Florida has implemented strong practices and policies to ensure quality care, patient safety, and Disaster Preparedness. However, the state is plagued by a health care workforce shortage, financial barriers to care, and limited hospital capacity, as well as a Medical Liability Environment that makes it exceedingly difficult to fill these gaps.
Florida's Quality and Patient Safety Environment has many strengths, including dedicated funding for both quality improvement within the emergency medical services (EMS) system and a funded state EMS medical director. The state has instituted triage and destination policies for both stroke and ST-elevation myocardial infarction patients, and it maintains a statewide trauma registry. However, emergency physicians in the state warn of a risk that Florida's trauma system could become fragmented.
Florida has implemented some important Disaster Preparedness policies and procedures to ensure that the state is able to respond quickly to a disaster or mass casualty event. For licensure, all Florida long-term care facilities and nursing homes are required to have annual internal facility disaster drills and exercises in addition to the higher level drills and trainings conducted with state agencies. Florida has greatly improved its registration of health professionals in the Emergency System for Advance Registration of Volunteer Health Professionals, with high per capita rates of physicians, nurses, and behavioral health professionals registered. Continuing to show its dedication to improving its Disaster Preparedness, Florida is nearing implementation of a statewide high-tech solution for electronic patient tracking to improve on its current low-tech patient-tracking system.
Florida faces a triple challenge in Access to Emergency Care: physician shortages, insufficient hospital capacity, and a lack of adequate health insurance coverage. Florida is experiencing a severe physician workforce shortage, with specialty coverage for emergency departments (ED) posing a particular challenge. Florida has an inadequate supply of neurosurgeons; emergency physicians; orthopedists and hand surgeons; ear, nose, and throat specialists; and registered nurses. Florida ranks last in the nation for children who are able to see a provider (91.7%). With full implementation of the Patient Protection and Affordable Care Act and the current lack of Medicaid expansion, access to primary care physicians may be further limited in the near future. Florida already has one of the greatest needs for additional primary care providers in the nation (4.5 providers per 100,000 people) and one of the lowest Medicaid fee levels for office visits, at 57.6% of the national average.
Florida has few psychiatric care beds (13.3 per 100,000 people) and EDs (8.1 per 1 million people), which likely contribute to long ED wait times (315 minutes from ED arrival to ED departure). Financial barriers to care also persist in Florida, which has high rates of uninsured adults and children (21.6 and 13.0%, respectively). Additionally, Florida has reportedly experienced severe medication shortages in pre-hospital and emergency care settings.
Despite having some key medical liability reforms in place, Florida has failed to make significant progress with its Medical Liability Environment since the 2009 Report Card. While medical liability insurance premiums for primary care physicians and specialists decreased slightly, they are still the highest in the nation. Concurrently, the state has very few insurers writing medical liability policies (2.4 per 1,000 physicians) and still lacks pretrial screening panels.
Florida's challenges in accessing needed care are particularly worrisome when coupled with its subpar performance in Public Health and Injury Prevention. The state has the highest rate of pedestrian fatalities (17.0 per 100,000 pedestrians), which is more than three times the average across the states, while the rate of bicyclist fatalities is more than twice the national average. These rates point to a need for concentrated public education on safe driving and focused enforcement of these laws. The state is moving forward in this area, having passed legislation in 2013 that bans texting for all drivers.
Many critical gaps in Access to Emergency Care threaten to overburden the emergency care system in Florida. The state needs to recruit, train, and retain all types of health professionals, including emergency physicians and specialists willing to be on call in the ED. At the same time, the state must increase Medicaid reimbursement levels that have steadily declined for the past decade, support increased hospital capacity to reduce the likelihood of ED boarding and crowding, and improve health insurance coverage for adults and children.
Improving the Medical Liability Environment further may help Florida in attracting and retaining health care providers. The state must make an effort to encourage additional insurers to write medical liability policies in the state and reduce the highes-in-the-nation insurance premiums. Implementing pretrial screening panels and requiring that expert witnesses be licensed to practice medicine in the state also may discourage frivolous lawsuits.