Hope for the Medical Industry

Tourism, construction and agriculture have been the heartbeat of Southwest Florida, but as those sectors have fallen, some are looking to healthcare to resuscitate the region. They view healthcare as a key to high-wage jobs and a vital economy, but the industry faces challenges that must first be addressed to achieve that vision and to serve local residents, particularly the growing aging population.

“In the last two years, our economy has been decimated because two out of three legs of our economic stool have collapsed,” says Todd Gates. Chairman of Naples-based construction, development and real estate company Gates, he was among the 38 members of a steering committee for the Visioning 2017 effort, a communitywide project involving people and organizations in Lee and surrounding counties, and overseen by Lee Memorial Health System.

“Healthcare is, and will be, especially going forward, one of the strongest economic engines in Florida. Once you see that and once you understand that, it’s like, ‘OK, we have to really, really nurture healthcare and promote the healthcare industry we have locally, and build on it.’”

Dr. Joseph Gauta, president of the Collier County Medical Society and founder of Especially for Women in Naples and Marco Island, believes more use of electronic medical records, revamping the Medicare system and more patient care delivered in the outpatient or ambulatory realm could occur in the next several years.

“I hope that medicine by then will become more efficient, meaning we will be able to do more with less,” he says.

Visioning 2017 assembled hospital officials, physicians, businesspeople, heads of nonprofit organizations and other community leaders to determine and address perceived problems in the community’s healthcare system. The steering committee conducted original research through more than 150 focus groups, reviewed published data and held town hall meetings, gathering input from more than 4,000 people, says Sally Jackson, system director of community projects for Lee Memorial Health System. “We were really looking for ways to improve the health status in the community overall or to improve the healthcare delivery system,” she says.

It identified eight recommendations, from addressing behavioral health to focusing on the quality of existing acute care programs. Those issues offer some insight into areas that will shape the future of healthcare in Southwest Florida and its contribution to the local economy.

BEHAVIORAL HEALTH
The top recommendation from Visioning 2017: treating mental health as an illness. But making progress requires a change in thinking, says Greg Gardner, vice president of the United Way of Lee, Hendry and Glades. Once mental illness is truly accepted as a medical issue instead of being dismissed as, “They’re just crazy,” the funding should follow, he says.

Recent research has shed light on how the brain works and on effective treatments, he says.
“We haven’t accepted this as a medical problem. Could we do better in our current system? Absolutely,” Gardner says of the medical community and insurers. “Until we embrace this as a medical issue, we can’t solve it.”

A community mental health and addiction committee, chaired by Lee County Commissioner Bob Janes, Lee Mem-orial CEO Jim Nathan and Bonita Bay Group Vice Chairman Brian Lucas, has developed a strategy to improve the lives of those with mental illness and attack the crisis.

Accomplishments include the opening of the Lee County Triage Center for Behavioral Health and the conversion of 15 beds at Lee Memorial Hospital for use as a geriatric
psychiatric program.

One of the key pieces still missing, says Gardner, is the lack of a psychiatry specialty in hospitals, which he equates to not having a cancer center. “If you’re a psychiatrist and can’t hospitalize a patient in your own community, then how do you treat that?”

The solution could be on the horizon in the form of The Pavilion at HealthPark. The 75-bed, acute psychiatric facility is going through the state’s certificate of need process and a decision could come in early fall. If approved, the facility could open in two and a half to three years.

PRIMARY CARE ALTERNATIVES
A major challenge for healthcare providers is the growing number of people who head to the emergency room for non-emergency or primary care. Lalai Hamric believes Visioning 2017 recommendations—pertaining to everything from mental health to the prevention of chronic disease—would help change that.

“The issue was, and still is, that there are a lot of people that don’t have access to primary, basic medical care,” says Hamric, CEO of Family Health Centers of Southwest Florida, a healthcare organization with 12 medical and six dental offices that provide care regardless of a patient’s ability to pay. It calls itself the “community’s doctor’s office.”

The challenges are many, with the biggest being Lee County’s large uninsured population—the second highest in the state, behind Miami-Dade County—and lack of indigent funding.
“It’s not a real desirable place [for physicians] to come and set up a practice. Who wants them as a patient? That leaves them to us,” Hamric says.

