HospitalTeaching HospitalsBroward HealthJackson Health SystemMount Sinai Medical Center Orlando Health Tampa General Hospital UF Health JacksonvilleUF Health Shands Hospital
Public HospitalsHalifax HealthLee Memorial Health System Memorial Healthcare System Sarasota Memorial Health Care System
Specialty Licensed Children’s Hospitals All Children’s HospitalMiami Children’s Hospital
Regional Perinatal Intensive Care CenterSacred Heart Health System
Children’s HospitalsArnold Palmer Hospital for ChildrenChildren’s Hospital at Sacred HeartChildren’s Medical Center at Tampa General HospitalChris Evert Children’s Hospital at Broward HealthGolisano Children’s Hospital of Southwest FloridaHoltz Children’s Hospital at UM/Jackson Memorial Medical CenterJoe DiMaggio Children’s Hospital UF Health Shands Children’s Hospital
SAFETY NET HOSPITALS BY THE NUMBERSSafety net hospitals shoulder a disproportionate share of Florida’s health care responsibilities. These 14 safety net hospital systems, comprising 23 hospitals, represent only 10 percent of all hospitals in Florida, yet they account for 25 percent of all hospital admissions in the state.
Florida’s safety hospitals provide:Safety Net Hospitals:
Leading the Way to a Healthier Florida When Floridians face their gravest challenges, a unique part of the state’s health care infrastructure is there to support them. For the burn victim suffering devastating injuries, the father in need of an organ transplant, the child with a rare form of cancer, the motorcyclist clinging to life after a highway crash, the single mother facing an unknown disease without health insurance—for thousands of people like these across the state with critical health care needs, Florida’s safety net hospitals are their only lifeline.
The teaching, public and children’s hospitals that make up the Safety Net Hospital Alliance of Florida (safety net hospitals) play a crucial role in caring for our state’s neediest citizens, providing highly specialized medical care, and training our next generation of doctors to ensure a healthy future for Florida.
Safety net hospitals and our communities also provide essential local revenue support to help pay for Florida’s Medicaid program. In fact, our hospitals and communities provided more than $755 million in local revenues in 2010 that allowed the state to draw down more than $1 billion in federal Medicaid matching funds.
Beyond our impact on health care, safety net hospitals are also major economic catalysts in each of the communities we serve. In 2010, our hospitals collectively employed more than 77,000 non-physician workers and utilized more than 13,000 physicians. Our operating budgets totaled nearly $11 billion and helped to support a myriad of local businesses. Combined, we invested in more than $1.7 billion in infrastructure improvements—which have direct and indirect economic benefits in our communities. We also helped to stimulate the exchange of goods and services in every part of the state, from the Panhandle to South Florida.
Our Mission and Why We’re Important
OF ALL CHARITY CARE
41%
OF ALL MEDICAID DAYS
40%
OF LEVEL I TRAUMA CENTER ADMISSIONS
100%
OF PEDIATRIC LEVEL I TRAUMA CARE
100%
OF GRADUATE MEDICAL EDUCATION
68%
BILLION IN OPERATING EXPENDITURES
$11$
$
Florida’s safety net hospitals are only 10% of the state’s hospital systems.
SAFETY NET HOSPITALS BY THE NUMBERSTrauma Care:
Specialized Services:
Our Trauma and Specialty Care
LEVEL I TRAUMA CENTERS
100%
TRAUMA VISITS WEIGHTED FOR SEVERITY
75%
ELECTROCARDIOGRAM SERVICES
73%
RENAL DIALYSIS TREATMENTS
42%
AMBULANCE SERVICE TRIPS
42%
BURN ICU DAYS100%
REGIONAL PERINATAL INTENSIVE CARE CENTERS
75%
ORGAN ACQUISITION AND BANKING
70%
Florida’s safety net hospitals are only 10% of the state’s hospital systems.
We Heal... We Teach... We Care
Safety net hospitals provide the majority of trauma care in Florida, and offer an array of highly specialized services that aren’t available elsewhere—and benefit everyone in the state.
Trauma centers we hope to never use Trauma is the number one killer of people between the ages of 1 and 37. The typical trauma patient is a male between the ages of 16 and 29 who’s been involved in a motor vehicle accident. Timely access to a trauma center may be the difference between life and death or recovery and permanent disability. Here, too, the contrast between safety net hospitals and other hospitals is stark. Unlike an emergency room, a trauma center must have highly trained specialists in-house or immediately available 24/7. They must also have access to emergency air transportation for life-threatening needs.
