Guide to Understanding Florida's FQHCs and 330 Expansion ...

Exacerbating the shortage of available healthcare services is the fact that many physicians in Florida
are reducing or eliminating needed services due to high liability insurance costs. A November 2004
study published in the Archives of Internal Medicine examining the impact of the medical
professional liability insurance crisis on access to care in Florida concluded that the current
professional liability insurance crisis is having a major affect on the availability and delivery of
healthcare services in rural areas of Florida. Premiums for Professional Liability Insurance had a
mean increase of 93.5%. Nearly fifty-three percent (52.6%) 411 of 781 physicians surveyed for the
study had decreased or eliminated services during the past year. Most dramatic was the reduction in
OB/GYN services. Seventy percent (70.2%) of OB/GYN practitioners had reduced or eliminated
services and 61.3% (73 of 119) had decreased or eliminated vaginal deliveries. These facts are
troubling; especially in light of the fact that there are 33 counties in the state that lack even one
OB/GYN. Likewise, 14 counties lack even one pediatrician. Florida will need to address the critical
shortage of healthcare providers and the high cost of liability insurance in its efforts to make
healthcare more accessible to the residents of the state.
Access to specialty care that goes beyond the primary healthcare level is a particular challenge for
low income Floridians. FQHC doctors, nurses and case workers constantly strive to find specialists
to whom they can refer their patients. Many specialists are not willing to see uninsured patients on a
sliding fee scale and those that are, usually have strict limits on the number they will accept. Fewer
and fewer numbers of specialists accept Medicaid for a variety of reasons, which include relatively
low reimbursements rates. Some counties have attempted to address this problem through the
creation of specialty care networks in which specialists agree to take a certain number of nonpaying
patients per year. Doctors in Florida who provide their services voluntarily (at no cost) can
be covered by liability insurance under the state’s Sovereign Immunity program. This has helped
alleviate the problem in some areas but almost all of these programs are limited to county or city
residents leaving those outside the defined geographic area without access to their benefits. It
remains to be seen whether Florida’s Medicaid reform initiative will alleviate or exacerbate the lack
of access to specialty care for Florida’s Medicaid and uninsured patients.
FACHC’s Statewide Strategic Planning
As the state’s primary care association (PCA), the Florida Association of Community Health
Center’s (FACHC) role is to support Florida FQHCs in their efforts to increase access to primary
and preventative healthcare services. This requires ongoing cooperation with other statewide and
regional organizations with similar goals. Key partners include the Florida Department of Health,
Rural Health Networks, County Health Departments (CHD), Area Health Education Centers
(AHEC), The Agency for Healthcare Administration (AHCA) and others. FACHC also works with
the National Association of Community Health Centers (NACHC) and National Office of Rural
Health as well as other PCAs in our region.
Resources in our state are diminishing, competition is growing and the pace of change is
accelerating. Public safety net programs like Medicare and Medicaid continue undergoing reforms,
the outcomes of which are yet to be determined. FACHC and its partners must be ready to respond
to changes and challenges as well as new threats to the public’s health and safety. Change can bring
new opportunities when careful planning results in appropriate strategies designed to respond to a
constantly shifting healthcare environment.
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