,000). Limited funding may impede efforts to improve the state’s higher than average rate of unintentional fall-related fatal injuries (9.4 per 100,000 people). The state also ranks among the bottom 10 for both yearly influenza vaccines and pneumococcal vaccines among adults aged 65 years and older (61.5 and 62.9, respectively).
Recommendations. Florida should act immediately to address its severe shortage of physicians. A significant step in that direction would be to reduce the $500,000 soft cap on non-economic damages that currently applies to non-emergency care providers. While the state has instituted a $150,000 cap on non-economic damages for emergency care providers, emergency physicians in the state report continuing problems with getting specialists to provide critical on-call services to emergency patients. To address this problem and help ensure that patients have access to on-call specialists, the state should consider extending sovereign immunity protection to providers of state and federally mandated emergency care.
Florida would benefit greatly from efforts to increase the number of emergency medicine residents in the state. Providing additional residency training opportunities may encourage more physicians to enter emergency medicine as their primary specialty, which may be particularly important as a significant percentage of the current emergency medicine workforce nears retirement.
Access to medical care in Florida would benefit significantly from increased Medicaid reimbursement rates. The state’s reimbursement rate for office visits is less than 71 percent of the national average, and the trend over time has shown declining rates (10.1 percent decrease from 2004 to 2007).