In Florida, every Level 1 Trauma Center and half of all trauma centers are within safety net hospitals. Our hospitals provide the highest- level expertise and the most cutting-edge technology for communities throughout the state. In total, there are 26 trauma centers in the state; 7 level I, 13 Level II, and 6 Pediatric. (This does not include the 5 provisional level II and 1 provisional level I). Unfortunately, the funding for such services has become inadequate and unpredictable.
Specialized services specific to safety net hospitalsOutside the world of safety net hospitals, many other businesses determine their service or product offering based on the volume of need and the price they can charge for that offering. That formula for economic viability doesn’t apply to the provision of highly specialized healthcare services like burn, neonatal and transplantation; and does not trump our mission. These services can only be rendered by the most highly trained clinicians (both physicians and nurses). The necessary equipment is equally specialized, and the recovery is lengthy and labor-intensive. The result is care provision that drains budgets, but is priceless to those whose lives are saved.
While some hospitals avoid the financial drain of these known money-losers, safety net hospitals—compelled by their mission to serve everyone in their communities with essential services—embrace them. There would be no burn intensive care anywhere in Florida if it were not for the safety net hospitals. This small group of hospitals also provides 75 percent of the perinatal intensive care, 70 percent of the organ acquisition and banking, and over half of the neonatal intensive care.
None of us likes to consider the possibility that we or our loved ones will ever need these services. But thanks to the safety net hospitals, they’re available for all Floridians.
We Heal... We Teach... We Care
SAFETY NET HOSPITALS BY THE NUMBERSMost of us associate medical education with Florida’s public and private
university system, and that’s accurate—to a point. But there’s only so much that can be learned in a classroom. Clinicians need a clinical setting to put the finishing touch on their training. Nearly 68 percent of Florida’s Graduate Medical Education (GME) or “residency” training occurs in safety net hospitals. Each year, these hospitals support about 2,600 residents in more than 245 accredited programs. About 30 percent of the residents will become primary care practitioners.
The annual cost of this training totals $628 million, with safety net hospitals receiving federal government reimbursement for only about 40 percent of that amount and zero from the state. This means that these hospitals must pick up the tab for the other 60 percent, or about $375 million of the state’s GME costs. Why is that contribution essential? GME training has a direct impact on the availability and quality of physicians who care for Florida’s citizens. Florida’s GME programs are above the national average, with 59.4 percent of our residents ultimately practicing in Florida. Retention after residency is a much greater predictor of where a physician will practice than the medical school they attended.
Without regard for our strong resident retention, Florida has invested in medical schools and not medical residencies. As a result, Florida has become an exporter of medical school graduates. By 2015, half of our state’s medical school graduates will go to other states to complete their training. Therefore, our investment in medical schools will in large measure benefit other states, and does nothing to retain physicians and improve Florida’s physician workforce shortage.
Florida’s physician workforce needs are significant. We have the largest and fastest-growing percentage of citizens aged 65 and older, whose health care needs typically increase with age. Not surprisingly, our physicians are aging too. We rank fifth in physicians aged 60 or older (AAMC, 2011) and many worry that we will experience a future physician shortage even more severe than our current shortage of nurses. But medical education does more than prepare for the future.
Residents provide health care services to a largely underserved, underinsured population during their training, and they play a critical role in research. Residency programs also attract faculty physicians who make significant contributions to research and advances in biomedical technology throughout the state. When there are gaps in funding and physician manpower, as there always are, it is the safety net hospitals that fill those gaps.
Our Graduate Medical Education
GME training68%
OF RESIDENTS remain in Florida
59.4%
RESIDENTS trained annually
2,600
ACCREDITED programs
245
MILLION annual training costs
$628$
$
Florida’s safety net hospitals are only 10% of the state’s hospital systems.
We Heal... We Teach... We Care
CHILDREN’S HOSPITALS BY THE NUMBERS
Our Children’s HospitalsPEDIATRIC specialty trauma centers100%KIDS treated at our specialty-licensed children’s hospitals on Medicaid
70%OF CUTS totaling MORE THAN $106.3 MILLION8 YEARS
of PEDIATRIC ICU hospital days48.4%
MILLION cut this year $13.5
*Florida’s safety net hospitals are only 10 percent of the state’s hospital systems.
