Mary Mayhew stresses why Florida health care must prepare for many kinds of disasters

Mary Mayhew. Image via Florida TaxWatch.

In Florida political circles, the COVID-19 response has become something many would like to forget altogether. But Mary Mayhew, president and CEO of the Florida Hospital Association, said it’s critical to look back.

She said the public health disaster tested the hospital infrastructure in Florida and around the world. That stress showed the ways the system is prepared for disaster and where it falls woefully short. Regardless, the system can always do better, she suggested.

“We’ve got to keep looking at those opportunities to improve the efficiency, to reduce barriers, to improve health status, and to embrace these new models of care,” Mayhew said in a speech to Florida TaxWatch members. “We want this state in the country to be the best health care delivery system for today and tomorrow.”

Thanks to Florida’s senior population and an above-average number of retirees, the state’s system also remains especially vulnerable when revenues are threatened. That threat materialized when elective surgeries were halted. And the government’s tinkering with Medicare and Medicaid presents a similar peril.

Calling Medicare the 800-pound gorilla of American health care, she noted 40% of hospital revenues at most institutions come from the federal program. “When you add in Medicaid, you’re up to 65-70% of their budget,” she said.

On top of that, Florida leads the country in the number of Medicare Advantage users, which means private insurers provide Medicare benefits. In this state, about 57% of Medicare enrollees end up covered by two insurers, Humana and United.

Additionally, Florida has 3.2 million individuals enrolled in healthcare through the federal marketplace established by the Affordable Care Act. This all makes Florida health care providers especially reliant on federally controlled coverage. That brings a certain risk.

“You don’t want to depend on a hospital that is hemorrhaging revenue,” she said.

Florida also has a staff turnover problem to face with health care, which the pandemic made even more apparent. Competitive rates for workers have promoted perpetual jumps from employer to employer that have calmed in recent years, but systems are still less stable than before the pandemic.

“Nobody wants every 12 weeks, a new group of staff to be coming in and out. You’re trying to build a culture. you want to have everyone abiding by your protocols,” Mayhew said.

She noted Florida were able to handle heightened capacity demands. During the peak of the Delta variant in 2021, many states had to ration health care as hospitals ran out of room for beds. While Florida had to convert office space to treatment centers in some places, hospital capacity was not strained beyond that patients couldn’t be taken in. That was even as the state saw a collective 17,000 hospitalized at the worst period.

Mayhew noted that capacity can be important regardless of whether institutions face another pandemic. She reminded the Lee Health had to evacuate hospitals after Hurricane Ian last year left entire facilities without water.

“In an emergency like a hurricane, you want a capacity even though you don’t know you need it,” she said.

On a policy level, Mayhew said Florida remains at a disadvantage with Medicare formulas, some of which were frozen based on 1990s population distribution.

That means based on current population counts, Florida receives Medicare funding of less than resident physician positions per 100,000 residents, while New York has 75 such positions per 100,000 people.

“Sen. Chuck Schumer is not likely going to turn around and say, send more money to Florida,” she said. Schumer, the Senate Majority leader, represents the state of New York.

But she praised the Legislature for seeking other ways of redirecting Medicaid funding, like toward graduate medical education. Ultimately, 63% of physicians stay in the communities in which they complete their education.

Some industries face worse challenges than others. Florida nursing homes, for example, saw the greatest decline in workers during the pandemic and that continues to impact the sector today.

But she said Florida can still help improve workforce challenges and better prepare health care for disasters in ways that improve access and ensure positive outcomes.

“In health care, we can’t just be bailing out the boat,” she said. “We have to be charting the course.”