Healthcare Challenges

I write this review in the waning days of 2006 as well as my term as President of the Broward County Medical Association. We have addressed numerous challenges in providing quality, affordable healthcare for all our citizens. Of particular note has been the increasing cooperation and joint efforts of the Miami-Dade (DCMA), Broward (BCMA), and Palm Beach County Medical Associations (PBCMS), and the South Florida Hospital & Healthcare Association SFHHA). Below is a brief summary of some of our key issues.

Access to emergency care

In addition to providing emergency medical and trauma care, our area emergency rooms have become the safety net and primary care provider for the thousands of uninsured patients in South Florida. They are truly overwhelmed. Many key specialties, such as neurosurgery, are in short supply. Many patients have had to be transported to more distant hospitals because the specialty service they needed was unavailable. With numerous municipalities, EMS systems, hospitals and physicians, efficient coordination of scarce resources is a challenge. Anti-trust and other State and Federal laws and regulations increase the difficulty in finding a solution. The three counties and the SFHHA have formed a joint committee earlier this year and are working to address the issue on a community wide basis. In addition, Palm Beach County has formed an Emergency Department Management Group looking to specifically address access to ER specialty care. We wish them good luck.

Medicaid Reform

In 2005 Florida spent $14 billion on Medicaid, consuming 24% of the state’s budget. Unchecked, it is estimated Medicaid will consume 59% of the budget by 2015. The massive Medicaid overhaul (“Reform “) is a bold attempt to stabilize spending while improving the quality of care. Broward County (along with Duval) has been selected as the experiment to introduce the new program, which began this summer. Over 70,000 patients are being moved into new Medicaid captitated HMO’s. Patients will be given to opportunity to choose among a variety of competing customized plans with differing benefit packages. Primary care physicians previously receiving fee for service will be forced to sign up with the HMO’s or lose their patients. Physicians, patients, hospitals, managed care companies, and all sorts of ancillary providers are anxiously looking at this program to see how they will be affected.

The BCMA has interviewed several groups providing Medicaid reform plans, including the North and South Broward Hospital Districts (“South Florida Community Care Network”, Renaissance Health Systems, and SunCoast Physicians Health Plan. We have made the information available to our members.

Medicare Payment Cuts

Medicare patients continue to grow in numbers and care needs. Nevertheless, Medicare, through its totally unrealistic Sustainable Growth Rate (SGR) formula, plans on a five percent cut in physician fees at the start of the New Year. Many South Florida physicians will be forced by economic necessity to cut back on the number of new Medicare patients they will see in the coming year. This is a critical access of care issue for our senior citizens. We all need to get involved and petition Congress in Washington to correct this egregious error in calculating reimbursement.

Liability Reform

Inappropriate and frivolous litigation continues to be an invisible tax on all Floridians, artificially raising the costs of all goods and services. This is no where more evident than healthcare, where physicians and hospitals bear an enormous financial burden insuring against and paying out lawsuit awards. This year saw both success and failure in the liability reform arena. State constitutional Amendment 3, passed by the voters two years ago, was supposed to insure patients the lion’s share of any judgment or settlement. By a clever ruse, the trial bar has successfully thwarted the will of the people with their waiver of rights form, which was recently approved by the Florida Supreme Court. Our success was in the legislature, where the House and Senate successfully passed the abolition of joint and several liability. Parties to a suit only marginally at fault will now only be responsible for the percentage negligence directly attributed to them. “Deep pockets” will no longer have to bear the burden of paying for damages attributed to someone else.

Affordable Housing

Affordable housing is the number one economic issue currently affecting South Florida. It is making it difficult to recruit the people needed to provide health care in our community. Nurses, medical technicians, and clerical personnel are becoming difficult to recruit and retain because of the high cost of housing. Despite a recent down turn in the market, the difference between median income and housing price remains dysfunctional and needs to be addressed.

Recruitment of new physicians

The population is aging. So is the physician population. Many doctors, of the so called “baby boom” generation have already retired early. Many more will be retiring in the next few years. Many are retiring early, still in their prime. Others are relocating to distant states, such as Idaho and Iowa. Why are we losing some of our best doctors? Although the weather may be beautiful, many physicians find the medical practice climate brutal. The costs to maintain a medical practice continue to climb steadily (salaries, housing, and insurance for medical and commercial liability). Fear of an undeserving lawsuit continues to be a chilling factor. Doctors are leaving. Who is going to replace them? New physicians, even those whose residencies were in Florida, are looking elsewhere to begin practice. Our biggest challenge is to ensure that physicians will want to practice in Florida. The physician and hospital communities must build on their cooperative efforts of 2006 and continue their joint efforts in 2007. As President of the BCMA, it has been my privilege to be involved in making South Florida a better community we can all be proud of.