CHILDREN’S HOSPITALS IN THE SAFETY NET ALLIANCESpecialty-licensed children’s hospitals
All Children’s Hospital, St. Petersburg
Miami Children’s Hospital, Miami
Children’s hospitals within hospital systems
Arnold Palmer Hospital for Children at Orlando Health, Orlando
Chris Evert Children’s Hospital at Broward Health, Fort Lauderdale
Holtz Children’s Hospital at Jackson Health System, Miami
Joe DiMaggio Children’s Hospital at Memorial Healthcare System, Hollywood
Sacred Heart Children’s Hospital at Sacred Heart Health System, Pensacola
Shands Hospital for Children at University of Florida, Gainesville
The Children’s Hospital of Southwest Florida at Lee Memorial Health System, Fort Myers
When a child is born with a birth defect, or becomes sick or injured, families turn to Florida’s children’s hospitals to treat their critical health care needs. The Safety Net Hospital Alliance of Florida is home to nine of the state’s 15 children’s hospitals, including two specialty-licensed, free-standing children’s hospitals. Together, we are committed to providing specialized and comprehensive medical services for all children in need.
As the safety net for children and families, our children’s hospitals deliver expert care for the most severe and complex medical problems. These nine hospitals provide nearly 50 percent of the pediatric Intensive Care Unit (ICU) hospital days in Florida.
Our specialty-licensed children’s hospitalsAcross Florida, there are less than a handful of specialty-licensed, free-standing children’s hospitals to serve the state’s residents. Two of these facilities – All Children’s Hospital in St. Petersburg and Miami Children’s Hospital – are members of the safety net alliance. The entire mission of these two hospitals is focused on treating sick and injured kids, and both hospitals provide care to a very high percentage of children on Medicaid.
At these hospitals, roughly 70 percent of all children treated are on Medicaid. They treat kids from every county of the state and with an average of 65 percent of their hospital beds dedicated to intensive care, they maintain high severity caseloads for sick and injured children. They also maintain pediatric trauma centers and operate large pediatric teaching programs.
In recent years, the Florida Legislature has laudably protected these specialty-licensed children’s hospitals from the full scope of Medicaid reimbursement cuts that other hospitals have faced. However, the bottom lines of these hospitals are still strained by the fact that Medicaid reimbursements are below the actual cost of providing care, and these hospitals do not receive any federal support from Medicare.
Our children’s hospitals within hospital systemsIn addition to the specialty-licensed children’s hospitals, there are seven other hospital systems within the safety net alliance that operate major children’s hospitals. The entire mission of these children’s hospitals also is focused on treating sick and injured kids. They also treat a very high percentage of children on Medicaid, maintain pediatric trauma centers and operate large pediatric teaching programs.
Continued on back
We Heal... We Teach... We Carewww.safetynetsflorida.org
OUR STORIES
Toddlers become pals while battling rare heart disorders
The playful smiles of three-old-year friends Cody and McKenzie provide no hint of the frightening moments their families faced during each child’s earliest weeks. They were born just a day apart–each with different rare heart defects that would require several intricate surgeries, stays in All Children’s Hospital’s Neonatal Intensive Care Unit and Cardiovascular Intensive Care Unit, and interventions in the Cardiac Catheterization Lab.
Cody had a defect known as hypoplastic left heart system, in which the left half of the heart is not fully developed. Approximately one in every 4,115 babies is born with this type of problem. McKenzie was born with a problem that is even rarer. Called truncus arteriosus, it’s a defect that occurs in one in approximately 12,200 babies. Instead of the normal two ventricles coming out of the heart’s four pumping chambers, in truncus arteriosus there is only one ventricle.
But here are some odds that are even longer: Cody and McKenzie, born just a day apart, are from families that live just a few miles apart and attend the same church. Both families live more than 120 miles away from All Children’s in St. Petersburg, but they knew they needed the hospital’s expert care for a life-threatening heart defect.
Having a newborn with such a serious problem can lead a parent “to feel lost a lot of the time,” says McKenzie’s mother. She is thankful for the support and understanding her family experienced at All Children’s. “The entire staff goes out of their way to make you feel grounded.”
