In a health-care environment already in turmoil because of shifting political winds, regulation and deregulation, and evolving technology comes another conundrum: Polk County’s population continues to grow at an astounding rate.
Population experts predict the traditionally rural county may shoot up from about 650,000 people to about 1 million people by 2040.
Meanwhile, Polk County will see changes as the population ages, said J. William Gardam, president and chief executive officer of Peace River Center, a major supplier of behavioral health services in Polk County. As the retiring baby-boomer generation continues to age, requiring more health care and supportive services, there will be fewer working-age adults.
"And we need to consider that 70 percent of adults with intellectual and developmental disabilities live with their parents. But as the parents age, we will have a growing special-needs population that lose their homes and caregivers. We need to find ways to care for and house these people," Gardam said.
Polk County already is facing big obstacles to delivering health care. According to Florida Health Charts, on a per-person basis, Polk County currently has fewer hospital beds than the state average and far fewer licenses for dentists, mental-health professionals and family-practice doctors.
"It just gets worse if we had another (350,000) people," said Lance Anastasio, chairman of the Citizens Oversight Committee that oversees funds disbursed from the voter-approved, half-cent sales tax for indigent health care. "We have a lot of square miles to cover."
And access is a big issue, Anastasio said.
"Can you get a bus, a ride with a friend, or if both spouses are working and have a single car, can you figure out how to get to an appointment?" he asked.
Anastasio, who retired five years ago as chief executive officer of Winter Haven Hospital, said the no-show rate for behavioral-health appointments is high, between 30 percent and 40 percent, much of that caused by transportation issues.
Although headway is being made in sharing resources, such as behavioral-health experts co-locating in primary-care medical clinics, there needs to be more sharing of resources.
"There is too much 'going-our-own way' and not enough coordination," Anastasio said. "The Citizens Oversight Committee looks at coordinating all the grants we can to avoid duplication."
Decades-long attempts to provide more coordination of services got a boost in recent years from the federal Affordable Care Act, which brought electronic record keeping and many other changes, including a requirement that nonprofit hospitals conduct regular community-needs assessments. The assessments plan for three years, not the 20 years that would prepare for the continuing wave of population growth. But they have been useful to focus resources.
Generally, the assessments conducted by Lakeland Regional Health, Winter Haven Hospital and Polk Vision list similar barriers, including lack of insurance, health care literacy and language issues, transportation issues, too few physicians and other providers, and lack of coordination.
Community health clinics
In the past four years, primary health care has become more available to lower income and uninsured residents as Central Florida Health Care, the local federally qualified community health system, has grown from six to 14 clinics. The clinics see low-income residents, many of them uninsured, others relying on Medicaid or minimal insurance plans. An estimated 15 percent of Polk County residents do not have insurance, according to the Robert Wood Johnson County Health Rankings report, compared with 16 percent of Floridians and 11 percent of Americans.
"If we got funding, we would keep opening clinics," said Ann Claussen, chief executive officer of Central Florida Health Care. "In the population we serve, the need is huge. We could open three more clinics and serve the population without batting an eye. But we have to make smart decisions; we cannot open without financial support."
Opening a clinic with all the needed services — primary care for adults and children, OB-GYN, dental care, behavioral-health services, pharmacy and X-ray — costs between $1.5 million and $2 million, Claussen said. "We have to figure out how we are going to pay for things before we jump in and open up."
In 2015, the Central Florida Health Care administrative team started tapping into a complicated financial process using new market tax credits, which allowed the agency to purchase two new clinics, refinance two and get new equipment. "In seven years, it waives $3.5 million in debt," Claussen said of the financial maneuver.
Currently, clinics are located in Dundee, Frostproof, Haines City, Lake Wales, Lakeland, Mulberry and Winter Haven in Polk County, as well as clinics in neighboring Highlands and Hardee counties.
"The need is so strong that we are only one in 70 in the country" to win a new access-point grant that will allow Central Florida Health Care to open a full-service clinic in Haines City, Claussen said.
Next up, Central Florida Health Care is searching for funding to combine its adult and pediatric clinics in Lakeland onto one campus and expand dental services to all age groups, Claussen said. Already, the agency has purchased the land beside its existing adult-services clinic on North Florida Avenue. And it is in talks with Hillsborough County’s federally qualified community health clinic, Suncoast Community Health Centers, to replicate its dental-residency program in collaboration with a dental college out of New York.
Hospitals
Although there is a nationwide shift to shorter hospital stays and more outpatient services, hospitals in Polk County are in continuing development and upgrade mode — much of it to accommodate expansions of emergency departments and specialized care, such as heart centers and rehab, pediatric centers, psychiatric services and outpatient urgent care and ambulatory-care centers.
The largest project, the soon-to-open Lakeland Regional Health Carol Jenkins Barnett Pavilion for Women and Children, will fill gaps in pediatric care and allow for growth, said Deana Nelson, senior vice president of administration and chief strategy officer. The eight-story pavilion includes the county’s first level 3 neonatal intensive care unit, pediatric emergency department, pediatric surgical suites, a pediatric intensive care unit and more.
"It is not just the building but the programs and physicians and providers that will be here, which will make the need to leave the community for specialty care almost nonexistent," Nelson said.
Lakeland Regional Health and other hospitals in Polk County are relying on affiliations with Nemours Children’s Hospital of Orlando to supply pediatric specialty care, and with other large medical centers to provide consultation services, much of it through tele-health.
"From a general perspective, as we look 20 years from now, we are going to see more mergers and acquisitions," said Ann Barnhart, chief executive officer of Heart of Florida Regional Medical Center in Haines City. "The stand-alone rural hospitals will more than likely close if they do not become part of a larger system."
In the past few years, all the hospitals in Polk County and neighboring cities have affiliated with or been purchased by larger systems – Lakeland Regional Health with regional chain Orlando Health System; Winter Haven and Bartow with regional chain BayCare Health System; and Heart of Florida and Lake Wales with national chain Community Health Systems. National chain HCA built Poinciana Medical Center, just outside the Polk County line.
And Altamonte Springs-based Florida Hospital has purchased a large tract in far eastern Lakeland near Florida Polytechnic University. It has not announced specific plans for the land.
As larger hospitals and health systems expand their footprints, they are able to share infrastructure, purchasing and data for analysis, driving down costs and improving quality and access, Barnhart said.
"As reimbursements are continuing to fall for acute care, both from managed care and government sector, hospitals are learning to do more for less money," and with better efficiency, she said.
"Typically if services are non-profitable or less profitable, we will see more consolidation of those services," Barnhart said.
"In Polk County, we don’t have large cities so we will look at what makes sense for one of the larger hospitals in the system to provide those services," she said.
Marilyn Meyer can be reached at marilyn.meyer@theledger.com or 863-802-7558. Follow her on Twitter at 863-802-7558.