Accomplishments related to primary care so far include the opening of two United Way houses in Dunbar and East Fort Myers, where offices for several social services agencies are centralized. Referral and education programs that relate to pregnancy, wealth management, cancer, smoking and other concerns have been launched for uninsured patients and those living below the poverty level.

The recommendation to develop community/neighborhood clinics for chronic disease prevention, education and management also would provide a primary-care alternative for the community, she says.

Hamric’s dream is to see a disease-management program jointly run by practices and staff with trained nutritionists, dietitians and/or nurse educators by 2017. Physicians could send patients with diabetes, asthma, sickle-cell anemia, hypertension and obesity to those centers for prescriptions or checkups, instead of filling their waiting rooms.

“You don’t have people clogging up your system,” Hamric says. “That frees up their practice to take new patients. [The doctors are] not going to lose patients, but will get everybody in.”

ELECTRONIC MEDICAL RECORDS
The mystery of medical records may be long gone by 2017. The ability of physicians and hospitals to quickly share medical records and for patients to access them is one of the most compelling visions for the future of healthcare.

“This is doable,” says Mike Smith, chief information officer for Lee Memorial Health System. “This is a real possibility now.”

Efforts are boosted by President Obama’s stimulus package, which provides funding for electronic medical records—an area that is expected to create jobs and new technology. The paper-based systems that hospitals and physician practices use are fragmented, leave room for more error and make it difficult for doctors to share patient information, he says.

“Healthcare is extraordinarily information-intensive,” Smith says.

Challenges include the availability of technology and funding, ensuring confidentiality and security, and having the workforce to implement electronic medical records. Lee Memorial Health System’s $75 million conversion to electronic medical records, which is under way and expected to be complete in 2015 or 2016, could transcend boundaries, he says. For example, a physician in Michigan would be able to access records for a visiting Southwest Florida patient.    

“The whole cost of healthcare and healthcare coverage concerns waste and healthcare reform. The idea is to move healthcare toward a more efficient model,” Smith says. “Healthcare IT won’t do anything in and of itself, but you can’t get what you need to accomplish without healthcare IT.”
Hamric says the whole community “speaking to one another” in the form of electronic medical records could eliminate the duplication of costly tests, for example. It also could open the door to such suggestions as mobile clinics, which could reduce the primary care problem. “If you don’t have an electronic record, how do you know you aren’t treating the same people? If you can’t track it, how do you know you are making them well?”

It would also enable patients to engage directly with those records, which will make them more empowered and informed, Smith says. Some health record software that’s coming on the market allows patients to see what the physician has entered into the file, schedule appointments, get reminders, monitor chronic care management, see treatment results and interact online with their doctor.

“It’s proven that the more active you are in your care, the better the care and the more cost-effective the care,” he says.

Gauta, who introduced electronic medical records when he opened his Naples practice in 2001, recouped the cost within two years. “My patients had better care because of it,” he says. “It’s a huge initial upfront cost, which President Obama is addressing with his healthcare initiative, and I think that will help sway people to use it.”

WORKFORCE SHORTAGE
Southwest Florida is paging additional doctors (see “Leading Question” on p. 10), nurses and other healthcare professionals.

“The healthcare industry is under a lot of pressure to be delivering top-drawer care for people who are not feeling well and are scared to death that their life is in danger,” says Denise Heinemann, a faculty member and former dean in the College of Health Professions at Florida Gulf Coast University.

Data from the Florida Center for Nursing shows a shortage of 52,000 nurses in the state by 2020 and a need for more than 7,000 occupational therapists by 2014. Due to the area’s aging population, demand also exists for physical therapists and similar skills related to such procedures as joint replacements.

“If you look at the needed positions, plus the fact that the workforce is aging, then you realize that even if the economic conditions now lessen the impact of the shortage, it’s going to come back,” Heinemann says.

As with other recommendations, funding will be a factor in whether the region gets the healthcare workforce it needs. “We may see something in the future which continues to increase the amount of money the federal government puts in training for healthcare practitioners,” she says.

Local higher education institutions have already added new programs to feed the demand, and having more professionals available could improve patients’ experiences. Findings from the Visioning 2017 process showed that people desire a warm, inviting, less intimidating medical experience, Gates says. Offices and medical facilities need to be more human-relations oriented, from the sound and lighting to customer service.

“People get sick. People get old whether it’s a bad economy or good economy,” he says. “When you get sick you don’t want the second or third string. People want the very best healthcare and they want to feel good while they go through the process.”