The integration of All Children’s with Johns Hopkins Medicine has brought new opportunities for collaborative research and education among the pediatric heart specialists in St. Petersburg and Baltimore. These endeavors will help many more children who need the most advanced cardiac care in order to survive and flourish.
To show their thanks, McKenzie’s family is starting a support group in their community for families of children with congenital heart defects so that they can share some of the education, support and hope they received at All Children’s.
These children’s hospitals include: Arnold Palmer Hospital for Children at Orlando Health; Chris Evert Children’s Hospital at Broward Health, Fort Lauderdale; Holtz Children’s Hospital at Jackson Health System, Miami; Joe DiMaggio Children’s Hospital at Memorial Healthcare System, Hollywood; Sacred Heart Children’s Hospital at Sacred Heart Health System, Pensacola; Shands Hospital for Children at University of Florida, Gainesville; and The Children’s Hospital of Southwest Florida at Lee Memorial Health System, Fort Myers.
Unfortunately, the Legislature has targeted these seven hospital systems for significant Medicaid cuts, which has directly impacted the pediatric programs at their children’s hospitals. The federal Medicare disproportionate share funding available to these hospitals in no way offsets these significant state Medicaid cuts. In the last eight years, safety net children’s hospitals have been forced to absorb
safety net children’s hospitals have been cut by more than
The bottom line on Medicaid cuts and caring for kidsYears of sustained Medicaid cuts have disproportionately impacted safety net children’s hospitals, which collectively provide nearly 50 percent of the state’s pediatric ICU hospital days, and nearly 44 percent of the state’s pediatric acute, ICU and neonatal ICU hospital days. These safety net hospitals must also contend with high Medicaid caseloads for which the state does not reimburse the full cost of providing care. With nearly two out of three children in Florida insured under the Medicaid program, these reimbursement shortfalls are undermining our hospitals’ mission to care for all, regardless of their ability to pay.
Whether treating a toddler with a congenital heart defect or supporting a cancer-stricken teen through chemotherapy treatments, the safety net children’s hospitals are dedicated to providing the highest levels of care to all kids who need help. Legislatively-imposed Medicaid cuts that disproportionately impact safety net hospitals could erode access to care for Florida’s sick and injured children and harm hospital pediatric programs that benefit all of the state’s children.
We Heal... We Teach... We Care
SAFETY NET HOSPITALS BY THE NUMBERSThe economic impact of safety net hospitalsHere is a snapshot of the economic impact that Florida’s safety net hospitals had in 2010. Collectively, our 14 hospital systems provided:
*2009 data, as AHCA discontinued tracking infrastructure improvements in 2010.
Florida’s safety net alliance hospitals are major employers and economic engines for our regions and for the state of Florida.
Typically, safety net hospitals are among the largest employers in every community we serve. Collectively, these 14 hospital systems provide more than 77,000 non-physician hospital jobs to Floridians, providing excellent employment opportunities to our citizens with a vast range of highly skilled to entry-level positions.
Additionally, safety net hospitals collectively utilize more than 13,000 Florida physicians, who are either on staff or have hospital privileges.
But the true economic impact of our hospitals doesn’t end with employment inside the hospital walls. Safety net hospitals collectively generate more than $10 billion in operating expenses annually. A significant percentage of these expenses are dedicated to employing a myriad of local businesses and vendors, and forging community partnerships—meaning that safety net hospitals help local economies and health care networks to thrive.
Further, safety net hospitals collectively made more than $1.7 billion in infrastructure improvements in 2009, the latest year state data on such improvements was available. These bricks-and-mortar investments add value to communities, spur further economic development in the surrounding neighborhoods, and provide opportunity for local construction contractors.
Additionally, the affiliations that safety net hospitals have with state universities and colleges help attract research dollars to Florida and attract the next generation of physicians and nurses to train, work and live in the state.
Our Economic Impact
JOBS for non-physician hospital employees
77,292
POSITIONS for physicians who are either on staff or have hospital privileges
13,318
BILLION in total payrolls
$4.49$
$
BILLION in infrastructure improvements that enhance health services for citizens, bring added value to communities and spur local construction trades*
$1.7
BILLION in total operating expenses that help support myriad local businesses and vendors
$10.7
Florida’s safety net hospitals are only 10% of the state’s hospital systems.
